Insurance Medical

TRACY L. MICHAELIS

***** **** ****** **** • Santa Clarita, CA 91351

Cellular: 661-***-**** • E-MAIL: aczv4f@r.postjobfree.com

OBJECTIVE: Seeking a full time permanent position as a MEDICAL BILLER / COLLECTOR for Amvik Solution –ABA Medical Billing Department, Chatsworth, CA

SUMMARY OF QUALIFICATIONS

Over 2 years of Experience in medical billing with strong knowledge and understanding of HCFA-1500 claim forms and appeal processes.

Knowledge of Applied Behavioral Analysis (ABA) billing

Strong analytical and multi-tasking skills, excellent problem solving skills, attention to detail and follow through

Ability to analyze, comprehend and calculate the appropriate payment rates for corresponding services based on individual contractual agreements or fee schedules

Ability to collect on private pay accounts and patient responsibility balances within the guidelines, negotiating payments plans as necessary

Excellent data entry skills and strong attention to detail

Ability to apply common sense and understanding to carry out detailed procedures for payment

Organized and worked with Examiners using computer to enter, access, search and retrieve data. Stayed current with diary tasks

Skilled at using the Billing and Posting Program – Central Reach

Ability to analyze Explanation of Benefits

Responsible for claim resolution from initial billing through final resolution to claim corrections and appeals, elevating issues as appropriate and timely

Experienced at billing all payer types including third party commercial insurance companies

WORK EXPERIENCE

ELIZABETH DREIS CONSULTING (Pilot Project / temp) 03/20/2017 – 3/26/2017

Providing research for a medical specialist’s Medi-Care 2017 MAC non-facility fee schedule pricing with detail HCPCS and CPT code details and generating an Excel spreadsheet.

Contacted six large insurance carriers and obtaining detailed re-negations procedures for future processing and created an Excel spreadsheet for administrative processing organization and control.

Research and analyzed a 25 mile specialty study for re-negation of Medi-Care pricing proposal.

OFFICE WORKS / AUTISM LEARNING PARTNERS, Glendale, CA (temp) 01/09/2017 – 03/15/2017

Biller, Payment Poster & Collector for

ABA Therapies

Billed Primary and Secondary Insurance Carriers when the need to correct a claim arose.

Payment Poster, Verifier checks in Navision for payment Posted Payments Manually and Bulk in Central Reach

Collector: Obtained Insurance Verifications and Benefits, Coordinated benefits with Primary Medical Insurance and Anthem Medi-Cal Secondary Insurance with either an Exclusion Letter from the Primary carrier or Denial EOB from Primary, coordinated authorizations for proper code sets and dates of services for timely filing. Billed the Anthem Medi-Cal with the Anthem Medi-Cal Authorization with CMS-1500 form. Daily verified claims on Availity, Cigna, or by phone for EOBs under payment per the 2015 Medi-Cal Applied Behavior Therapies Contracted Rate Fee Schedule.

Corrected claims and appealed various claims for a multitude of reasons, with the Anthem Provider Dispute Resolution Request format, used Availity to determine if claims were paid at the contract rate proper payments for the above mention fee schedule and calculated the correct amount to be paid sought out re-processing for payment.

VOLT WORKFORCE SOLUTIONS / St. Jude Medical – Sylmar, CA (short temp) 11/28/2016 – 12/14/2016

Ordered pacemakers: cellular adapters, transmitters and broadband kits into the SAP system for business initiative by via E-mails, and data entry procedures.

William – Sonoma – Valencia Town Center, Valencia, CA (temp / seasonal employee) 11/20/2016 – 11/30/2016

Seasonal Sales Associates – Assisted customers with seasonal sales, arranged display sales tables for retail sales,.

SAGE STAFFING / VALENCIA SURGICAL CENTER – VALENCIA, CA (temp) 06/08/2016 – 08/08/2016

Medical / Surgical Insurance Verifier and Authorization Verifier and Coordinator

SPECIALITIES: Cosmetic & Reconstructive Surgery, Ear, Nose and Throat Surgery, General Surgery, Gynecological Surgery, Orthopedic Surgery, Pain Management, Plastic Surgery and Podiatric Surgery

TRACY L. MICHAELIS Cell: 661-***-**** Page 2 of 3

SAGE STAFFING / VALENCIA SURGICAL CENTER – VALENCIA, CA (temp) Continued 06/08/2016 – 08/08/2016

Provided medical insurance verifications for in and out of network benefits for a freestanding outpatient surgical / facility benefits

Verified all commercial insurance coverage, worker’s compensation insurance, personal injury claims, and state programs and determined patient’s responsibility if applicable

Obtained pre-certification case number and fax numbers to submit clinical reports for authorization

Sought and obtained authorization for workers’ compensation claims for outpatient surgeries.

Obtained insurance authorizations online for Lakeside / Heritage and Regal Medical Group HMO patients

Reviewed authorizations for effective date and verified CPT codes

Completed all assigned tasks in a timely manner

Maintained a high level of professionalism and customer service with all interactions with all related parties

MEDICAL BILLING PROFESSIONALS – SANTA CLARITA, CA (laid off) 09/21/2015 – 05/02/2016

Billing Account Representative / Reimbursement Specialist

SPECIALITIES: Diagnostic Laboratory, OB/GYN and Mental Health

Billing and appeals manager for Medicare and Medi-Cal patients, i.e., Responsible for appealing unpaid claims, re-submitted claim with medical record as supporting documentation for payment and letter of explanation for timely payment.

