Michele M Hickman
6800 South Wood Street, Chicago, Illinois 60636 * 773-476-6031 *
michele2121976@yahoo.com
PROFESSIONAL SUMMARY
Detail oriented and quality focused professional trained in Medical Administrative/Billing & Coding/Health Claims
Adjudicator. Successful track record of handling complicated assignments and administrative/clerical requests
Substantially trained in posting deposits/payments and reconciling accounts with an efficient degree of accuracy
Offer firm organization in software applications, database management and data entry; ability to master new
technology
SKILLS
Medical Terminology
HIPAA Trained
HCPCS
70 WPM
reconciliation
Accounts Payable
DMS
QRG
Optum Encoder Pro
CMS Inpatient Pricer
Familiar with Medicare
CPT
Physicians/Hospital Billing
23700/10-Key
EOB/Collections Indemnity Plans
Accounts Receivable
TAMS
Quick Cap
3M Core Grouping Software
EMPLOYMENT HISTORY
Chicagoland’s Medical Services Organization LLC, Hillside, Illinois
Claims Specialist
Familiar with Medicaid
ICD-9-CM
MS Office Suite
Medical Insurance/EOB
Data Entry
Outlook
VMWare
eCare
Encoder-Plus
06/2015-Present
Reviews and analyze detailed claim form to ensure proper adjudication
Assists Supervisor/Team Leader examining duplicate, timely filing and explanation of benefits report
Calculates reimbursement and copays according to contract and most current ICD-9/CPT code
Compares data on claim form with patient information in quick cap system
Examines claim form and quick cap system to determine eligibility and insurance coverage
Functions as a source and assist with training new staff
Resolves claim discrepancies as quickly as possible
Meets and exceeds production goals
Maintains providers by adding them to quick cap system
HCFA/UB Claims are adjudicated based on the most current ICD-9/CPT code for the date of service
Effectively evaluate claim facts and negotiating claim settlements
Daily processing of claims per day: 100-200
Ravenswood Physician Associates, Chicago, Illinois
Claims Specialist
02/2014-5/2015
Reviews claim to ensure maximum accuracy in data entry, system assessment and adjudication
Recognize and understand how to complete timely and accurate entry of claims data and payment
Enter new professional and hospital claims into Quick Cap according to the information on the HCFA1500/UB-04 claim forms
HCFA/UB Claims are adjudicated based on the most current ICD-9/CPT code for the date of service
Process EDI files for professional and hospital claims, via secure website portal
Comply with HIPAA guidelines and maintain strict confidentiality
Examines training/education materials and seek clarification when needed
Create new ER/Inpatient Authorizations into Quick Cap
Link appropriate referral/authorization to ensure accurate reimbursement and utilization management
Check for Eligibility/Provider Verification, Duplicate Billings, Timely Filing, Unbundling and Unclean Claims
Assist Claims Supervisor with special projects
Daily processing of claims per day: 100-200
EdLink, LLC., Chicago, Illinois
EdProvider Customer Service Representative
CAEL, Chicago, Illinois
Remote Payment Specialist
01/2010-09/2011
08/2005-12/2009
Consistently maintained accuracy in Accounts Payable Processing & Accounts Receivable; such as
discounts, percentages and ensured proper processing of manual pay adjustments
Coordinated responses to Invoices/Payment Transaction received from Colleges/Universities and
students; via emails and voicemails
Analyzed, verified transactions to ledgers and other records; investigated and corrected accounting
entries as needed.
Demonstrated the ability to fill in at a moment’s notice, quickly mastering new systems, processes and
workflows
Resolved months of backlogged work, restored order and organization to processes/records in disarray,
researched and solved billing problems and corrected invoicing and journal entry errors that had
previously been missed
Perform special tasks and duties as assigned by immediate supervisor
EDUCATION
Computer Systems Institute, Chicago, IL
Healthcare Career Program – Administrative
CERTIFICATION
NHA- Certified Medical Administrative Assistant
NHA- Certified Billing and Coding Specialist (CBCS)
Customer Service Certification
2013
Pending
Pending
2013
Summary of Qualifications
Works collaboratively with the professional staff.
Good eye for detail, well organized, skilled in setting priorities
Equally effective working independently and in cooperation with others
Highly motivated to achieve set goals
Successful in mastering new skills through hands-on experiences
Skilled and thorough in analyzing problem situations and finding creative solutions
Strength in analyzing, researching, organizing, and problem solving
Excellent organizational and communication skills
Hard worker, quick learner, and ability to assume responsibility
Responsible, efficient, flexible, dependable and punctual
Committed to providing total quality work
Work well under pressure to meet deadlines
Perform effectively despite sudden deadlines and changing priorities
Highly reliable self-starter; can be counted on to complete assignments, committed to top quality work
Self-motivated; able to take initiative
Excellent record of dependability and reliability
Versatile and multi-skilled person
Demonstrated ability to adapt to new equipment& technology