MELODY WILKERSON
Biggs,CA
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Work Type
Full TimeLocation Preference
On-SiteRemoteImportant To Me
Healthcare benefits401k matchCompany CultureWork from home optionSummary
Dedicated Medical Billing Specialist with over 26 years of experience managing the complete revenue cycle for Medicare, insurance, and secondary claims. Expertise in reducing claim denials and optimizing reimbursement through meticulous coding, effective appeals management, and advanced proficiency in electronic billing software. Processes 50 to 100 claims daily with an impressive 99% accuracy rate. Proven success in recovering outstanding payments through skillful negotiation with insurance companies.
Overview
26
26
years of professional experience
Work History
Medicare Biller
Orchard Hospital
05.1997 - 06.2025
- Collected and maintained accurate employment and insurance information for all patients to minimize errors and overpayments. Determined primary insurance versus secondary payer. Verifying eligibility and Medicare days for In-Patient and Swing Bed stays. Documented medical necessity. Ability to stay up to date by using the correct codes, such as ICD-10, CPT and HCPC codes/modifiers to ensure payment. Processed an average of 100 claims per day. Responded promptly to any requests for additional information from MAC. Kept detailed records for audit and compliance purposes. Protected patient information according to HIPAA. Kept and maintained account balances with follow up and correcting any payment discrepancies. Filed appeals when needed to ensure payment. Documented accounts of actions taken. Always billing in a timely manner.
Insurance Biller
Orchard Hospital
05.1997 - 06.2025
- Prepared and submitted an average of 50 claims per day to the appropriate insurance companies by sending them to the correct address. Verified patients’ eligibility and determined what services were covered and not covered. Reviewed patients’ charts, medical history and treatment to ensure accuracy. Translate medical services and diagnosis into standardized codes (ICD-10, CPT/HCPC codes) for billing purposes. Tracked submitted claims and follow up on any claims that are delayed or denied. Calculated and generated invoices for any patient responsibility, such as deductible, copay and coinsurances. Secured accounts to correct any posting errors or discrepancies. Adhered to all relevant regulations, including HIPAA, to protect patient information.
Secondary Biller
Orchard Hospital
05.1997 - 06.2025
- Ensured that primary insurance was paid and processed correctly. Obtained primary explanation of benefits (EOB). Verified eligibility for secondary insurance. Created secondary claims for all secondary insurance’s to be sent out correctly per each insurance’s guidelines and regulations. Tracked the status of all secondary responsibilities. Maintained accounts by working denials, calling insurance companies to work out any discrepancies. Reviewing accounts and changing them to patient responsibility after all insurance’s have paid. Maintained secure patient records and postings to the correct account. Adhered to all relevant regulations, including HIPAA, to protect patient information.
Data Entry Clerk
Orchard Hospital
05.1997 - 06.2025
- Accurately enter and post payments, adjustments, and denials for insurance companies. Reconciled payments received against the amounts billed. Assisted with creating and maintaining payment related reports for audits, quality assurance and everyday balances that were sent to accounts payable department. Required all payments to balance at end of each workday. Worked with billing specialists, patients and insurances to resolve payment discrepancies. Handled denied claims to provide necessary information. Maintained strict patient confidentiality and adhered to all hospital procedures and federal regulations, such as HIPAA.
Medical Records Clerk
Orchard Hospital
05.1997 - 06.2025
- Created new patient records. Updated existing records. Ensured that records are complete, accurate and well organized. Filed charts and entered patient information into database. Processed paperwork for discharged in-patient encounters ensuring all records for stay were complete and all doctor’s requirements were met before filing away. Retrieved documents to authorized and nursing station when needed. Responded to request for medical records from patients, insurance companies by adhering to very strict confidentiality policies, legal and regulatory standards, such as HIPAA. Answered phones, photocopied charts and managed supply needs. Assisted with auditors and quality assurance department.
Education
Certified Medical Secretary -
03.1985
- Coursework: Medical terminology, anatomy, health insurance and billing, office management, ledgers, knowledge of coding, computer and typing skills, 10-key, communication skills, patient scheduling, legal and ethical issues specific to healthcare, and Federal regulations like OSHA and general office safety.
- GPA: 4.0
High School Graduate - undefined
08.1984
- Coursework: General education, typing classes (50 words per minute) and shorthand class (100 words per minute).
- GPA: 3.75
Skills
- Experienced in ICD-10 documentation standards
- Knowledge of HIPAA standards
- Integrity in professional conduct
- Analytical reasoning
- Management of receivables
Critical thinking
CPT coding
Insurance verification
Payment posting techniques
Medical billing expertise
Accounts receivable management
Continuous learning attitude
Accomplishments
- Achieved [Diploma] by completing Western Career College with accuracy and efficiency.
- 10 year appreciation for dedication and commitment to Orchard Hospital.
- 20 year appreciation for dedication which plays a tremendous part in Orchard Hospitals success.
- 25 year appreciation for dedication which plays a tremendous part in Orchard Hospitals success.
- Certificate to Thank me for a job well done. November 11, 2000
- 20 year appreciation for dedication which plays a tremendous part in Oirchard Hospitals success in Medical Records November 1999
- Certification of Recognition for my valuable committment, November 1998.
- Certificate for my continued enthusiasm, support and participation in the Junior Volunteer Program in 1998
- Certification of Recognition for my valuable committment to Medical Records Department November 1997
Employee of the Month 2007
Awarded Certificate for Employee of the Month 2007 for my hard work.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Languages
English
Full Professional
Software
Prognosis
DSG
DDE/IVANS
Exel
Microsoft Word
Evident/Thrive
Trubridge
AS400
Teams
Interests
Billing
Data Entry
Commitment
Loyalty
Affiliations
- Orchard Hospital
Timeline
Medicare Biller - Orchard Hospital
05.1997 - 06.2025
Insurance Biller - Orchard Hospital
05.1997 - 06.2025
Secondary Biller - Orchard Hospital
05.1997 - 06.2025
Data Entry Clerk - Orchard Hospital
05.1997 - 06.2025
Medical Records Clerk - Orchard Hospital
05.1997 - 06.2025
Biggs High School - High School Graduate,
Western Career College - Certified Medical Secretary,