Description

MICHELE HICKMAN

1204 N. 91st Ave., Tolleson, Arizona 85353

872-226-3770

Michele2121976@yahoo.com

PROFESSIONAL SUMMARY: Detail oriented, communication skills, motivated, customer focused professional trained in Medical Administrative/Billing & Coding/Health Claims Examiner. Successful track record of working in a fast paced environment.

SKILLS & COMPETENCIES: Medical Terminology, Medicare/Medicaid, HIPAA Trained, CPT, ICD-9, ICD-10, HCPCS, Physicians/Hospital Billing, MS Office Suite, 70 WPM, 23700/10-Key, Medical Insurance/EOB reconciliation, EOB/Collections Indemnity Plans, Data Entry, Accounts Payable, Accounts Receivable, Outlook, DMS, TAMS, VMWare, QRG, Quick Cap, eCare, Optum Encoder Pro, 3M Core Grouping Software, Encoder-Plus, CMS Inpatient Pricer, Aldera, PNDM, Change Healthcare, VIDAClaim, VIDABility, VIDAPro, VITAL Platform, Daily processing of claims per day: 100-200, Daily process of provider outreach: 100 claim checks per day.

PROFESSIONAL EXPERIENCE:

Family Health Network, Hillside, Illinois                        February 13, 2017 – February 28, 2018

Claims Specialist

Approve or deny claims for payment by ensuring the payment is correct, verifying the proper authorizations were submitted, and resolving any system hold codes
Resolve reoccurring provider or member issues by identifying trends and recommending solutions to management
Contribute to team effort by accomplishing the related goals and results as determined by the Claims Manager
Maintains all necessary levels of member/patient privacy in accordance with HIPAA standards

Medix Staffing-Land of Lincoln Health Mutual Insurance, Chicago Illinois             March 2016 – July 2016

Claims Outreach, Contract

Analyzed returned checks to decipher if a contracted provider or the leased agreement with providers of PHCS networks
Researched information in Aldera and PNDM to determine incorrect provider entity legal name and mailing address
Maintained Excel spreadsheet by entering demographic information
Followed up with providers/office managers to request remittance address and practice name

Chicagoland’s Medical Services Organization LLC, Hillside, Illinois                                   February 2014 – February 2016

(Company previously named Ravenswood Physician Associates)

Claims Specialist

Assessed data on claim form in quick cap system to determine eligibility and insurance coverage
Processed HCFA/UB claims based on the most current ICD-9 & ICD-10/CPT code for the date of service
Calculated reimbursement and copays according to contract and most current ICD-9, ICD-10/CPT code
Assisted Supervisor/Team Leader in training a team staff and examined duplicate, timely filing and EOB report

Ravenswood Physician Associates, Chicago, Illinois

Claims Specialist

Responsible for entering new HCFA/UB claims into Quick Cap according to information provided on the HCFA-1500/UB-04 claim forms
Ensured HCFA/UB Claims were adjudicated based on the most current ICD-9/CPT code for the date of service
Performed and established a check for Eligibility/Provider Verification, Duplicate Billings, Timely Filing, Unbundling and Unclean Claims
Assisted and advised walk-in patients regarding questions about their claims

EdLink, LLC., Chicago, Illinois                                  August 2005 – September 2011

(Company previously named Council for Adult & Experiential Learning)

EdProvider Customer Service Representative

Council for Adult & Experiential Learning, Chicago, Illinois

Payment Specialist

Efficiently maintained accuracy in the processing of Accounts Payable & Accounts Receivable; such as balancing discounts, percentages and ensured proper processing of manual pay adjustments
Communicated responses of Invoices/Payment Transaction request from Colleges/Universities and students; via phone and email in a call center setting
Verified details of transactions and resolved accounting entries as needed
Rectified months of backlogged work by developing a solution to renegotiate billing problems and corrected invoicing of errors previously missed

EDUCATION:

Computer Systems Institute, Chicago, IL                                            2013

Healthcare Career Program – Administrative

CERTIFICATION:

NHA- Certified Medical Administrative Assistant                                     Pending

NHA- Certified Billing and Coding Specialist (CBCS)                                                                   Pending

Customer Service Certification                                                                                    2013