Merline Gordon
Redford,MI
Summary
Executed comprehensive billing, customer service, cash reconciliation, claims processing, and training strategies to foster operational excellence and contribute to company goals.
Overview
27
27
years of professional experience
Work History
Billing and Follow Up AR II
Trinity Health
Farmington Hills, MI
07.2018 - Current
- Executed routine follow-up functions, including investigation of overpayments, underpayments, credit balances, and payment delays.
- Reviewed and corrected 1500 HCFA claims with appropriate ICD-10-CM and CPT codes, adhering to diverse payer policies to facilitate timely reimbursement.
- Tracked and recorded claims status in appropriate systems, facilitating efficient payment settlements and follow-ups.
- Coordinated efforts with appropriate hospital departments to address billing discrepancies and secure essential demographic and financial details.
- Assessed billing issues and reported findings to facilitate improved accuracy and streamline follow-up workflows.
Payment Poster Specialist/Assistant Trainer
IHA/Trinity
Ann Arbor, MI
07.2012 - 07.2018
- Reviewed and reconciled daily payment batches, identifying discrepancies and ensuring financial integrity.
- Executed month-end close procedures to ensure accurate financial reporting.
- Reviewed and addressed insurance payment rejections while facilitating HSA payment processing for diverse payer groups.
- Accessed payer websites to download and print detailed explanations of benefits for client reference.
- Executed insurance verification processes on denied claims and resubmitted for payment.
- Achieved high accuracy in payment posting by training new employees on established guidelines. Enhanced quality control through regular audits of new employees' work.
Billing Analyst/Team Lead/Assistant to Billing Manager
Infectious Disease Center, PC
Farmington Hills, MI
02.2007 - 02.2012
- Executed billing processes for professional services related to outpatient infusion therapy and E&M services across hospital, home care, and travel patient settings.
- Achieved timely insurance verification and secured referrals for managed care accounts, enhancing patient access to services. Updated insurance fee schedule quarterly to maintain competitive pricing and compliance.
- Analyzed monthly chart data to assess and confirm appropriate levels of CPT and ICD-9 coding.
- Facilitated transmission of electronic claims to all payers while addressing front-end claim edits.
- Directed operations of patient collection department, ensuring adherence to fair debt collection practices.
- Streamlined bankruptcy file maintenance, enhancing organization and accessibility. Facilitated timely filing of proof of claims with probate court, contributing to efficient case processing.
- Assessed patient needs and provided tailored financial assistance options to alleviate financial burdens.
- Collaborated with Medicaid caseworkers to streamline updates of patient spenddown and deductible information.
- Supported billing manager in executing special projects through development of Excel spreadsheets, charts, and graphs.
- Facilitated training programs for new employees in patient collections and cash posting departments.
- Investigated overpayment discrepancies and facilitated appropriate refund preparations.
Claims Analyst
Great Lakes Health Plan
Southfield, MI
01.2002 - 01.2004
- Supported deployment of Facet software system to streamline processes and improve user experience.
- Analyzed and verified Medicaid claims, aligning with established state guidelines and internal procedures.
Claims Processor
Health Alliance Plan
Southfield, MI
01.1999 - 01.2002
- Conducted thorough evaluations of claims and referrals, ensuring precise translation into relevant ICD-9, CPT-4 revenue codes, and HCPCS codes.
- Addressed and resolved membership and eligibility issues to enhance customer satisfaction.
- Collaborated with providers to resolve claims issues and rectify processing errors.
Education
Bachelor’s Degree - Healthcare Administration
University of Phoenix
01-2010
Associates degree - Healthcare Administration
University of Phoenix
01-2007
Certificate - Medical Assisting
Paraprofessional Institute
01-1996
Medical Transcription and Medical Billing - undefined
Paraprofessional Institute
01-1996
Skills
- Achieved seamless operations through effective use of Medisoft, Diamond Facets, Champs, and C-Snap software Enhanced team collaboration by optimizing Microsoft Office 365 product usage Improved patient management outcomes by integrating NextGen, HealthQuest, and Epic systems
Timeline
Billing and Follow Up AR II
Trinity Health
07.2018 - Current
Payment Poster Specialist/Assistant Trainer
IHA/Trinity
07.2012 - 07.2018
Billing Analyst/Team Lead/Assistant to Billing Manager
Infectious Disease Center, PC
02.2007 - 02.2012
Claims Analyst
Great Lakes Health Plan
01.2002 - 01.2004
Claims Processor
Health Alliance Plan
01.1999 - 01.2002
Bachelor’s Degree - Healthcare Administration
University of Phoenix
Associates degree - Healthcare Administration
University of Phoenix
Certificate - Medical Assisting
Paraprofessional Institute
Medical Transcription and Medical Billing - undefined
Paraprofessional Institute