Mary E. GilliamChattanooga, TN 37411Phone: 423-629-5507Alt: 423-488-7133marygilliam@epbfi.com

October 13, 2015

To: Whom it may Concern It is with great enthusiasm to submit my resume for the position within your company. I am a self-motivated person with excellent interpersonal skills as well as a high standard of Professional ethics. My strengths are problem solving, research, and resolutions. I enclosed my resume as the first step in exploring opportunities of becoming a part of your organization.

My current occupation is Complex Claim Coordinator/ Medical Claims. This position has allowed me to enhance my skills with auditing accounts and direct billing procedures and Claim investigative techniques. Other pertinent responsibilities include resolving complex claims issues; I have excellent exceptional customer service abilities in regards to providing informative solutions for customers, clients and healthcare professional via phone or email.Creative problem solving, critical thinking, empathy and passive listening skills are essential in this field. My professional interaction allows me the ability to provide accurate responses to customer inquiries and utilize computer-based resources’ to educate and respond accurately, along with in innate ability to be compassionate and empathetic when appropriate when handling complex customers.. It would be a pleasure to further develop these skills to help fulfill the needs of your organization.

Thanks in advance for investing your time to review the skills and talents highlighted in this letter and in my resume. I would very much like to meet with you to discuss how well my qualifications align with your hiring needs for this position. Thank you for your consideration and I hope to hear from you soon. Please feel free to contact me via phone or email. Sincerely,

Mrs. Mary Gilliam

REMOTE, TELECOMMUNITE, OR VIRTUAL

Mary E. GilliamChattanooga, TN 37411

423-629-5507 (Home) (423) 488-7133 (cell)marygilliam@epbfi.com

Summary of Qualifications

Dedicated Professional with more than 10 years in Medical Insurance and Administration experience. Medical Claims Adjuster Unum for several years’ Extensive knowledge in Claims, Customer Service, Testing, Audit reporting, & Appeals.

Excellent human relations skills due to dealing with an array of providers, customers, and employees.

Computer proficient with Microsoft Excel, Word, Access, Windows Applications, IDX system. McKesson, Cisco and Meditech & Sage, Invision, Citrix, WGS, Navinet Healthfusion, Intellisys, Cloud.

Expert knowledge of the procedures of investigating and resolving fraudulent information from claims, discrepancies of members plan , and office documentation and medical billing

Proficient in Medical Terminology, CPT codes, Revenue and Diagnosis codes Superior ability to achieve immediate and long-term goals , excellent leadership skills Exceptional customer service abilities, Creative problem solving, critical thinking, empathy and

passive listening skills. Ability to analyze, plan, excellent research, problem solving and investigative skills .Able to manage multiple projects and tasks.

Solid data entry skills with accuracy and knowledge of claim payment system with UNUM Insurance as a Medical Claims Examiner for several years. As well as Accounts receivable collections experience. Denials and adjustments. Excellent Customer Services skills. Self motivated, hardworking, productive, quick learner, honest & knowledgeable.

Work Experience

Research complex claims for Commercial, Medicare and Medicaid Insurance carriers. Exceptional investigative skills, regarding fraudulent billing, claims

Research and follow-upon complex claim issues, filing Appeals. Work with Providers regarding proper medical documentation and necessary billing forms needed for CMS and other carriers, needed for proof of accurate plan of treatment.

Interact with patient regarding types of insurance and personal information to process medical claims correctly. Obtain percerts and authorizations. Medical Claims Adjuster/ UNUM for several years.

Neurosurgical & Spine of Chattanooga, Chattanooga TN November 2013 to PresentMedical Claims Insurance Billing Specialist Investigate and research complex claims for billing errors and resolve them in timely manner. Claims Examiner experience, Also Billing of UB04 and HCFA 1500

Previous claims billing and insurance follow experience with Medicare, Commercial, and Medicaid carriers. Verifying cpt coding errors, such as Diagnosis & modifiers. Correspond with various insurance agencies and providers regarding billing and CPT, ICD 9 coding of Medical

claims for Commercial, Medicaid and Medicare plans. Extensive knowledge of filing Medical Appeals and Electronic claim filing.

Resolve reimbursement & denial discrepancies discovered during Monthly Audit and reports. Prepare and monitor Appeals, Manage Account Receivable daily, audits and claims follow up;

posting denial and payment: Excellent experience and knowledge in all aspect of Medicaid, Tenncare and Managed Care plans

and CMS Medicare. Obtain precertification or authorization for surgical procedures, MRI, and ESI.

University Surgical Associates, Chattanooga, TN January 2000 - October 2013 Claims Coordinator / Insurance Follow-up Medical Billing/ Customer Service

Investigate and research complex claims issues and resolve them in timely manner. Monitor claims payment resolution regarding fee schedules compliance. Obtain Precertification and or Authorizations for inpatient, outpatient procedures. Review medical claims for workers compensation and or private carriers. Verifying cpt coding

errors, such as Diagnosis & modifiers both on HCF 1500 OR UB04 claims. Correspond with various insurance agencies and providers regarding billing CPT, ICD 9 & RVU coding of Medical claims for Commercial, Medicaid and Medicare plans. Extensive knowledge of filing Medical Appeals and Electronic claim filing.

Interact with certified coders and insurance carriers to resolve reimbursement & denial discrepancies discovered during Monthly Audit and reports.

Prepare and monitor Appeals for high dollar claims Excellent experience and knowledge in all aspect of Medicaid, Tenncare and Managed Care plans. Manage Account Receivable daily, audits and claims follow up; posting denial and payment:

Prelog medical information and Medical Claims processing IDX, Microsoft. Submit reimbursement of payments.

Medical Claims Examiner for Unum Ins. Company for several years. Call center and Customer Service providing informative solutions for customer, clients and

healthcare professional. Via phone or email. Provide accurate response to customer inquiries. And also show compassionate and empathetic when appropriate when handling complex customers. Billing question, collection and payment arrangements. Eligibility verification and assists in various indigent programs.

References: Attached

References: Mrs. Dawn Rubin, Office Manager/ RN

(423) 595-3474

Former Co-worker Mrs. Pamela Brown, Team Leader Clinical Fraud Investigator- Wellpoint(423) 698-5707

Mrs. Julie Ewing, Former Supervisor(423) 805-3617

Personal Reference: Ms. Agnes Oglesby (615) 995-1505- Office Manager Windsor Medicare