Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Misty Moad

Springfield,MO

Summary

Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Seasoned Medical Insurance Specialist with excellent planning and problem solving abilities. Offering 16 plus years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments.

Overview

16
16
years of professional experience
1
1
Certification

Work History

Insurance Service Representative III

Mercy Hospital Springfield
Springfield, MO
08.2016 - Current
  • Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
  • Attended training and educational seminars to enhance knowledge and credentials.
  • Assisted in training new employees on departmental processes and procedures.
  • Corresponded with insured or agent to obtain information or inform of account status or changes.
  • Utilized computer system to update customer profiles and manage other data entry needs.
  • Used insurance rate standards to calculate premiums, refunds, commissions and adjustments.
  • Reviewed medical records to ensure accuracy of billing information and patient data.
  • Managed numerous client accounts to track and collect money owed.
  • Trained new team members on company policies and accounting systems to keep team operations productive and efficient.
  • Investigated and resolved issues to maintain billing accuracy.
  • Assessed billing statements for correct diagnostic codes and identified problems with coding.
  • Performed insurance verification, pre-certification and pre-authorization.
  • Reviewed legal claims for accuracy and issues.
  • Submitted claims to insurance companies.
  • Assisted with year-end closing tasks including preparing journal entries.
  • Maintained accurate records of collections, adjustments and denials in the system.
  • Checked claims coding for accuracy with ICD-10 standards.
  • Assisted in developing strategies for improving collections processes.
  • Enforced compliance with organizational policies and federal requirements regarding confidentiality.
  • Participated in workshops, seminars, and training classes to gain stronger education in industry updates and federal regulations.
  • Contacted insurance providers to verify insurance information and obtain billing authorization.
  • Answered customer inquiries regarding billings, payments, account status.
  • Researched and resolved billing inconsistencies and errors through individual and collaborative analysis.
  • Tracked changes in legislation that could affect billing procedures.
  • Investigated incorrect billings and processed refunds as necessary.
  • Worked with team members and leadership to identify and develop process improvements.
  • Verified insurance coverage and identified third-party payers for billing purposes.
  • Implemented new policies related to billing processes when required.
  • Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
  • Investigated past due invoices and delinquent accounts to generate revenues and reduce number of unpaid and outstanding accounts.
  • Provided support to other departments within the organization as needed.
  • Executed account updates and noted account information in company data systems.
  • Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
  • Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
  • Worked with cross-functional teams to achieve goals.
  • Understood and followed oral and written directions.
  • Provided excellent service and attention to customers when face-to-face or through phone conversations.
  • Assisted with customer requests and answered questions to improve satisfaction.
  • Planned and completed group projects, working smoothly with others.

Billing Specialist

Ozark Community Hospital
Springfield, MO
07.2007 - 08.2016
  • Reviewed medical records to ensure accuracy of billing information and patient data.
  • Reconciled codes against services rendered.
  • Investigated and resolved issues to maintain billing accuracy.
  • Performed accurate and fully compliant monthly closing processes, accruals and journal entries.
  • Assessed billing statements for correct diagnostic codes and identified problems with coding.
  • Performed insurance verification, pre-certification and pre-authorization.
  • Reviewed legal claims for accuracy and issues.
  • Calculated billing charges, prepared and submitted claims to insurance companies.
  • Assisted with year-end closing tasks including preparing journal entries.
  • Submitted claims to insurance companies.
  • Maintained accurate records of collections, adjustments and denials in the system.
  • Checked claims coding for accuracy with ICD-10 standards.
  • Assisted in developing strategies for improving collections processes.
  • Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
  • Enforced compliance with organizational policies and federal requirements regarding confidentiality.
  • Participated in workshops, seminars, and training classes to gain stronger education in industry updates and federal regulations.
  • Contacted insurance providers to verify insurance information and obtain billing authorization.
  • Answered customer inquiries regarding billings, payments, account status.
  • Researched and resolved billing inconsistencies and errors through individual and collaborative analysis.
  • Tracked changes in legislation that could affect billing procedures.
  • Investigated incorrect billings and processed refunds as necessary.
  • Worked with team members and leadership to identify and develop process improvements.
  • Reviewed engine assigned codes and modifiers to update and verify accuracy.
  • Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
  • Verified insurance coverage and identified third-party payers for billing purposes.
  • Implemented new policies related to billing processes when required.
  • Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
  • Provided support to other departments within the organization as needed.
  • Executed account updates and noted account information in company data systems.
  • Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
  • Completed efficient drop and bulk filing to maintain well-organized and easily accessed systems
  • Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
  • Maintained open communication with team members and stakeholders, resulting in successful project outcomes.
  • Understood and followed oral and written directions.
  • Displayed strong telephone etiquette, effectively handling difficult calls.

Education

Bachelor of Arts - Major in Psychology Minor in Sociology

Columbia College
Columbia, MO
08-2023

Associate of Applied Science - Paralegal Studies

Rhodes College
Spring, TX
06-2000

Skills

  • New Policies Processing
  • Eligibility Determination
  • Claim Amount Calculations
  • Client Interviews
  • Teamwork and Collaboration
  • Data Entry
  • Insurance Claim Forms Review
  • Customer Service
  • Small Claims Payouts
  • Reporting Abilities
  • Medicaid Knowledge
  • Account Management
  • Insurance Plan Verification
  • Background in Insurance
  • Medical Terminology
  • Outstanding Clerical Abilities
  • Account Management Expertise
  • Billing Software
  • Decision-Making
  • Reporting Skills
  • Information Verification
  • Paperwork Processing
  • Payment and Investigation Escalations
  • Active Listening
  • Patient Rapport
  • Coverage Determination
  • Composing Business Correspondence
  • Organizing and Prioritizing Work
  • Critical Thinking
  • 10-Key Touch
  • Liability Management
  • Regulatory Compliance Understanding
  • Secure Data Practices
  • Attention to Detail
  • Documentation Skills
  • Application Review
  • Insurance Coverage Verification
  • Data Integrity
  • Data Transcription
  • Documentation Abilities
  • Microsoft Office
  • Business Correspondence
  • Appointment Scheduling
  • Insurance Terminology
  • Data Entry Software
  • Understanding of Medical Terms
  • Regulatory Compliance Adherence
  • Claims Processing

Certification

  • Missouri Associate Alcohol Drug Counselor I (MAADC I)
  • Improving Cultural Competence - Diversity & Inclusion CEC Certificate
  • Substitute Teaching Certification general studies

Timeline

Insurance Service Representative III

Mercy Hospital Springfield
08.2016 - Current

Billing Specialist

Ozark Community Hospital
07.2007 - 08.2016

Bachelor of Arts - Major in Psychology Minor in Sociology

Columbia College

Associate of Applied Science - Paralegal Studies

Rhodes College

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Misty Moad