Melissa Majka
Billing Revenue Specialist
Telford,PA
Summary
Hardworking professional with 25+ years experience who applies official coding conventions and rules established by American Medical Association and Centers for Medicare and Medicaid Services who adheres to medical records policies and procedures to comply with HIPAA regulations. Confident Medical Coder adheres to data confidentiality and privacy rules in all workflows and promotes dynamic interpersonal skills. Knowledgeable medical office professional talented at correcting and resubmitting claims, preparing patient charts and reviewing health records to identify proper diagnosis codes for billing. Advanced knowledge of private insurance processes and codes. Track record of effectively troubleshooting issues and maintaining patient confidentiality.
Overview
22
22
years of professional experience
3
3
years of post-secondary education
Work History
Billing Revenue Specialist
OPTUM
Norristown, PA
06.2017 - Current
- First role with Optum360 was on Government Services Team for Great Midwest
- Oversaw Colorado Medicaid process, automated and provided positive reimbursement results
- Assist in development of supporting SOP's for process development
- Volunteered to join Third Party Billing-EAST Team who took on responsibility to manage another entity. (Baltimore) This entity was brand new and was asked to represent Baltimore Medicaid process, automation and provide positive Account receivables
- Developed REJECT 43 PROCESS to provide Maryland Medicaid automated process utilizing multiple databases to refine and pull accurate data
- Developed Standard Template HCFA form per Maryland Medicaid Carrier Requirements. Worked closely with East Team Analysts to streamline, update and validate processes
- Assist in development of supporting SOP's for process development with Business Analyst approval.
Client Support
PROFESSIONAL DATA SOLUTIONS
Blue Bell, PA
01.2013 - 05.2017
- Functions for Information Systems firm serving national marketplace, on daily basis such as monitoring IDRequest, balancing client data, national account update transmissions, database update requests, claim data re- transmissions and other ad hoc customer requests.
- Established development of Training Program and supporting documentation.
- Assist in program/element updates in source management system, participate in new software release updates every 6 months, and assist support technical staff.
- Maintain machine log and keeping all PC software and antivirus updated.
Financial Counselor/Accounts Receivable/Precertification Backup
ALLIANCE CANCER SPECIALISTS
Sellersville, PA
08.2011 - 01.2013
- Liaison between patients and insurance companies, facilitating communication between patient and doctors, medical staff and administrative staff.
- Assists new and existing patients with financial concerns by performing accurate insurance benefit investigations, pricing and predeterminations on case-by-case basis.
- Researched, prepared and collected necessary Grant application requirements to qualify patients in need of financial assistance with chemotherapy regimen cost shares to meet financial obligations.
- Responsible for Patient Accounts Receivable for 3 locations, including patient statements, payments and collections.
- Setup payment plans after evaluation of financial status within office protocols.
Level I Software Support
STI COMPUTER SERVICES INC
Eagleville, PA
03.2011 - 07.2011
- Provide Help Desk Function, Support and Troubleshoot issues for 1800+ clients with Practice Manager Medical and Appointment Scheduling Modules utilizing medical background in assisting with problem resolution.
- Assist clients in loading and upgrading software to current version.
- Training of new Chart Maker Medical Suite software to clients.
- Resolved problems, improved operations and provided exceptional service.
- Organize, present and prepare materials for User Group Meetings held at various locations.
Accounts Receivable Representative
PHYSICIANS ENDOSCOPY LLP
Doylestown, PA
06.2008 - 03.2011
- Responsible for daily billing of facility claims, submission of clean claims, patient statements, accounts receivable follow-up, and overpayment/rejection resolution utilizing
- Advantx Medical Billing Software
- Worked Aging Reports which targeted claims unresolved within 30 days of submission
- Performed month end closing procedures within established timeframe
- Utilized effective communication to follow designated procedures with insurance carriers, center staff, practice staff, and patients to expedite accurate claim resolution and timely payments.
- Communicated with customers to identify and resolve outstanding payments.
- Reviewed accounts on monthly basis to assess aging and pursue collection of funds.
Medical Billing/Software Support Consultant
MOUNT AIRY PEDIATRICS LLP
Mount Airy, PA
03.2003 - 06.2008
- Managed entire billing office and staff including education, software updates, system maintenance, procedure implementation and follow-up to ensure maximum reimbursement for medical and inpatient professional services utilizing Medent Billing software.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Reviewed patient records, identified medical codes and created invoices for billing purposes.
- Trained new employees on multiple medical billing programs and data entry software.
Sr. System Analyst/Senior Trainer
CHESTNUT HILL HEALTHCARE
Chestnut Hill, PA
09.1997 - 04.2000
- Coordinated “Help Desk” solutions, documentation and resolution for 15+ clients on
- Medic Vision system
- Created, developed and implemented training Department's Manual and Training program.
- Provided practice integration, training, “LIVE” support, and system master file and security maintenance.
- Identified areas that could be improved through specific processes and addition of new software.
- Created all troubleshooting documentation and distributed it to team members and key stakeholders.
- Collaborated with upper management to drive strategy and implement new processes.
Education
Maine Chiropractic Assistant Clinical Certification -
Samoset Resort
Rockport, ME 01.1995 - 01.1995
Certificate of Management -
University of Maine
Orono, ME 01.1991 - 01.1991
Medical Laboratory Technology Program - undefined
University of Maine
01.1983 - 01.1986
Skills
Medicare and Medicaid process
undefinedWork Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse
Quote
Every day of our lives we are on the verge of making those changes that would make all the difference.
Mignon McLaughlin
Timeline
Billing Revenue Specialist
OPTUM
06.2017 - Current
Client Support
PROFESSIONAL DATA SOLUTIONS
01.2013 - 05.2017
Financial Counselor/Accounts Receivable/Precertification Backup
ALLIANCE CANCER SPECIALISTS
08.2011 - 01.2013
Level I Software Support
STI COMPUTER SERVICES INC
03.2011 - 07.2011
Accounts Receivable Representative
PHYSICIANS ENDOSCOPY LLP
06.2008 - 03.2011
Medical Billing/Software Support Consultant
MOUNT AIRY PEDIATRICS LLP
03.2003 - 06.2008
Sr. System Analyst/Senior Trainer
CHESTNUT HILL HEALTHCARE
09.1997 - 04.2000
Maine Chiropractic Assistant Clinical Certification -
Samoset Resort
01.1995 - 01.1995
Certificate of Management -
University of Maine
01.1991 - 01.1991
Medical Laboratory Technology Program - undefined
University of Maine
01.1983 - 01.1986
Similar Profiles
Nowelle HoweNowelle Howe
Quality Specialist at OptumQuality Specialist at Optum
Rushik Reddy GangamRushik Reddy Gangam
Software Engineer - Remote at OptumSoftware Engineer - Remote at Optum
Arun ChoudharyArun Choudhary
Quality Analyst at OptumQuality Analyst at Optum
Adam DugginsAdam Duggins
Associate Director, Workforce Planning at OptumAssociate Director, Workforce Planning at Optum
Ryan WentzRyan Wentz
Lab Pack Chemist at Clean Earth EnvironmentalLab Pack Chemist at Clean Earth Environmental