Kelly Ventura Melgar
Burnsville
Summary
Certified and detail-oriented Medical Billing and Coding graduate with over 5 years of experience in healthcare settings. Skilled in ICD-10, CPT, and HCPCS coding systems, revenue cycle management, insurance verification, and claims resolution. Bilingual in English and Spanish with a strong ability to communicate effectively with patients, insurance companies, and healthcare professionals. Knowledgeable in patient financial matters with background as Patient Financial Representative. Experienced in providing comprehensive support for patient financial services including insurance verification, collections, and payment processing. Strengths lie in problem-solving skills, ability to manage high-stress situations, and strong interpersonal communication. Previous impact includes improved efficiency of financial processes and enhanced patient experience through clear communication of complex financial matters.
Overview
10
10
years of professional experience
Work History
Patient Financial Representative – 277 Claim Rejections
M Health Fairview
MN
12.2021 - Current
- Process complex insurance claims and denials in compliance with payer guidelines.
- Perform timely follow-ups and appeals to ensure maximum reimbursement for services.
- Communicate with clinical staff, patients, and insurance companies to resolve billing inquiries.
- Manage a caseload of over 100+ active claims weekly, improving reimbursement success rates.
- Verified patient insurance information and eligibility for services.
- Assisted patients with financial counseling and payment options.
- Processed billing inquiries and resolved patient account issues.
- Supported compliance with healthcare regulations and policies.
- Maintained up-to-date knowledge of medical terminology, coding, reimbursement policies, procedures, and regulations.
- Researched and resolved complex billing issues with payers or other departments within the organization.
- Processed insurance claims using electronic billing systems efficiently and accurately.
- Verified medical codes for diagnosis, treatments, procedures and supplies using ICD-10 coding system.
Collections Compliance Specialist
Allina Health Reliance Recoveries
Minnesota
07.2021 - 12.2021
- Handled high-risk accounts such as bankruptcies, probates, and motor vehicle accidents.
- Collaborated with legal team to resolve escalated cases and ensure regulatory compliance.
- Maintained accurate records of compliance activities and findings for review.
- Assisted in developing strategies for improving overall compliance performance.
- Responded promptly to inquiries from government agencies regarding regulatory issues.
- Managed customer accounts to ensure timely payments and collections.
- Communicated with customers regarding overdue accounts and payment arrangements.
- Utilized collection software to track account status and payments received.
- Negotiated payment plans with clients to facilitate debt recovery.
- Maintained accurate records of interactions and agreements in database systems.
- Resolved customer disputes related to billing and account inquiries promptly.
- Negotiated payment plans with customers to ensure timely repayment of debt.
- Adhered to company policies and applicable laws while collecting debts from customers.
Medical Assistant
Allina Health Urogynecology Clinic
Minnesota
01.2020 - 07.2021
- Supported providers and nurses by rooming patients, managing patient flow, and administering medication.
- Maintained accurate patient documentation and delivered patient-centered care.
- Managed appointment scheduling for optimal clinic flow.
- Prepared examination rooms with necessary supplies and equipment.
- Educated patients about procedures and post-care instructions.
- Kept examination rooms clean, stocked with necessary supplies and prepared for incoming patients.
- Administered injections, medications and treatments as directed by the physician.
- Documented notes during patient visits.
- Maintained accurate medical records through filing, charting, transcription and data entry into electronic health record system.
- Collected samples from patients for laboratory testing purposes.
- Educated patients about medications, procedures and physician's instructions.
- Ensured that all instruments used during exams were cleaned properly after each use according to established protocols.
- Participated in team meetings to improve workflows and contribute to improving patient population outcomes.
- Ordered medical supplies, maintained inventory logs and restocked exam rooms when needed.
- Assisted with pre-operative preparation of patients including providing instruction about post-operative care plans.
Medical Assistant
M Health Fairview Cardiology Clinic
Minnesota
03.2020 - 12.2020
- Coordinated patient appointments and assisted with patient care delivery.
- Communicated effectively with patients and healthcare team to ensure quality care.
- Prepared examination rooms with necessary supplies and equipment.
- Conducted patient vital sign assessments and documentation.
- Educated patients about procedures and post-care instructions.
- Maintained accurate medical records in electronic systems.
- Kept examination rooms clean, stocked with necessary supplies and prepared for incoming patients.
- Assisted physicians with patient care by taking vital signs, patient histories and preparing patients for examinations.
- Administered injections, medications and treatments as directed by the physician.
- Scheduled appointments for patients via phone and in person.
- Collected samples from patients for laboratory testing purposes.
- Conducted EKGs, spirometry testing, audiograms and other diagnostic tests as requested by the physician.
- Ensured that all instruments used during exams were cleaned properly after each use according to established protocols.
- Positioned patients properly during examination or treatment for comfort and safety.
Patient Access Services Representative
M Health Fairview
MN
03.2018 - 01.2020
- Completed registration, insurance verification, referrals, and co-pay collections.
- Provided financial counseling and educated patients on healthcare benefits and responsibilities.
