Summary
Overview
Work History
Education
Skills
Work Availability
Quote
Timeline
Generic

Tina Mora

Loris,SC

Summary

Meticulous Insurance knowledge with a 32 year background in the Medical Industry. Talented at processing claims, coding and compiling statistical data for reports. Account recovery and payable experience. Strong attentions to detail and exceptional coordination skills.


Overview

8
8
years of professional experience

Work History

Medical Claims Specialist

VNA Options
Syracuse, NY
10.2016 - 11.2017
  • Submitted electronic/paper claims documentation for timely filing.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
  • Managed large volume of medical claims on daily basis.
  • Paid or denied medical claims based upon established claims processing criteria.
  • Reviewed documentation for appropriate coding, catching errors and makin revisions.
  • Denial of claims not covered under insurance plan.

Medicare Billing Specialist

GHI Insurance
East Syracuse, NY
07.2011 - 10.2016
  • Filed and updated patient information and medical records.
  • Recuperate money from Work Comp./Liability/No fault insurance carriers previously paid my Medicare.
  • Reviewed claims for accuracy related to case claims.
  • Prepared billing statements for patients and verified correct diagnostic coding.
  • Contact with Physicians and Attorneys regarding said claims not payable by Medicare.
  • Verification of ICD codes in relation to claims.

LPN Medical Claims Review

BC Excel
Syracuse, NY
05.2010 - 09.2011
  • Answered incoming phone calls from patients to provide basic assistance and triage medical concerns.
  • Reviewed denied medical claims.
  • Access Policy coverage and pulled contract for review.
  • Determined liability, compensability and benefits due on each claim.

Education

Associate of Applied Science - Criminal Psychology

Argosy University
Orange, CA
06.2016

Associate of Science - Licensed Practical Nurse

Boces
Oneida, NY
06.1990

High School Diploma -

Altmar Parish Williamstown Jr Sr High
Parish, NY
06.1984

Skills

  • Insurance Claim Forms Review
  • Determine Medical Necessity
  • Eligibility Determinations
  • ICD-10 Coding
  • Health Insurance Industry Knowledge
  • Claim Validity Determination
  • Creating Treatment Plans
  • Electronic Health Records Systems
  • Insurance Claims Management
  • Microsoft Excel
  • Complex Problem-Solving
  • Healthcare Terminology
  • Medical Billing and Coding
  • Knowledgeable about Diseases
  • Benefits Verifications
  • Legal Standards
  • Field Investigations
  • Payment and Investigation Escalations

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse

Quote

The way to get started is to quit talking and begin doing.
Walt Disney

Timeline

Medical Claims Specialist

VNA Options
10.2016 - 11.2017

Medicare Billing Specialist

GHI Insurance
07.2011 - 10.2016

LPN Medical Claims Review

BC Excel
05.2010 - 09.2011

Associate of Applied Science - Criminal Psychology

Argosy University

Associate of Science - Licensed Practical Nurse

Boces

High School Diploma -

Altmar Parish Williamstown Jr Sr High

Similar Profiles

CREATE PROFILE
Tina Mora