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Summary
Overview
Work History
Education
Skills
Work Availability
Quote
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Open To Work

Michele Plummer

Billing Specialist
Gresham,OR

Work Preference

Job Search Status

Open to work
Desired start date: Open to discussion

Desired Job Title

Medical Revenue Cycle ManagerMedical Billing Specialist

Work Type

Full Time

Location Preference

HybridOn-SiteRemote
Location: Portland, ORVancouver, WATampa, FLFort Myers, FLMobile, AL
Open to relocation: Yes

Important To Me

Career advancementWork-life balanceHealthcare benefitsPaid time offTeam Building / Company RetreatsPaid sick leave401k matchCompany Culture

Summary

Results-driven medical biller with extensive experience in account management and revenue generation. Proven ability to develop and implement strategies that enhance workflows and optimize billing processes. Strong leadership skills foster team success and improve overall performance.

Overview

21
21
years of professional experience

Work History

Billing Specialist

Oregon Cosmetic and Reconstructive Clinic
Happy Valley, Oregon
09.2020 - Current
  • Maintained current accounts receivable tracking database with client information and billing progress.
  • Enhanced month-end reporting processes for improved accuracy and efficiency.
  • Evaluated open accounts to identify past-due balances and implemented collection strategies.
  • Managed insurance claims submissions and follow-ups for timely reimbursement.
  • Answered customer inquiries regarding billings, payments, account status.
  • Investigated incorrect billings and processed refunds as necessary.
  • Managed all insurance and patient payments processing, invoicing, and collections tasks.
  • Trained new team members on our Amazing Charts/EHR software, company policies, and positions, and was cross-trained in all other positions as support for office systems to keep team operations productive and efficient.

Accounts Receivable Specialist

Providence Health & Services
Portland, OR
01.2020 - 07.2020
  • Processed 125 to 150 claims daily, ensuring accuracy and efficiency in resolutions.
  • Verified procedure and diagnosis codes in EPIC Software while managing work queue edits.
  • Conducted timely reviews of claim edits, validating coding through thorough document assessments.
  • Investigated pending claims due to clearinghouse issues, addressing edits reliably.
  • Interfaced with Medicare system as RTP biller to expedite claim resolutions efficiently.
  • Managed comprehensive checks on charge submissions to maintain billing integrity.
  • Resolved discrepancies in claims swiftly, facilitating prompt payments from Medicare.
  • Monitored workflow to optimize processing speeds and minimize backlogs.

Medical Biller / Charge Review & New Hire Trainer

Spectrum Dermatology PLLC
Scottsdale, AZ
01.2018 - 07.2019
  • Utilized ADV MD and EMA EMR software to review and input demographic and insurance data.
  • Analyzed patient encounter forms for diagnosis code accuracy, completeness, and specificity.
  • Approved charges for seven dermatologists and five physician assistants, ensuring correct diagnosis code pairing.
  • Handled all incoming calls from patients and insurance carriers regarding billing inquiries and estimates.
  • Trained new front office staff across four locations on ADV MD & EMA EMR systems.
  • Conducted monthly training sessions with front office staff to address insurance issues and policy updates.
  • Submitted corrected claims to insurance companies for resolution and managed appeals for disputes.
  • Documented training minutes to provide feedback to management and enhance staff performance.

Account Receivable Specialist

Resolutions Billing & Consulting
Queen Creek, AZ
07.2015 - 06.2017
  • Oversaw dispute resolution, claims follow-up, and payment posting for seven client accounts using Advanced MD and Kareo systems.
  • Managed high-volume phone lines with eight-member team, addressing insurance inquiries and patient statements.
  • Delivered exceptional customer service through active listening and accurate responses.
  • Identified errors and re-billed denied claims based on EOBs for A/R team review.
  • Interpreted medical reports to apply appropriate ICD-9, ICD-10, CPT, and HCPCS codes.

