Melissa McCall

Seeking a position to leverage abilities and continuously grow by taking on challenging tasks. Eager to contribute to team and company success while expanding knowledge on a daily basis.

• Senior Follow Up A/R Insurance Specialist, Works normal follow up reports and task for assigned clients - currently responsible for 5-6 clients with varying specialties, including anesthesiology, mobile radiology, ENT, Hand Surgery and Therapy and General surgery, as well as some lab billing, from Texas to California., Ensures team is assigned reports and task weekly, Ensuring all clients are properly covered, Maintains and ensures processes are done correctly by updating Checklist and communication with Lead and Manager on status of checklist, Day to Day communication with clients, Work with teams to improve KPI as well as keeps individual KPI up to goal, Gives management and client insight on trends, Ensures proper comments are on monthly report cards, Attends working sessions/AR meetings, Attends monthly Client meetings, Helps preventing fire drills, Verifying assignments are being completed by their team, Assigns work to team using priorities set by Lead/Manager, Attend Management meetings if needed, Train new employees if needed, Train on new clients if needed, Train team on processes of follow up
• Physician Billing/Patient Account Rep, Bill Medicaid Primary and secondary claim's using the e-Paces system on e-MedNY to generate timely payment of claims., Work various reports to process appeals for Medicaid denials., Research and solve unpaid A/R to bring over 90 day A/R down as much as possible, Work Medicaid Eligibility Reports to be sure patients are being billed correctly, Receive, research, resolve, and bill ACM Lab charges for Medicaid patients, Use various websites to determine patient's insurance eligibility, bill or send to correct biller accordingly, Post payments received from various insurance companies as needed, Research and post 'Bad Debt' accounts weekly, Newsletter Committee writing column 'For Your Health', monthly, Rochester Regional - Regional Actions Committee - Activity committee to promote interaction of merged Rochester General and Unity Hospital/Clinic employees and to promote common ground through community service and charity fundraising. Plan activities for employees to promote a sense of unity.
• Office Management, Perform pre-employment background checks, and criminal background checks, Set up and maintain employee files, coordinate fingerprinting of new employees, Employee Orientation, Confirm certification and recertification's of all professional licenses for Dr's, nurses, Social Workers, and Therapists., Obtain and maintain all Certificates of Insurance for all Vendors, Handle all Resident Admissions, insurance pre-authorizations, financials and POA paperwork., Assist Residents in obtaining Medicaid if needed, Maintain Census Reports, Maintain all records as needed and required for NYS DOH
• Medical Insurance Follow-up Specialist, Oversaw two medical practices with a total of 10 Dr's to f/u on claims that were rejected, denied or never paid by insurance., Filed appeals, correct and repost claims with corrected DX's and/or modifiers, Heavy phone contacts with insurance companies, doctors' offices, and patients to problem solve to get the claims paid., Brought the 120 day + A/R balance from 10.84% on my combined accounts to 3.63%
• Medical Billing Specialist, Enter Demographics and verify insurance for various practices in preparation for charge entering, Enter charges and post payments for various practices and doctors, adhering to Medicare/Billing standard, with the goal of getting the claims out 'clean.', Responsible for three Orthopedic practices and 2 Dermatology practices, to see that they are entered cleanly, timely, end close by end-of-month., Check charges and bill insurance for 27 Medical providers and 12 Dental providers at 5 locations. Specializing in Medicaid and Medicaid Managed Care Insurance, Follow up on claims to assure that A/R is within a 90 day window., Research, correct or appeal any denials to get as many claims paid as possible.