- Verified insurance information to ensure accurate billing processes.
- Educated patients on accessing healthcare resources and benefits available.
- Handled sensitive information while maintaining patient confidentiality consistently.
- Streamlined check-in processes to enhance patient flow during visits.
- Provided back-up coverage for other areas within Patient Access Services when needed.
- Ensured that all required forms were completed correctly by the patient or guarantor prior to service being rendered.
- Resolved any discrepancies on accounts receivable invoices promptly and accurately.
- Answered incoming telephone calls promptly and courteously while providing accurate information regarding clinic services.
- Assisted patients with understanding their financial responsibilities prior to services being rendered.
- Verified demographic information for accuracy prior to entering into the computer system.
- Applied HIPAA privacy and security regulations while handling patient information.
- Obtained necessary signatures for privacy laws and consent for treatment.
Patient Care Coordinator
Smart Choice MRI
Richfield
07.2017 - 03.2018
- Coordinated patient appointments and scheduling for diagnostic imaging services.
- Managed patient records and ensured confidentiality compliance with regulations.
- Communicated with healthcare providers to gather necessary patient information.
- Assisted patients with insurance verification and pre-authorization processes.
- Provided guidance on procedures and answered patient inquiries effectively.
- Collaborated with medical staff to streamline patient intake processes.
- Trained new staff on patient care protocols and organizational policies.
- Monitored workflow to enhance efficiency in the patient care process.
- Assisted in creating a positive environment for patients, family members, and staff by providing excellent customer service.
- Provided administrative support for patient care staff.
- Ensured that all necessary documentation was completed accurately and submitted in a timely manner.
Referral Coordinator
Hennepin Healthcare
Minneapolis
12.2016 - 06.2017
- Managed referral processes between primary care providers and specialists.
- Coordinated patient appointments to ensure timely access to services.
- Reviewed referral documentation for accuracy and completeness.
- Communicated with patients regarding referral status and next steps.
- Maintained electronic health records to track referral progress efficiently.
- Scheduled patients according to availability, urgency and insurance authorization guidelines.
- Prioritized referrals according to urgency and adhered to appropriate referral deadlines.
- Reviewed demographic, clinical and insurance information before sending to referred specialists.
- Answered questions and resolved concerns raised by both patients and specialists.
- Reviewed data obtained from referring physicians for completeness and accuracy.
- Monitored patient progress throughout the referral process.
- Advised staff on appropriate protocols when making a referral.
- Verified documents and associated records to catch and resolve discrepancies.
Front Desk Receptionist
South side community clinic
Minneapolis
03.2016 - 12.2016
- Greeted and assisted patients upon arrival at the community clinic.
- Managed appointment scheduling using electronic health record systems.
- Handled patient inquiries and provided information about clinic services.
- Coordinated with healthcare staff to ensure smooth patient flow.
- Processed patient check-ins and maintained accurate records.
- Maintained clean and organized reception area for welcoming environment.
- Answered phone calls and directed inquiries to appropriate departments.
- Supported administrative tasks including filing and data entry for clinic operations.
- Provided excellent customer service by responding quickly to inquiries via phone or email in a professional manner.
- Handled payment processing and provided customers with receipts and proper bills and change.
- Managed incoming and outgoing mail, courier services, faxes and other correspondence.
Education
Medical Billing and Coding Diploma - Rosemount, MN
Dakota County Technical College
Rosemount, MN05.2024
Medical Assistant Diploma - Rosemount, MN
Dakota County Technical College
Rosemount, MN05.2020
Community Health Care Certificate - Bloomington, MN
Normandale Community College
Bloomington, MN05.2016
Skills
- ICD-10
- CPT
- HCPCS coding
- Epic Systems (EMR)
- Medical Terminology & Anatomy
- Insurance Verification & Billing
- 277 Claim Rejections
- HIPAA Compliance
- Strong communication and problem-solving
- Organized and works well under pressure
- Bilingual – English/Spanish
- Revenue cycle management
- Billing inquiries resolution
- Healthcare regulations knowledge
- Customer service
- Problem solving
- Attention to detail
- Medical billing
- Payment processing
Languages
Spanish
Professional
Timeline
Patient Financial Representative – 277 Claim Rejections
M Health Fairview
12.2021 - Current
Collections Compliance Specialist
Allina Health Reliance Recoveries
07.2021 - 12.2021
Medical Assistant
M Health Fairview Cardiology Clinic
03.2020 - 12.2020
Medical Assistant
Allina Health Urogynecology Clinic
01.2020 - 07.2021
Patient Access Services Representative
M Health Fairview
03.2018 - 01.2020
Patient Care Coordinator
Smart Choice MRI
07.2017 - 03.2018
Referral Coordinator
Hennepin Healthcare
12.2016 - 06.2017
Front Desk Receptionist
South side community clinic
03.2016 - 12.2016
Medical Billing and Coding Diploma - Rosemount, MN
Dakota County Technical College
Medical Assistant Diploma - Rosemount, MN
Dakota County Technical College
Community Health Care Certificate - Bloomington, MN
Normandale Community College