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Diana Melendez

Expertise In: Cardiology

Name : Diana Melendez
Experience : 16
Specialty : Cardiology
Location : SugarLand,TX
Description :

Diana Melendez wishes to seek a position, which will maximize the use of my knowledge and skills, allowing her to become a highly productive and effective worker.

Typing (35-40), Ten Touch By Key 10,000 plus keystrokes per hour, Good Telephone Etiquette, Proofreading skills, Microsoft Word, Microsoft Excel, Microsoft Office, Word Perfect, Microsoft Outlook, Ez-cap, Facets, maces, IDX, Athena, Medisoft, 3M Encoder


  • Responsible for account follow-up for all assigned accounts
  • Resolving billing problems and answering patient inquiries, Set up financial arrangements as needed.
  • Responsible to keep accounts receivable current including monitoring for delinquent payments
  • Responsible for handling incoming mental and substance abuse in HCFA and UB92, 04 claims ensuring a high level of customer service and maximizing productivity.
  • Responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims. Authorizes the appropriate payment or refers claims to investigators for further review, Conducts data entry and re-work; analyzes and identifies trends and provides reports necessary.
  • Constantly meet established productivity, schedule adherence and quality standards.
  • Responsible for handling workflow in Facets
  • Knowledge in the contracted managed care plan terms and rates.
  • Knowledge in unbundling, COB, and other over-billing methodologies
  • Primary responsibility to maximize reimbursement by contacting third party payer and patients.
  • Update patient insurance and demographic information
  • Responsible for paperless collection system and initiating follow up activity on accounts with third party payers.
  • Meeting established performance standard for accounts receivables follow up.
  • Meeting monthly collection goal.
  • Document collection activity in financial comments and assigns the appropriate
  • Action/rejection codes.
  • Initiates charge and payment disputes to resolve coding and payment issues on accounts.
  • Responsible for researching and processes basic insurance denials and appeals with minimal assistance.
  • Contacting patient/guarantor/third party payer either by telephone or in writing to resolve open issue on an account.
  • Responsible for processing and reconciling billing statements to premium payments.
  • Responsible for  accounts by utilizing a variety of programs to invoice premiums, apply payments, process lockbox files, complete all actions required to process monthly premiums and make any needed annotations
  • Process all necessary monthly billing functions including outgoing and incoming FTP for Payment.
  • Provide research and resolution on member accounts to include identifying and calculating required adjustments. Running accounts utilizing department resources to include reports and systems.
  • Ensuring that functions are performed within regulatory standards, Responsible for obtaining a working knowledge of all internal and external systems, as required creating and maintaining accurate accounts.  Others duties as assigned.
  • Billed UB and HCFA for a major Hospital
  • Looked up all the codes to make sure we were billing them correctly.
  • Knowledge of ICD 9, CPT codes and EOB.
  • Trained new employees for medical billing.
  • Worked in the switchboard to relief the receptionist on breaks.
  • Answered billing questions for Spanish Speaking customers
  • Collected money for hospital facility and patients
  • Process physical therapy, emergency room, Labs, DME, UB’92 claims, HCFA claims.
  • Process claims over 230 a day and having an accuracy of 98%
  • Process primary care physician and ancillary provider claims per the IPA matrix guidelines for assigned IPA. 
  • Knowledge of HCFA, TDI and THD regulations necessary for the processing of Medicare and Medicaid claims.
  • Assistant as needed in the processing of EDI and primary care physician claims.
  • Achieve and maintain and overall claims processing accuracy of 98 %.
  • Cross train to other IPA’s
  • Received cash and checks receipts, maintained General Ledger book and computer record of band deposits.
  • General responsibilities include making photocopying of deposits and other project as needed within the accounting department.
  • Direct Customer contact to handle vendor calls concerning invoice problems
  • Answered phones, greeted and assisted visitors and handled general administrative duties such as filing, faxing, photocopying and mailing
  • Scheduling in-office appointments.

Medical Billing and Coding