Revenue Cycle Management

Orange Coast E.N.T - Head & Neck Surgery
Irvine, CA
10.2012 - 01.2015
  • Executed in-office billing training through Allscripts to enhance operational efficiency.
  • Performed full-cycle medical billing in a high-volume Otolaryngology and Audiology practice.
  • Directed installation of streamlined work methods to improve office workflow effectiveness.
  • Reviewed denials daily in Payer Path, ensuring prompt claims processing and resolution.
  • Collaborated with physicians on coding, modifiers, and CCI edits for accurate charge entry.
  • Negotiated new contracts and higher reimbursement rates between management and insurance payers.
  • Facilitated credentialing for new provider onboarding effective 08/01/2014.
  • Conducted insurance eligibility checks and pre-authorization for outpatient surgeries and procedures.

Business Office Insurance Collector

USPI - Arizona Orthopedic Surgical Hospital
Chandler, AZ
07.2009 - 07.2012
  • Managed accounts receivables for all contracted insurance carriers, including Surgical, Radiology, and Physical Therapy claims.
  • Contacted insurance companies to obtain claim payment statuses and wrote appeals for denied or underpaid claims.
  • Processed denials daily in Zirmed, ensuring timely electronic submission of claims with necessary corrections.
  • Reviewed Medicare denials and rejections daily through Medicare DDE, utilizing IVANS Portal for efficient tracking.

Accounts Receivable Specialist

Ironwood Cancer & Research Centers
Chandler, AZ
10.2007 - 07.2009
  • Managed follow-up on 1,500 accounts monthly for Alpha split among A/R Department staff.
  • Investigated billing discrepancies and appealed underpaid claims while resubmitting corrected claims.
  • Utilized knowledge of Oncology and Radiology CPT codes to ensure accurate pairing with ICD-9 codes.
  • Trained new hires in departmental procedures and best practices as per instructions.
  • Served as United Healthcare Liaison for ICRC, coordinating monthly meetings with UHC Representative to address underpayment and denial trends.

Billing Office Manager

E.N.T Associates
Portland, OR
11.2006 - 08.2007
  • Accurately entered procedure codes, diagnosis codes and patient information into billing software
  • Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received
  • Confirmed patient information, collected copay's and verified insurance eligibility
  • Carefully prepared, reviewed and submitted patient statements
  • Posted Insurance payments, patient payments and collected patient payments over the phone after discussion of acct
  • Daily balance and deposit

Insurance Specialist/Collections/Billing

The Urology Clinic, P.C.
Portland, OR
01.2005 - 05.2006
  • Verified patient information and insurance eligibility, entering data into database.
  • Posted charges, payments, and adjustments according to insurance contracts.
  • Answered calls in Billing Department to resolve patient and insurance inquiries.
  • Assisted patients with payments over phone and supplying medical records as needed.
  • Ensured accurate coding for maximized efficiency in claims processing.

Education

Degree - Travel & Tourism

Western Business College
1988

One Year - General Studies

MT Hood Community College
1987

High School Diploma - General

Sam Barlow High School
Online
1986

Skills

  • Strong work ethic
  • Team collaboration
  • Billing and coding expertise
  • Revenue cycle management
  • Claims review and appeals
  • Patient consultation and education
  • Billing software proficiency:
  • AdvancedMD
  • Allscripts PM, EHR, and Payer Path
  • Medical Manager
  • Medic
  • Amazing Charts PM/EHR
  • EPIC

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote

Your time is limited, so don’t waste it living someone else’s life.
Steve Jobs

Timeline

Billing Specialist

Oregon Cosmetic and Reconstructive Clinic
09.2020 - Current

Accounts Receivable Specialist

Providence Health & Services
01.2020 - 07.2020

Medical Biller / Charge Review & New Hire Trainer

Spectrum Dermatology PLLC
01.2018 - 07.2019

Account Receivable Specialist

Resolutions Billing & Consulting
07.2015 - 06.2017

Revenue Cycle Management

Orange Coast E.N.T - Head & Neck Surgery
10.2012 - 01.2015

Business Office Insurance Collector

USPI - Arizona Orthopedic Surgical Hospital
07.2009 - 07.2012

Accounts Receivable Specialist

Ironwood Cancer & Research Centers
10.2007 - 07.2009

Billing Office Manager

E.N.T Associates
11.2006 - 08.2007

Insurance Specialist/Collections/Billing

The Urology Clinic, P.C.
01.2005 - 05.2006

Degree - Travel & Tourism

Western Business College

One Year - General Studies

MT Hood Community College

High School Diploma - General

Sam Barlow High School

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Michele PlummerBilling Specialist