Melissa Moss
Charleston,WV
Summary
Detail-oriented Data Analyst with a proven track record in data entry and analysis, demonstrating strong organizational skills and effective communication. Proficient in Microsoft Office Suite and various business applications, leveraging technical expertise to streamline data management processes. Committed to continuous professional development and delivering actionable insights to support strategic decision-making.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Provider Billing
HealthSmart Benefits Management, LLC (acquired by) UnitedHealth Group
06.2013 - Current
- Fluent in W9s.
- Responded to incoming calls and directed provider inquiries.
- Provide support to the external provider representative to resolve provider data issues.
- Conduct research to address provider-related issues.
- Submit provider data entries to resolve provider or client-related demographic information changes.
- Initiate and manage submission of provider adjustment forms.
- Create and maintain spreadsheets used to produce provider directories for multiple products.
- Monitored, revised, and audited provider data.
- Analyzed necessary adjustments to key provider groups and model contract.
- Indexing medical records, assisting positions in obtaining records, identifying records and images, and processing medical record requests.
- Processed insurance claim payments efficiently.
- Worked in a team environment via remote and centralized office locations.
- Follows company guidelines regarding the ethical standards of business information.
- Engages in prompt and effective communication through various channels.
Medical Claims Examiner
Wells Fargo
06.2010 - 01.2013
- Consistently exceed KPI standards for quality and production.
- Update and maintain provider demographics data for all LOBs to facilitate accurate claims processing.
- Apply network repricing rules for claims processing.
- Collaborate with external teams to troubleshoot provider payment issues.
- Assist with W-9 database cleanup and go-forward maintenance procedures.
- Worked with multiple teams to develop and standardize rules for provider fee schedules.
- Processed claims adjudication efficiently.
- Worked in a team environment via remote and centralized office locations.
- Follows company guidelines regarding the ethical standards of business information.
- Responds to emails and other various forms of communication effectively and in a timely manner.
Education
High School Diploma -
Sissonville High School
Charleston05-2008
Skills
- Claims processing and adjudication
- Managed national accounts
- Proficient in Cognizant’s claims systems
- Oversaw provider data management
- Familiarity with ICD-10 guidelines
- Experienced in utilizing medical terminology
- Skilled in utilizing QicLink program
- Customer support expertise
- Time management
- Effective communication
- Proficient typing skills
- Problem Solving
Leadership Experience
- Enthusiastically seeks opportunities to collaborate with other teams to complete organizational initiatives
- Enjoys learning new skills and working with others to train for updated procedures – embraces change
Certification
- Basic Life Support
- MS Office Suite
- CPT Coding
- Proficient in Microsoft Teams
- HIPAA
References
References available upon request.
Timeline
Provider Billing
HealthSmart Benefits Management, LLC (acquired by) UnitedHealth Group
06.2013 - Current
Medical Claims Examiner
Wells Fargo
06.2010 - 01.2013
High School Diploma -
Sissonville High School
Similar Profiles
Kymberly P. JonesKymberly P. Jones
Field Medical Underwriter at Rogers Benefits Consulting Group LLCField Medical Underwriter at Rogers Benefits Consulting Group LLC
Heather D. NormanHeather D. Norman
Executive Assistant to the Vice President at S.W.A.G. Benefits Group, LLC.Executive Assistant to the Vice President at S.W.A.G. Benefits Group, LLC.
Roselynn SalcieRoselynn Salcie
Client Relationship Manager at LINQ Group Benefits, LLCClient Relationship Manager at LINQ Group Benefits, LLC