Melissa Radabaugh
Lompoc,United States
Summary
Organized Medical Biller boasts 20+ year career performing difficult multitasking and claims-processing tasks. Works quickly with insurance companies to resolve problematic disputes and handle patient inquiries. Excellent collaborating with medical professionals, insurance providers and clients to handle invoicing within high-traffic office environment. Experienced in both front and back office practices. Adaptable Office Manager with distinguished skills in budgeting, data entry and communications. Offers expert abilities in streamlining offices for improved functionality and productivity. Quick to support visitors and staff with diverse needs.
Overview
33
33
years of professional experience
Work History
Senior Medical Billing Specialist
Advanced Performance Physical Therapy & Rehabilita
Lompoc, CA
05.2008 - Current
- Developed and implemented processes to ensure accurate coding of diagnoses and procedures.
- Verified insurance coverage eligibility with insurance companies.
- Resolved complex billing issues in a timely manner.
- Assisted patients with questions regarding their bills and payments due.
- Managed all liens for MVA/PI cases and negotiated case settlement agreements with attorneys.
- Processed credit card payments from patients online or over the phone.
- Reconciled discrepancies between payment postings and invoices received from providers.
- Conducted follow-up calls to insurers to ensure prompt payment of claims submitted by physicians and providers.
- Maintained up-to-date knowledge of coding systems such as ICD 10 and CPT codes used in medical billing processes.
- Monitored aging reports to identify unpaid or overdue accounts receivable balances.
- Analyzed trends in denials, rejections, underpayments., to improve reimbursement rates.
- Documented all communications with insurers, both verbal and written.
- Generated patient statements for unpaid balances due after insurance payments were applied
- Maintained an organized filing system for all documents related to medical billings and collections.
- Applied HIPAA privacy and security regulations while handling patient information.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Completed and submitted appeals for denied claims.
- Submitted appeals using provider portals and phone communication.
- Reviewed claims for coding accuracy.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Contacted insurance providers to verify insurance information and obtain billing authorization.
- Handled billing, waivers and claims for private and commercial clients.
- Distributed or posted financial data to appropriate accounts and prepare simple reconciliations.
- Monitored reimbursement from managed care networks and insurance carriers to verify consistency with contract rates.
- Organized information for past-due accounts and transferred to collection agency.
- Analyzed patient accounts for accuracy and completeness of documentation and billing information.
- Reviewed claims rejections and denials to determine appropriate action needed for resolution.
- Processed appeals on denied claims as necessary.
- Responded to inquiries from providers regarding claim status, reimbursement rates.
- Assisted in developing new policies and procedures related to medical billing practices.
- Provided training and support to staff members on medical billing processes.
- Reviewed payment plans with patients according to established protocols.
- Called insurance companies to verify patient benefits.
- Leveraged EMR software to post payments received for medical services.
- Answered customer questions to maintain high satisfaction levels.
- Submitted all claims to insurance companies, electronic as well as paper.
- Managed all payments processing, invoicing and collections tasks.
- Monitored past due accounts and pursued collections on outstanding invoices.
- Collected, posted and managed patient account payments.
- Investigated past due invoices and delinquent accounts to generate revenues and reduce number of unpaid and outstanding accounts.
- Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
- Trained new team members on company policies and accounting systems to keep team operations productive and efficient.
- Developed strong professional rapport with vendors and clients.
Credentialing and Contracting Officer
Advanced Performance Physical Therapy
Lompoc, CA
05.2008 - Current
- Negotiated Insurance Contracts
- Credentialed New Providers, Locum -Tenen's/Recent Graduates
- Proficient with Medicare, Medi-Cal/Cencal, Tricare credentialing
Office Manager
Greg Radabaugh Construction
Lompoc
06.2001 - Current
- Managed all incoming and outgoing documents related to construction projects.
- Identified areas of improvement in existing office processes and procedures.
- Developed and implemented improved administrative processes for the department.
- Coordinated with external vendors to ensure timely delivery of materials and services.
- Maintained accurate records of construction project costs, expenses, and progress reports.
- Organized meetings between clients, contractors, architects, engineers. as needed for construction projects.
- Assisted in preparing contracts for potential new construction projects.
- Scheduled inspections by local authorities at various stages of the construction process.
- Responded promptly to requests from clients regarding changes or updates to their project plans.
- Processed invoices from contractors and suppliers ensuring accuracy prior to payment approval.
- Oversaw the onboarding process for new employees assigned to specific construction jobs.
- Ensured that all paperwork was completed accurately before submitting it to relevant agencies.
- Coded and entered daily invoices with in-house accounting software.
- Used judgment and initiative in handling confidential matters and requests.
