medicare medicaid specialist resume example with 9+ years of experience

(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
Professional Summary

    My medical career began with BG Anesthesia in 2011. I was an office assistant so I helped with a little bit of everything. A few of the duties I carried out included but were not limited to: scheduling injection appointments for the anesthesiologists, run eligibility and determine the patient's copay prior to the procedure, take self pay payments, input patient data into the computer, batch and post payments from insurance companies, call patients regarding their balance, get authorization from providers for patient refill requests and more.

    In pursuit of a full time position, I began work at UMC Physician Network Services in June of 2013 on the Medicare/Medicaid team working denials. In my time there I gained a wealth of knowledge in regards to medicare and Medicaid including the requirements needed for claims to be paid in full and the correct way to navigate both corrected and denied claims. I am continuously looking for ways to expand my understanding of the medical field in all areas as well as to increase what I already know.

In an attempt to continue my learning, I accepted a position at Texas Mutual Insurance as a medical coder. This position has allowed me to gain knowledge of the workers compensation part of insurance and see claims for in and out patient hospital bills.

I know that I can be a great asset to any company with the knowledge and skills that I bring to the table along with being a great team player with the ability to perform on my own.

  • medical terminology 
  • familiar with medicare & Medicaid
  • able to read medical records
  • familiar with appeal and corrected claim deadlines
  • familiar w/appeal and corrected claim requirements
  • friendly
  • inviting
  • willing to share knowledge
  • teachable
  • familiar w/insurance portals
University Of Phoenix Phoenix, AZ Expected in 2012 Associate of Arts : Medical office management - GPA :
Lubbock High School Lubbock, TX Expected in 2004 High School Diploma : - GPA :
Work History
Aspire Public Schools - Medicare/Medicaid Specialist
Los Angeles, , 05/2013 - Current
  • follow up on denials
  • submit appeals and corrected claims
  • gain knowledge of the different policies associated w/the different insurance companies
  • mail off set insurance claims on a weekly basis
  • work with the clinics to get claims paid
  • use the cpt and icd9 books in order to determine if coding denials are incorrect/correct
  • help to train new employees
  • for several months I was in charge of the 'email queue' which was a queue that the clinics used to communicate corrections made to charges and I would fulfill their requests
  • review medical records to determine if documentation would support an appeal
BG Anesthesia - Office Assistant
City, , 08/2011 - 03/2013
  • entered pt demographics
  • collect self pay payments
  • post insurance payments
  • schedule block appointments
  • check eligibility and pt responsibility prior to procedure
  • submit refill requests on behalf of the providers
  • call pt's regarding their open balance

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Resume Overview

School Attended

  • University Of Phoenix
  • Lubbock High School

Job Titles Held:

  • Medicare/Medicaid Specialist
  • Office Assistant


  • Associate of Arts
  • High School Diploma

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