Melanie Robinson
SPRINGFIELD
Summary
Hands-on professional offering a keen understanding of data confidentiality and HIPAA regulations. Highly trained Medical Coder knowledgeable in AMA and the CMS coding rules.
Overview
18
18
years of professional experience
Work History
Insurance Analyst
Heritage Medical Associates
Nashville, TN
01.2024 - Current
- Analyze insurance claims for accuracy and compliance with regulations.
- Review medical records to ensure proper billing and coding procedures.
- Work denied claims through practice management queue
- Creation and submission of appeals
- Interpret and apply compliance guidelines to maintain billing integrity
- Monitor claim processing timelines to identify potential delays or issues.
- Collaborate with healthcare professionals to resolve insurance-related inquiries efficiently.
Certified Medical Coder
Family Health Center of Ashland City
Ashland City
03.2023 - Current
- Reviewed medical records and assigned appropriate codes to diagnoses, treatments, procedures, and services rendered by healthcare providers.
- Identified areas that require improvement in order to maintain accuracy of coded data.
- Investigated discrepancies between billed charges and actual payment amounts received from insurance companies.
- Submitted corrected claim forms when necessary due to errors found during review process.
- Maintained updated knowledge of coding requirements, which included continuing education and certification renewal.
- Submitted claims to insurance companies electronically or by mail.
- Resolved denied claims by researching payer requirements and preparing appeals.
Patient Financial Advocate
St Luke's Healthcare System
Boise
01.2019 - 06.2022
- Initiated application processes to add patients to assistance programs at bedside and followed through until completion.
- Screened patients for eligibility for state, local and federal assistance programs.
- Counseled patients on potential financial liabilities and payment requirements.
- Stayed current on community-based resources and services useful to patients.
- Explained policies, procedures and services to patients.
- Accessed programs and set up correct payment strategies based on patient means and needs.
- Compiled information from patients and caregivers or family members to identify care concerns.
- Organized timely and accurate referrals to help patients obtain health care services and access available resources.
- Collaborated with clinical and administrative staff to meet patient needs.
Patient Business Associate
St Luke's Healthcare System
Boise
07.2010 - 12.2018
- Tracked referral request progress and resolved issues to maintain smooth processing.
- Assisted patients by answering questions and providing information regarding referrals.
- Entered confidential patient information and updated electronic records in database.
- Managed and obtained insurance authorizations for patient referrals from physicians.
- Aided clinical team to support administrative needs for clinical referrals.
- Gathered and verified insurance requirements to meet payer requirements.
- Obtained PA for services such as diagnostic imaging.
- Worked closely with financial counselors to guide patients on financial obligations and decision-making.
- Verified documents and associated records to catch and resolve discrepancies.
- Performed additional office duties, handling patient service inquiries and receiving payments.
- Answered questions and resolved concerns raised by both patients and specialists.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
Medical Billing Specialist
The Surgeons Office
Ontario
02.2008 - 06.2010
- Posted charges, payments and adjustments.
- Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
- Identified errors and re-filed denied or rejected claims quickly to prevent payment delays.
- Completed appeals and filed and submitted claims.
- Posted and adjusted payments from insurance companies.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Prepared billing statements for patients, ensuring correct diagnostic coding.
- Contacted patients for unpaid claims for HMO, PPO and private accounts and performed friendly follow-ups to ensure proper payments were made according to contracts.
Education
CPC - Professional Coding
AAPC
Nashville, TN12.2022
Some College (No Degree) - Public Administration
Austin Peay State University
Clarksville, TNSkills
- Organized and Efficient
- Resolving Problems
- Building Rapport and Credibility
- Verbal and Written Communication
- Patient Confidentiality and Data Security
- Medical History Documentation
- Proficiency in Epic, eCW, Azalea and MacPractice
- Health Information Access Management
- Attention to Detail
- Time Management and Prioritization
- Claims Handling and Coverage Verification
- Billing Issue Resolution and Support
- Conflict Resolution
- Medical Terminology
Timeline
Insurance Analyst
Heritage Medical Associates
01.2024 - Current
Certified Medical Coder
Family Health Center of Ashland City
03.2023 - Current
Patient Financial Advocate
St Luke's Healthcare System
01.2019 - 06.2022
Patient Business Associate
St Luke's Healthcare System
07.2010 - 12.2018
Medical Billing Specialist
The Surgeons Office
02.2008 - 06.2010
Some College (No Degree) - Public Administration
Austin Peay State University
CPC - Professional Coding
AAPC