Pamala Miller

Mobile Phone: 214-850-5118

E-mail: pmf542d8@westpost.net
REIMBURSEMENT SPECIALIST: BILLING, CODING, COLLECTIONS, PAYMENT POSTING, AND APP
EALS LEVEL I, II, III INCLUDING EXTERNAL REVIEW:
Twenty years of progressive reimbursement with management experience demonstrati
ng a consistent track record of outstanding reimbursement of all bill-to-type ca
rriers, including customer service advocate creating increased district sales gr
owth as manager of the largest territory in a national company. Equally strong q
ualifications in all areas of billing, coding, collections, payment posting, EOB
, to appeals in all areas of operations: P&L, budgeting, human resources, traini
ng, merchandising, HIPAA, security and other functions to increase funding. Work
ing as an advocate, liaison, effective communicator, leader and problem solver;
who builds teamwork and possesses the drive to surpass goals.

CAREER HISTORY
Wellmart Medical Specialty Group Owner: Ken Ketcher 214-263-8864 (Company mov
ing to OK).
2002-present Promotion to Director of Reimbursement
2001-2002 Reimbursement of billing, coding, payment posting, EOB, and appea
ls including medical case management, pre-authorization and refund/recoupment
avoidance.
*Management of 20+ employees, including SOP implementation and training based on
insurance trends as needed.
*Increase of daily collections to less than 1% to 3% for 30-120 day in A/R.
*SOP and implementation of case management, utilization review of medical report
s, and coordination of order of events.
*Chart review for billing, collections and appeals regarding diagnosis, assistin
g in dictation and writing medical reports for physician review.
*Securing reimbursement utilizing Federal Rules and Regulations of any denied cl
aims from physician offices with reconsideration request to Appeal Level I-III.
*Patient and physician advocacy including grievance hearings.
******************************************************
Oratec Interventions Director: Kathy Kirkland 817-915-2243 (Company sold and
moved to CA).
1998-2000 Promotion to Reimbursement and Appeals Manager including Medical
Case Management.
1990-1998 Reimbursement Specialist in billing, collection, EOB, payment po
sting, pre-authorization, Appeals case management, and refund/recoupment avoidan
ce.
*Management of 15 employees, training, SOP creations, and implementation of serv
ices.
*Appeals Case Manager: Performed medical case management, utilization review of
billing/collection and appeals with correct CPT/ICD-9 and Modifier.
*Review of medical reports, coordination of order of events including diagnosis,
written medical reports for PA, RN/LVN and physician review.
*Training of employees, physicians, securing reimbursement with Federal Rules an
d Regulations of incorrectly, untimely paid or EFT/EOB regarding denied claims f
rom a multi-specialized group of physician offices.
*Utilization to insurance carrier's regarding reconsideration request to Appeal
Level I-III.
*Implementing Federal Rules and Regulations for denied or incorrectly paid claim
s.
*Patient and Physician advocacy and grievance hearings.
RELEVENT EXPERIENCE
*Fast-track advancement through progressively responsible positions.
*Upholding high standards of billing, collections, appeals and reimbursement iss
ues with respect and dignity for a diverse population of patients, physicians, a
nd insurance carriers ranging from newborn to geriatric in a variety of settings
including Surgical, Pediatrics, Renal, ER, OR, PICU, DME, Chiropractic, Cosmeti
c, Cardiology, Orthopedic, Radiology, Diagnostic, OB-GYN, Pain Management, PT, S
T, OT, Imaging, CT Scan, MRI, Hospital/Hospitalist, Neurology, Oncology and Ambu
latory Surgery.
*Implemented corporate human resources policies, SOP and initiatives.
*Managed employee relations, all areas of specialized departments. Averaging fro
m 20 to 45 associates and management personnel. Designed curriculum and implemen
t train-the-trainer programs to develop associates.
*Experienced in personnel recruiting, selection, training, developing, schedulin
g, evaluating performance and supervision.
*Led staff to achieve performance goals and maintained the lowest turnover rates
in the region.
*Conducted sales training seminars biannually for up to 120 new hires region-wid
e.
*Traveled nationwide to assist in recruiting personnel and coordinating new faci
