Melissa Turner
Fort Wayne,IN
Summary
Personable and dedicated customer service representative with extensive experience in the medical billing and insurance industry. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Gifted at working with all types of customers. Looking for a new role where hard work and dedication will be highly valued.
Overview
28
28
years of professional experience
Work History
Claims Analyst
PHP TPA Services
Fort Wayne, IN
09.2022 - 08.2023
- Processed medical, dental pharmacy and short term disability claims as well as requested funding and maintained banking for self insured employer groups.
- Provided Customer Service to my assigned employer groups and their insurance brokers on processed and future claims for their members.
- Provide statistics to PHP TPA Services Management Team for my assigned employer groups.
- Work with providers as well as outside coding vendors to ensure proper claim processing.
Provider Services Representative
Parkview Health Plan Services
Fort Wayne, IN
05.2016 - 08.2021
- Provided customer service to providers within the Signature Care network resolving problems with knowledgeable and friendly service regarding their claims and contracts. Routed unresolved issued to the Contract Specialist or Management.
- Maintained and updated the data base for Signature Care's provider directory by adding new or updating current provider information to existing contracted groups. .
- Researched and presented information for providers requesting to join Signature Care provider network to the network request committee.
- Verified network required credentials of providers.
- Assisted the claims department with fee schedule and coding issues.
Urgent Care Registration
Redimed
Fort Wayne, IN
09.2003 - 03.2019
- Greeted and assessed patients' needs, complaints, and symptoms to provide appropriate care at time of entry to the clinic. Alerted appropriate medical staff in case of emergent needs.
- Entered patient demographic and insurance information into the practice management system. Verified insurance eligibility utilizing real time eligibility software.
- Entered billing charges according to CPT and ICD coding guidelines.
- Collected and posted patient balances and set up payment plans.
- Answered phone calls and triaged medical questions.
- Scheduled appointments for Occupational Health patients.
- Assisted in training new employees.
Medical Insurance Collector
Parkview Health
Fort Wayne, IN
08.2010 - 05.2016
- Maintained work queues for outstanding/unresolved medical claims for commercial insurances including Signature Care, Aetna, Anthem, United Healthcare, CIGNA and PHP as well as numerous third party administrators. Researched coding and medical records to ensure correct coding. Write and submit insurance appeals for denied or underpaid claims.
- Answered incoming calls and emails from providers, insurance networks or payors concerning outstanding or processed medical claims.
- Utilized various insurance company data bases for submitting online claim appeals.
- Research overpaid claims and refund the appropriate payor.
- Assist Parkview Customer Service's department with claims patients were disputing.
- Notified management of claim denial trends.
- Created training guidelines and assisted in training new employees.
Patient Account/Collections Account Manager
Indiana Medial Associates
Fort Wayne , IN
09.1995 - 08.2010
- Answered phone calls and emails on billing inquiries from patients and insurance companies on medical claims from a multi specialty physicians office.
- Submitted claim appeals to Medicare, Medicaid and all commercial insurance companies for denied or inappropriately paid medical claims.
- Audited patients billing history per their request and explained all charges and payments.
- Sent collection letters and made collections phone calls to collect patient balances or set up on payment plans. Worked directly with physicians and the CEO to turn accounts to collection agencies or file small claim law suits.
- Adjusted all bankruptcy claims out of the practice management system and noted accounts.
- Followed up on all accident related claims.
- Assisted patients with applying for Medicaid or other financial aid.
Education
High School Diploma -
Paul Harding High School
Fort Wayne, IN05-1988
Some College (No Degree) - Medical Assisting
Ivy Tech Community College
Fort Wayne, INSkills
- Proficient in medical terminology
- Excellent verbal/written communication and phone etiquette
- Claims history analysis
- Claims review
- Insurance knowledge
- Claim investigation
- Skilled in Microsoft Word and Excel
- CPT and ICD10 knowledge
- Professionalism and HIPAA knowledge
References
References available upon request.
Timeline
Claims Analyst
PHP TPA Services
09.2022 - 08.2023
Provider Services Representative
Parkview Health Plan Services
05.2016 - 08.2021
Medical Insurance Collector
Parkview Health
08.2010 - 05.2016
Urgent Care Registration
Redimed
09.2003 - 03.2019
Patient Account/Collections Account Manager
Indiana Medial Associates
09.1995 - 08.2010
High School Diploma -
Paul Harding High School
Some College (No Degree) - Medical Assisting
Ivy Tech Community College
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