Billing account manager for Women’s Emergency medical group (Medi-Cal)

Diagnostic Laboratory services account billing manager (Medicare with supplemental HMO insurance, etc.), to ensure timely payment (re-submitting claim, providing with medical record supporting documentation, etc.)

Insurance verification specialist for Covered California patients (carrier payment tracing and collections)

Insurance verifications (via phone / online) for all medical insurances and worker’s compensation.

Serves as a liaison between the provider, patient, and insurance carrier to see patient’s medical bills paid.

Demonstrated the ability to process and bill medical insurances: HMO, EPO, PPO, Medi-Cal, Medicare and Workers’ Compensation; ICD-9 and ICD-10 and CPT coding for multi-specialties

Patient data entry, posting charges, documenting electronic records.

Analytical skills with EOBs and RAs and at writing and submitting appeal letters and providing the correct documentation for payment.

Paper and electronic claims, statements, spreadsheets, and reports

Ability to write and contest appeals for in and out of network benefits for professional medical services rendered.

Gap of Employment – Completed Home Study of Professional Medical Coding Curriculum through AAPC and Taking care of family members that had reconstructive surgeries 9/2013 - 6/2015

INT’L CHURCH THE FOURSQUARE GOSPEL – LOS ANGELES, CA (temporary) 03/12/2013 – 08/14/2013

Administrative Assistant

Non-profit organization / Insurance Department (Property, Workers Comp, Personal lines, etc.) Annual renewal, filing, scanning, purging files and reviewing complex Excel spreadsheets for renewal data

Gap of Employment - Death of a family member, as a result having to take care for a family member 11/2011 – 2/2013

AUDIOLOGY ASSOCIATES – VALENCIA, CA 01/2011 – 10/2011

Insurance Eligibility Verifier / Worker’s Compensation Billing & Collections

SPECIALITY: Audiology

Advised provider with insurance eligibility verifications for third party insurances: HMO, PPO, TRICARE, EPO, Medicare, and Indemnity & Workers’ Compensation, both online and by phone, for patient’s in and out of network benefits, co-payment, deductibles and coinsurance using math skills.

Solid understanding of Medical Terminology, HIPAA, OMFS, ICD-9, CPT-CM and HCPC’s coding; and billing procedures for CMS-1500 billing; Obtained supportive claims documentation from workers’ compensation claims examiners, employers. Responsible for requesting authorizations for medical services from claims examiners;

Performed internal audit & analysis of retro-authorizations from Utilization Review (UR) departments; Researched, analyzed and corrected EOB’s and EOR’s, for timely reimbursement for medical service and DME; Electronically

Documented electronic file with claim status and posted payments on practice management accounting systems for write-offs, discounts, and contractual adjustments.

Gap of Employment – Actively seeking full time permanent employment 07/2010 – 12/2010

TRACY L. MICHAELIS Cell: 661-***-**** Page 3 of 3

So. CALIFORNIA MEDICAL BILLING, VALENCIA, CA Externship (160 hours) 05/2010 – 07/2010

SPECIALITY: Mental Health

Telephone insurance verifications for physicians and Non Physician Providers; Sought benefits for medical services / medical equipment. Mental health insurance verifications researched carve outs for non-parity, outpatient mental / behavioral healthcare.

OTHER RELEVENT WORK EXPERIENCE

CHARTER COLLEGE – STUDENT / MEDICAL INSURANCE BILLING & CODING 4.0 GPA 09/2009 – 07/2010

Stay at Home Mother caring for young children 12/1997 – 08/2009

Receptionist & Billing Assistant YANZ & HERTZ ATTORNEYS AT LAW - Glendale, CA 04/1995 – 05/1996

Sorted, date stamped and distributed mail, updated employee’s benefits status, processed payroll, A/R and A/P and answered eight phone lines. Assisted with the mailing and processing of monthly statements.

RELIANCE INSURANCE COMPANY – Glendale, CA 09/1991 – 11/1994

Human Resources Assistant Workers Compensation Claims Assistant

Assisted Human Resources Supervisor with basic HR functions for new employees: maintained attendance, processed new hire benefits paperwork and assisted new hires with questions as they arose.

Assistant to the Claims Manager – maintained confidential corporate communications for claims handling.

Managed receipts, expense reports and reimbursements for Claims Manager and management team

Contacted insured or other involved persons to obtain necessary information to process claim. Documented conversations for information to claim file. Provided customer service such as giving information to insured, injured worker or providing referrals to outside vendors as requested by the Examiner.

Processed claims for indemnity payments. Processed non-medical bills for payment.

Organized and worked with Examiners using computer to enter, access, search and retrieve data. Stayed current with diary tasks.

EDUCATION / CERTIFICATIONS / MEMBERSHIPS

Member of the American Academy of Professional Coders

Southern California Medical Billing (Externship 160 Hours)

Charter College - Diploma in Medical Insurance Billing and Coding, 4.0 GPA

The King’s University – Undergraduate Diploma in Theology & Biblical Studies

Graduated Burbank High School, Burbank, CA

COMMUNITY SERVICE

Co-Leader of Brownie & Girl Scout Troop for 5 years

Assistant as needed Cub Scout Mom

PTA President at Cedarcreek Elementary School 2006- 2007

Santa Clarita / William S. Hart Scholarship Foundation Application / Essay Reader – Since 2015

Making and Decorating Gingerbread houses for silent auction to raise funds for the Santa Clarita Boys and Girls after school care fund

2006 Granted Award for the Dedication to Elementary Age Children from the Local PTA Regional President Brenda Kealing

Assisted in raising over $25,000 for the Cedarcreek PTA

Made and delivered over 50 family dinners to families in crisis situations

TLM Desktop / CURRENT Resume 04202017

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