Teresa Miller
Cullman,AL
Summary
Adept at navigating the complexities of insurance claims processing and denial management, I leveraged my expertise in HCPCS knowledge and continuous learning mindset to enhance operational efficiency at MediSYS. My proficiency in medical coding and commitment to patient confidentiality consistently ensured compliance and maximized reimbursement rates, establishing a track record of excellence in healthcare billing.
Overview
25
25
years of professional experience
Work History
Medical Insurance Specialist
Cullman Regional Medical Center
Cullman, AL
07.2020 - Current
- Maintained up-to-date understanding of insurance payment practices.
- Performed administrative tasks such as filing paperwork, preparing reports, answering phones, scheduling appointments.
- Remained current on latest industry trends by gaining comprehensive knowledge of financial and insurance products, services, and best practices.
- Reviewed claims for accuracy before submitting for billing.
- Advised clients on how to maximize their health care benefits while minimizing out-of-pocket expenses.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Reviewed administrative guidelines whenever questions arose during processing of claims.
- Resolved complex insurance issues by communicating with providers, patients, and third-party payers.
- Sent clinical request and missing information letters to obtain incomplete information.
- Maintained up-to-date knowledge of changes in state and federal laws pertaining to health care coverage.
- Used contract notes and processing manual to correctly apply group-specific classifications to claims.
- Ensured compliance with HIPAA regulations when handling sensitive patient information.
- Conducted audits of billing documents to identify discrepancies between billings and actual services rendered.
- Communicated regularly with physicians' offices regarding status updates on pending claims or reimbursements.
- Reviewed and processed medical insurance claims to ensure accuracy of information and compliance with established regulations.
- Inputted data into the system, maintaining accuracy of provider coding information and reported services.
- Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
- Provided guidance on medical reimbursement issues such as coding, claim forms, and fee schedules.
- Researched medical codes used in billing processes to ensure accuracy of documentation.
- Investigated discrepancies between billed charges and approved payment amounts from third party payers.
- Developed relationships with key personnel at provider organizations for better coordination of services provided under contracts.
- Analyzed patient records to determine eligibility for coverage, benefit levels, and other related matters.
- Assisted in developing new procedures and policies related to medical insurance operations.
- Collaborated with other departments within the organization such as finance or accounting when needed.
- Accurately processed large volume of medical claims every shift.
- Participated in training sessions regarding new policies or procedures related to medical insurance processing.
- Handled third-party insurance processing tasks to assist patients.
- Prepared detailed summaries of medical claims data for review by upper management.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Utilized various software and tools to streamline processes and optimize performance.
- Assisted with customer requests and answered questions to improve satisfaction.
- Completed day-to-day duties accurately and efficiently.
- Provided support and guidance to colleagues to maintain a collaborative work environment.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Conducted system analysis and testing to identify and resolve technical issues or inefficiencies.
- Operated equipment and machinery according to safety guidelines.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
Insurance Claims Specialist
UAB
Birmingham, AL
02.2008 - 07.2020
- Maintained up-to-date understanding of insurance payment practices.
- Performed administrative tasks such as filing paperwork, preparing reports, answering phones, scheduling appointments.
- Processed payments for services rendered in accordance with the terms of the policy or contract.
- Reviewed claims for accuracy before submitting for billing.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Reviewed administrative guidelines whenever questions arose during processing of claims.
- Resolved complex insurance issues by communicating with providers, patients, and third-party payers.
- Sent clinical request and missing information letters to obtain incomplete information.
- Maintained up-to-date knowledge of changes in state and federal laws pertaining to health care coverage.
- Used contract notes and processing manual to correctly apply group-specific classifications to claims.
- Ensured compliance with HIPAA regulations when handling sensitive patient information.
- Conducted audits of billing documents to identify discrepancies between billings and actual services rendered.
- Communicated regularly with physicians' offices regarding status updates on pending claims or reimbursements.
- Reviewed and processed medical insurance claims to ensure accuracy of information and compliance with established regulations.
- Inputted data into the system, maintaining accuracy of provider coding information and reported services.
- Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
- Provided guidance on medical reimbursement issues such as coding, claim forms, and fee schedules.
- Researched medical codes used in billing processes to ensure accuracy of documentation.
- Investigated discrepancies between billed charges and approved payment amounts from third party payers.
- Administered standard contract benefits to process pending claims for dental benefits.
- Developed relationships with key personnel at provider organizations for better coordination of services provided under contracts.
- Analyzed patient records to determine eligibility for coverage, benefit levels, and other related matters.
- Collaborated with other departments within the organization such as finance or accounting when needed.
- Accurately processed large volume of medical claims every shift.
- Participated in training sessions regarding new policies or procedures related to medical insurance processing.
- Handled third-party insurance processing tasks to assist patients.
- Prepared detailed summaries of medical claims data for review by upper management.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Created accurate financial records including invoices, bills of lading, payments received and made.
- Updated and maintained databases with current information.
- Approached customers and engaged in conversation through use of effective interpersonal and people skills.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Identified needs of customers promptly and efficiently.
- Utilized various software and tools to streamline processes and optimize performance.