- Handled scheduling and managed timely and effective allocation of resources and calendars.
- Managed office budget to handle inventory, postage and vendor services.
- Coordinated office activities and operations to secure efficiency and compliance with company policies.
- Managed office inventory and placed new supply orders.
- Monitored payments due from clients and promptly contacted clients with past due payments.
- Maintained impeccable office organization to support efficiency, professionalism and performance objectives.
- Administered payroll and maintained proper documentation of employee personnel.
- Managed, scheduled and coordinated office functions and activities for employees.
- Interpreted and communicated work procedures and company policies to staff.
- Organized and maintained documents, files and records.
- Determined staffing requirements, interviewing, hiring and training new employees
- Liaised with customers, addressed inquiries, handled meeting requests and answer billing questions to provide outstanding customer care.
- Analyzed internal processes and recommended and implemented procedural or policy changes to improve operations.
- Monitored office supplies to replenish needed inventory before depletion.
- Managed paper or electronic filing systems by recording information, updating paperwork and maintaining documents.
- Streamlined office processes and procedures to boost profits and productivity and facilitate continuous improvements.
Front and Back Office Medical Assistant
Randall Michel, MD FACS
Lompoc, CA
06.1991 - 10.2003
- Greeted patients and verified patient information.
- Assisted in scheduling appointments, verifying insurance coverage, and collecting payments
- Managed office schedule to coordinate with hospital surgical schedule
- Scheduled all surgical procedures at the hospitals, arranged for assistant surgeons when necessary, scheduled all pre-op lab work and required studies.
- Scrubbed in with doctor at hospital when OR staff was short or on length cases
- Set up sterile surgical trays, prepped patient's and scrubbed to assist doctor with head and neck cosmetic cases including but not limited to cervical facial rhytidectomies, blepahroplasty, rhinopasty, chin augmentation, brow-lifts
- Proficient in surgical instrument cleaning, packaging and sterilization
- Prepared examination rooms with necessary supplies and instruments.
- Provided support to physicians during examinations and procedures.
- Maintained cleanliness of front office areas including lobby reception desk area and exam rooms.
- Answered phones promptly and responded to inquiries from patients or providers in a professional manner.
- Responded to requests for medical records from other healthcare facilities or attorneys in accordance with HIPAA regulations.
- Ordered clinical supplies for the office on a weekly basis ensuring all items were within budget guidelines.
- Scheduled diagnostic tests such as X-rays, CT scans MRI's at hospitals or imaging centers based on physician orders and instructions.
- Performed various clerical duties such as filing paperwork, faxing documents, photocopying records.
- Provided instructions to patients regarding medication use and lifestyle modifications needed for improved health outcomes.
- Managed daily operations of the back office including stocking shelves with medical supplies and equipment maintenance.
- Facilitated communication between physicians, providers, nurses regarding patient care plans.
- Prepared treatment rooms for patients by cleaning surfaces and restocking supplies.
- Scheduled appointments for patients via phone and in person.
- Measured vital signs and took medical histories to prepare patients for examination.
- Conducted insurance verification and pre-certification and pre-authorization functions.
- Responded to patient callbacks and phone-in prescription refill requests.
- Educated patients about medications, procedures and physician's instructions.
- Interviewed and engaged patients to obtain medical history, chief complaints and vital signs.
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
- Cleaned and maintained medical equipment following procedures and standards.
- Assisted with diagnostic testing by collecting and packaging biological specimens for internal and laboratory analysis.
- Documented notes during patient visits.
- Contacted pharmacies to submit and refill patients' prescriptions.
- Labeled and completed lab requisitions using ICD and CPT coding.
Education
General Education
Allan Hancock College
Santa Maria, CASkills
- Problem Solving Techniques
- Medical Terminology Understanding
- Strong Work Ethic
- Medical Practice Operations
- Attention to Detail
- Effective Multitasking
- Patient Registration
- Insurance Eligibility and Verification
- Medical History Obtainment
- Administrative Support
- Medical Procedures Scheduling
- Inventory Maintenance
- Strong Interpersonal Skills
- Schedule Creation
- Electronic Health Records Management
Affiliations
- Christian Camp Volunteer
- Baker
- Gardner
References
References available upon request.
Timeline
Senior Medical Billing Specialist
Advanced Performance Physical Therapy & Rehabilita
05.2008 - Current
Credentialing and Contracting Officer
Advanced Performance Physical Therapy
05.2008 - Current
Office Manager
Greg Radabaugh Construction
06.2001 - Current
Front and Back Office Medical Assistant
Randall Michel, MD FACS
06.1991 - 10.2003
General Education
Allan Hancock College
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