lity opening activities.
-Reimbursement Specialist with promotion to management due to the following expe
rience in all areas of the company and the need to expand with growth. Specifica
lly, I would bring to your company:
*20 years of experience in reimbursement of all levels, revenue cycles, reportin
g with skill set up to Team Lead, Supervisor and Management. Management, trainin
g, and mentoring of 25+ employees regarding reimbursement, medical billing, insu
rance claim filing, collection, payment posting with efficiency, medical case ma
nagement, ICD-9 expertise to match CPT/HCPC coding, reimbursement issue, appeals
, medical case management, utilization review, scheduling, pre-authorization, ve
rification, EHR/EMR, refund/recoupment cease and desist to Payor, medical review
, IRO, external review with extensive knowledge of Federal, State, ERISA, DOL, W
ork Comp, CMS and Medicaid Rules and Regulations.
*Collection of A/R: turned $250,000 in collections, into $12 million within firs
t 3-6 months and up to $20 million in collections and increasing receivables eac
h year.
*Hard working and energetic; flexible; adapt easily to change of environment and
work schedule.
*Maintain critical thinking skills essential to providing competent and dignifie
d patient care.
*Personable with a positive attitude. Interface effectively with patients, famil
ies, physician and nursing staff.
*Experience coding / billing/collections and appeals.
*Effective and efficient with data entry and claims, and efficient insurance dat
a entry skills.
*Follow instructions and pre-established guidelines to perform the functions of
the job. Self-disciplined, detail-oriented, organized and who can work independe
ntly but also as a team player.
*Excellent verbal and written communication skills to answer questions or clarif
y information about billing processes for clients.
*Knowledge of computer programs including billing software (MestaMed, Meditech,
MediSoft, Lyric, AdvMD, Lytec, Centricity, IGX, Availity, THIN, E-Clinical/Offic
e Practicum software. This includes scanning/imaging with EHR and EMR. Various i
nsurance websites with online billing, collections and reconsideration requests,
and many others including Microsoft office products for '2003, through year '20
10.
*Understanding of basic to expert of all bill-to-type major medical coverage pl
ans, such as Medicare, Medicaid, Fee-for-Service Plans, self-insured, (HMOs), (P
OS) ,(PPO), CHIP, including W/C. Utilization of all Federal Rules and Regulation
s.
*Knowledge of business office procedures with SOP implementation and understandi
ng.
*Skilled in answering a telephone in a pleasant and helpful manner. Customer Ser
vice skills, with knowledge to listen first, and set time with client for immedi
ate follow-through.
*Posting, collections and coding experience with efficiency.
*Experience with E-Clinical/Office Practicum software. This includes scanning/im
aging with EHR and EMR.
*Time management, organized, detailed and efficient.
Throughout my career, I consistently deliver as resume states, increasing revenu
e including annual sales growth with customer service of all internal and extern
al clients and managed the largest geographic territory company-wide.
Although in recent years my career has been in an administrative capacity, I hav
e always had a passion for improving, learning and reaching goals - prompting me
to resume my career in this industry.
EDUCATION
*March 2010 HIPAA Certification.
*Ongoing Business and insurance law including computer skills.
*Ongoing Insurance reimbursement trends for all bill-to-type insurance wi
th the ability to process denials into funded claims with utilization of HCPC/CP
T/ ICD-9, ICD-10, NUCC-HCFA, ANSI 5010, and EHR/EMR.
*Ongoing Experience of insurance trends, and knowledge of how to bill co
rrect and concise billing to ensure clean claim submittal.
*May 2003 Dearborn Leonard's Completion of workers compensation, group ce
rtification.
*1982-1984 Richland and Eastfield College.
*1980-1982 Honor Classes for High School courses with education at Richlan
d College.

REFERENCES
Ken Ketcher 214-263-8864 Work Reference
Kathy Kirkland 817-915-2243 Work Reference
Connie Davis 469-385-7284 Work Reference
Janice Naderkhani 310-201-0910 Personal Reference
Pat Taylor 972-442-9152 Personal Reference