- Assisted with customer requests and answered questions to improve satisfaction.
- Completed day-to-day duties accurately and efficiently.
- Provided support and guidance to colleagues to maintain a collaborative work environment.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Conducted system analysis and testing to identify and resolve technical issues or inefficiencies.
- Operated equipment and machinery according to safety guidelines.
- Maintained updated knowledge through continuing education and advanced training.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
Insurance Claims Specialist
MediSYS
Gardendale, AL
06.2000 - 02.2008
- Maintained up-to-date understanding of insurance payment practices.
- Performed administrative tasks such as filing paperwork, preparing reports, answering phones, scheduling appointments.
- Processed payments for services rendered in accordance with the terms of the policy or contract.
- Reviewed claims for accuracy before submitting for billing.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Reviewed administrative guidelines whenever questions arose during processing of claims.
- Resolved complex insurance issues by communicating with providers, patients, and third-party payers.
- Sent clinical request and missing information letters to obtain incomplete information.
- Maintained up-to-date knowledge of changes in state and federal laws pertaining to health care coverage.
- Used contract notes and processing manual to correctly apply group-specific classifications to claims.
- Ensured compliance with HIPAA regulations when handling sensitive patient information.
- Conducted audits of billing documents to identify discrepancies between billings and actual services rendered.
- Communicated regularly with physicians' offices regarding status updates on pending claims or reimbursements.
- Reviewed and processed medical insurance claims to ensure accuracy of information and compliance with established regulations.
- Inputted data into the system, maintaining accuracy of provider coding information and reported services.
- Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
- Provided guidance on medical reimbursement issues such as coding, claim forms, and fee schedules.
- Researched medical codes used in billing processes to ensure accuracy of documentation.
- Investigated discrepancies between billed charges and approved payment amounts from third party payers.
- Administered standard contract benefits to process pending claims for dental benefits.
- Developed relationships with key personnel at provider organizations for better coordination of services provided under contracts.
- Analyzed patient records to determine eligibility for coverage, benefit levels, and other related matters.
- Collaborated with other departments within the organization such as finance or accounting when needed.
- Accurately processed large volume of medical claims every shift.
- Participated in training sessions regarding new policies or procedures related to medical insurance processing.
- Handled third-party insurance processing tasks to assist patients.
- Prepared detailed summaries of medical claims data for review by upper management.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Created accurate financial records including invoices, bills of lading, payments received and made.
- Updated and maintained databases with current information.
- Approached customers and engaged in conversation through use of effective interpersonal and people skills.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Identified needs of customers promptly and efficiently.
- Utilized various software and tools to streamline processes and optimize performance.
- Assisted with customer requests and answered questions to improve satisfaction.
- Completed day-to-day duties accurately and efficiently.
- Provided support and guidance to colleagues to maintain a collaborative work environment.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Conducted system analysis and testing to identify and resolve technical issues or inefficiencies.
- Operated equipment and machinery according to safety guidelines.
- Maintained updated knowledge through continuing education and advanced training.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
Education
ICD-10 And CPT Medical Coding, Med Terminology
Medical Coding Certification
Birmingham, AL11-2016
Real Estate
First Real Estate License Course
Gardendale, AL04-1996
Associate of Arts - Liberal Arts
Jeffrson State Community College
Birmingham, AL05-1986
Advanced Studies
Gardendae High Schooll
Gardendale, AL05-1984
Comunicatiom
University of Alabama At Birmingham
Birmingham, ALSkills
- Payment posting
- Denial management
- Insurance verification
- HCPCS knowledge
- Medical coding
- Anatomy
- Medical billing
- HIPAA compliance
- Patient confidentiality
- Appeals handling
- Private insurance policies
- Claims processing
- Medicaid guidelines
- Claim denial resolution
- Meticulous recordkeeping
- Data security procedures
- Professionalism and ethics
- Electronic health records (EHR)
- Insurance claims
- Healthcare billing
- ICD-10-cM coding
- Telephone etiquette
- Electronic claims processing
- HIPAA
- Claims processing proficiency
- Medical terminology
- HIPAA compliance awareness
- Quality assurance checks
- Continuous learning mindset
- Financial analysis
- Insurance claims processing
- Provider relations
- Records security practices
- ICD codes
- Medical Terminology Familiarity
- Medical record review
- Insurance claims management
- Customer service
- Knowledgeable in [software]
- Critical Decision-making
- Thorough claims reviews
- Proficiency in [software]
Affiliations
Engages in various outdoor pursuits including walking, horseback riding, farm activities, and travel
Spouse and parent of one daughter and one son-in-law
References
References available upon request.
Timeline
Medical Insurance Specialist
Cullman Regional Medical Center
07.2020 - Current
Insurance Claims Specialist
UAB
02.2008 - 07.2020
Insurance Claims Specialist
MediSYS
06.2000 - 02.2008
ICD-10 And CPT Medical Coding, Med Terminology
Medical Coding Certification
Real Estate
First Real Estate License Course
Associate of Arts - Liberal Arts
Jeffrson State Community College
Advanced Studies
Gardendae High Schooll
Comunicatiom
University of Alabama At Birmingham
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