Open To Work
Michelle Tipton
Houston,TX
Work Preference
Summary
Skilled Medical Claims Specialist with expertise in CPT/ICD coding and insurance verification. Proven ability to analyze and correct patient accounts, ensuring accuracy and compliance.
Overview
8
8
years of professional experience
Work History
Medical Claims Specialist
PFS Financial Services
Houston, TX
10.2023 - Current
- Analyze patient accounts to identify missing or incorrect data, including demographics, insurance details, CPT/ICD codes, and other billing elements.
- Correct and update billing records within the billing EMR software to ensure accuracy and compliance.
- Review EOBs and payment remittances from healthcare providers and insurance carriers to determine whether claims require resubmission, reconsideration, appeal, or escalation.
reconsideration, appeal, or escalation. - Communicate with health plans via electronic systems to obtain claim status, denial reasons, or additional required information
Track claim statuses using EMR systems maintaining accurate
documentation. - Monitors accounts for updates on claim status, and review HCFA 1500 and UB04's forms in EMR systems.
Ambulatory Service Representative II
Texas Children Hospital
Houston, TX
03.2022 - 10.2023
- Managed patient scheduling and appointment coordination using electronic health record (EHR) systems.
- Facilitated effective communication between patients, families, and healthcare providers to enhance service delivery.
- Processed insurance verification and authorizations to ensure patient coverage and minimize financial barriers.
- Maintained accurate patient records and documentation in compliance with HIPAA regulations and hospital policies.
- Scheduled new/existing patients appointments in Epic for Gynecology, Urologist, and Oncologist.
- Answered over 50 plus inbound calls daily regarding scheduling and medical questions from patients.
Billing Specialist
Texas Diagnostic Laboratories
Houston, TX
08.2021 - 03.2022
- Processed billing statements and invoices for laboratory services, ensuring accuracy in patient accounts.
- Collaborated with healthcare providers to resolve billing discrepancies and enhance collections.
- Track claim statuses across multiple operating systems and maintain accurate documentation
- Conducted audits of billing records to maintain compliance with regulatory standards and internal policies.
- Analyze patient accounts to identify missing or incorrect data, including demographics, insurance details, CPT/ICD codes, and other billing elements.
Medical Records Analyst
United Memorial Medical Center
Houston, TX
07.2020 - 08.2021
- Analyzed patient records for accuracy and compliance with regulatory standards.
- Implemented quality control measures to enhance data integrity and reduce discrepancies.
- Collaborated with clinical staff to streamline medical record retrieval processes.
- Trained new team members on electronic health record systems and best practices.
Service Advisor II
Superior Healthcare
Houston, TX
06.2019 - 07.2020
- Enhanced customer satisfaction by resolving inquiries and providing timely support.
- Coordinated patient appointments and managed scheduling for optimal service delivery.
- Streamlined communication between patients and healthcare providers to improve service efficiency.
- Resolved State complaints for the member by calling provider offices.
- Responsible for conducting eligibility screenings, assessments, and signed up members for care management.
Medical Record Technician
Advantmed, LLC
Houston, TX
02.2019 - 06.2019
- Managed electronic health record (EHR) systems to ensure data accuracy and compliance with regulations.
- Oversaw medical record retrieval process, enhancing efficiency in patient information access.
- Developed training materials for new staff, improving onboarding processes and operational knowledge.
- Audited medical records for completeness, ensuring adherence to quality standards and regulatory guidelines.
HIM Coordinator
Altus Houston Hospital
Houston, TX
01.2018 - 02.2019
- Compiled and verified surgical outpatient and inpatient observation imaging charts for accuracy and completeness.
- Demonstrated ability to operate autonomously while contributing effectively within team settings.
- Facilitated timely processing of subpoenas from attorneys for LOP clients.
- Facilitated communication within imaging department by transmitting imaging reports to provider offices.
Education
Associate of Science - Health Information Technology Management
The College of Health Care Professions
Houston, TX03-2017
Bachelor of Science - Healthcare Information Management
Southern New Hampshire University
Hooksett, NH08-2028
Medical Coding & Billing - Comprehensive Medical Coding
Houston Community College
Houston, TX06-2024
Skills
- Medical Billing
- CPT/ICD codes
- Medical claims processing
- Insurance verification
- Denials & Appeals
- EOBs, & remittances
- Collections
- HCFA 1500, & UB04's forms
Timeline
Medical Claims Specialist
PFS Financial Services
10.2023 - Current
Ambulatory Service Representative II
Texas Children Hospital
03.2022 - 10.2023
Billing Specialist
Texas Diagnostic Laboratories
08.2021 - 03.2022
Medical Records Analyst
United Memorial Medical Center
07.2020 - 08.2021
Service Advisor II
Superior Healthcare
06.2019 - 07.2020
Medical Record Technician
Advantmed, LLC
02.2019 - 06.2019
HIM Coordinator
Altus Houston Hospital
01.2018 - 02.2019
Bachelor of Science - Healthcare Information Management
Southern New Hampshire University
Associate of Science - Health Information Technology Management
The College of Health Care Professions
Medical Coding & Billing - Comprehensive Medical Coding
Houston Community College