Richelle Payton
Albuquerque
Summary
Enthusiastic office and medical billing specialist with extensive experience in claims processing, EOB analysis, and HIPAA compliance. Proven track record in handling Medicare, commercial, and dental claims while utilizing software like Salesforce and Nextgen to ensure accuracy and efficiency.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Claims Technician
HCSC (Blue Cross Blue Shield)
Albuquerque
02.2025 - 07.2025
- Process Medicare/Commercial claims
- Process dental, ambulance, DME claims
- Process IDR Adjustments
- Processed and sent requests for medical records to facilitate claim resolution
- Research missing providers from claim (Calling providers)
- Researched pricing discrepancies for claims related to drugs and procedures
- Knowledge of procedure codes, CPT codes, and HCPCS
- Maintained knowledge of HIPAA and PHI compliance
- Utilized Microsoft Teams, Excel, Word, and Outlook for daily communication and documentation
- Meet daily production goals
- Acquired knowledge of UB and paper claims procedures
- Knowledge of professional & facility claims
Data Entry Operator
Ata Services Inc
Albuquerque
08.2023 - 06.2024
- Processed New Mexico Renewal Medicaid applications to ensure timely and accurate service delivery.
- Ran eligibility assessments with New Mexico Workforce Solutions, verifying income from multiple sources to support compliance.
- Responding to requests for data
- Applying data program techniques and procedures
- Conducted research to gather relevant data, enhancing data accuracy for decision-making.
- Knowledge of ASPEN software and Salesforce
- Knowledge of other programs, SNAP and TANF
- Contracted Under New Mexico Human Services Department
A/R Claims Specialist
Presbyterian Medical Services
Albuquerque
12.2021 - 08.2023
- Created accurate claims to ensure timely processing
- Create claims for medical and dental
- Send claims electronically and paper (1500)
- Bill commercial, Medicaid, Medicare, and IHS
- Verifying insurances for medical and dental
- Understand EOBs for medical & dental
- Ensured compliance with HIPAA standards
- Cross-trained team members on cash posting procedures
- Utilized Nextgen software for efficient EHR management
Externship student (Dental assistant)
Comfort Dental
Albuquerque
02.2020 - 03.2020
- Chairside Assisting
- Prepared instrument trays for efficient procedure setup
- Executed coronal polishing to enhance oral hygiene
- Sterilization Assisting
- Infection control
- Guided patients to seats to ensure timely appointments
- Basic Dentrix software knowledge
- Reviewed and corrected rejected insurance claims
Assistant Manger
Security Finance
Bloomfield
11.2017 - 01.2019
- Developed management skills through hands-on assistant manager training.
- Managed cash handling processes to ensure accurate financial transactions.
- Conducted over 100 daily collection calls to ensure timely payment.
- Reviewed and processed loan applications for approval or denial.
- Processing loans and payments
- Completed comprehensive income tax training to understand tax regulations and procedures.
Education
Dental Assistant Graduate -
Carrington College
Albuquerque, NM02-2019
Medical Office Clerk Graduate -
San Juan College
Farmington, NM11-2008
High School Diploma Graduate -
Bloomfield High School
Bloomfield, NM05-2007
Skills
- Claims processing
- Claims adjustment
- EOB analysis
- Procedure coding
- Insurance verification
- HIPAA compliance
- Data entry
Certification
- CPR/BLS, 12/01/19
- First aid, 12/01/19
- DANB (Dental assisting)
- HIPPA, 12/01/19 & 12/01/21
- Medical Office Assistant Certification, 2008
- Dental Assistance Certification, 2021
Timeline
Claims Technician
HCSC (Blue Cross Blue Shield)
02.2025 - 07.2025
Data Entry Operator
Ata Services Inc
08.2023 - 06.2024
A/R Claims Specialist
Presbyterian Medical Services
12.2021 - 08.2023
Externship student (Dental assistant)
Comfort Dental
02.2020 - 03.2020
Assistant Manger
Security Finance
11.2017 - 01.2019
Dental Assistant Graduate -
Carrington College
Medical Office Clerk Graduate -
San Juan College
High School Diploma Graduate -
Bloomfield High School