10708 North Nebraska Ave. # 7, Tampa, Florida. 33612 Telephone: 813-337-9040

Email SCOTTLMCLEOD@YAHOO.COM or SLEEMCLEOD@GMAIL.COM

SCOTT L. MCLEOD

Objective: To secure an employment position for advancement in the Insurance and Medical Healthcare Claims Processing fields. To advance in Medical Claims Examining, Medical and Insurance Billing or other areas of employment.Summary of Qualifications: Extensive background in Medical Insurance Claims and Healthcare Management. 19 years experience in Medical Claims, EDI, Claims Examining and Adjusting. EDI Processing, Configuration, Knowledge of Managed Care, Workman’s Compensation, Medicaid claims field and Knowledge of Workman’s Compensation stat mandate laws, HIPAA, and Medical re-pricing and reviewing. Validate Claims information. Loss Time, Pharmacy Processing, DME, Familiar with CPT codes ICD-9, HMO, Networks, HCFA 1500 forms, Team Leader Skills. Etc .. Special Skills: EDI Processing, Claims Processing, EOB Research Data Entry Indexing Spreadsheet reviewing Configuration, Provider Contracts, Medical Terminology , Re-pricing / Fee Scheduling, Workman’s Comp. Claims Managed Care Claims Fraud Determination Review Duplicates Provider ContractsProfessional Experience:08/2012- 05/2013 WellCare Healthplans Tampa, Florida.Claims SpecialistProcess Claims, Provider Hospital and Physicians medical billing. EDI Processing, Medicare, Medicaid, Work Comp and Commercial. Configurations, Investigating and determining authorizations on cover items. Paying claims based on per contract with each individual provider. Pay per contract allowance. Reviewing contracts on cost per medical services and treatments. Proper Revenue Codes, CPT Codes, EOB’s, ICD-9, Etc. Investigate and research for duplicate billings per itemizations. Medical and Hospital Claims UB04 and HCFA 1500 forms. Investigate overpayments from previous accounts. In charge of Special Projects .Loss Time Verification, Verify all information on claim before paying or denying claim. (Position was eliminated)08/2007 – 06/2012 Coventry Healthcare Work Comp Service Center Tampa, Florida.Technical Claims SpecialistProcesses paper claims and electronic work queues, including complex HCFA 1500 and UB04, in accordance with company policies and procedures. Interprets and processes difficult adjustments in accordance with company policies and procedures. Reviews basic pended claims to determine the appropriateness of the claim status and takes necessary action based on status. Researches issues, compiles feedback and drafts corresponding business requirements documents and business decision documents as needed. (Laid-off)10/2006 – 02/2007 Tampa Bay Endoscopy Outpatient Center Tampa, Florida.Medical Billing Patient Monthly Statements for Self Pay, Work Comp, Managed Care, Printing statements. Printing HCFAs and UB92 Forms. Patient Account Research. Medical terminology, CPT, ICD9, Authorizations, Timely filings, Assisting Office Director, File Room responsibilities, managed Care, Medicaid, 2nd and 3rd party billing. A/R Accounts, Billing by paper and EDI. Verify patient information. Multi-task duties. (Seasonal work)07/2004 – 03/2006 Amerigroup Community Care Tampa, Florida.Claims Analyst IIIResearch and make benefit determinations for the processing or medical and hospital claims according to contractual and processing guidelines. Identify and communicate claims processing, Maintain production and quality in accordance with the departmental standards. Attend and participate in team/training meetings as needed. Organize and handle individual workload to ensure that all new work and pended are processed basis. Contribute to the overall success and attainment of team goals by assisting with special projects and working overtime when needed. Coding and medical terminology. Work in a production and quality oriented environment. EDI. Configuration. (Laid off)10/2002 – 06/2004 Teamhealth Healthcare, Tampa, Florida.Insurance Biller / Collections Medical billing and collections. Claims analyst, EDI Processing, Configurations, Work Comp claims, insurance biller.

2nd and 3rd party billing. Printing claims to paper on HCFA 1500 forms. Training new employees. Assistant office manager. Researching past due accounts. Capitations. Authorizations. Loss time verification.

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09/2001- 04/2002 WellCare Inc. 6800 N. Dale Mabry Tampa, Florida.Claims SpecialistProcess Claims, Provider Hospital and Physicians medical billing. EDI Processing, Medicare, Medicaid, Work Comp and Commercial. Configurations, Investigating and determining authorizations on cover items. Paying claims based on per contract with each individual provider. Pay per contract allowance. Reviewing contracts on cost per medical services and treatments. Proper Revenue Codes, CPT Codes, EOB’s, ICD-9, Etc. Investigate and research for duplicate billings per itemizations. Medical and Hospital Claims UB04 and HCFA 1500 forms. Investigate overpayments from previous accounts. In charge of Special Projects. Verify all information on claim before paying or denying claim. (laid off)05/2000 – 06/2001 Florida Claims Solutions / Health Plan Services Tampa, Florida.Claims SpecialistReviewing and Processing medical claims EDI Processing, Pay Claims. Verify all information on claims, check for any duplicate billings. Reviewing contracts on cost of medical services. Check for duplicate billings per itemization. To verify if provider is in our networks. Check for according to contract coverage. Check for overpayments of previous accounts. Medical and Hospital claims. UB04 and HCFA 1500 forms. Claims Automation Specialist. Pediatric, OB/GYN. In charge of Special Projects. Resolving Claim issues. Loss Time Verification. (Laid off02/1997 – 08/1998 Pediatric Healthcare Alliance Tampa, Florida.Insurance Biller / Collections

Medical billing and collections. Claims analyst, insurance biller. 2nd and 3rd party billing. Printing claims to paper on HCFA 1500 forms. Training new employees. Assistant office manager. Researching past due accounts. Capitations. Authorizations. Training, HMOs, PPOs, Policy interpretation. Reviewing insurance coverage and contracts. Data Entry. Multiple tasks. Checking patient's information. Using Medical Manager systems. (laid off) 1995 - 1997 Genex Insurance Services / on-site Alexsis Insurance Tampa, Florida.Medical Bill Reviewer, Workman's Compensation medical claims health insurance examiner, Configurations, EDI Processing, Data Entry of medical physician and hospital claims to be certain it is workman's compensation related. Check all information on claims to be sure of any corrections to be made. Entering data from systems billing, send back denied claims to providers for any more information or corrections. Using state mandates to re-price, fee schedule claims. Search for any duplications on incoming claims. Verify all information to be on the proper forms. Knowledge of medical terminology such as CPT codes, ICD-9, PPO, EOMB's, HCFA 1500 forms. UB-92 forms. Team lead over special projects. Administrative assistant, enter medical coding on IDX systems, processed incoming and outgoing mails and claims. FED-EX, UPS, Postal Service Faxing, Training of new employees, multiple tasks. (Laid off)Education:1991, Seminole Technical Education, Tampa, FloridaHigh School Diploma Computer Skills, Software, Etc:Microsoft Office 2000, Office XP, Outlook, Excel, WordPerfect, Access, PowerPoint, MS Word, Windows Explorer, Etc. Medical Manager systems, Diamond, Crystal, SMS, SDI, SSI, Citrix, Excelys, Facets, and more.

Skills:Medical Terminology, CPT, ICD9, Rev. Codes, HCFA CMS 1500 forms and UB04 Claim Forms.

Revised 2015