Karissa Edelen
Longmont
Summary
Accomplished Medical Billing Professional with 25+ years of experience in workers’ compensation, specializing in complex claims and coding compliance. Recognized in mentoring teams, enhancing workflows, and ensuring accuracy in high-volume settings. Knowledgeable in DOWC regulations and coding systems, with a commitment to operational efficiency and continuous improvement.
Overview
26
26
years of professional experience
Work History
Complex Bill Processing Analyst
Pinnacol Assurance
Denver
05.2016 - Current
- Review and audit complex medical billing to ensure accuracy in CPT coding, denial resolution, and payment determination.
- Serve as a subject matter resource to team members, providing guidance on coding, billing discrepancies, and complex claim resolution.
- Reduced appeals and rework through detailed documentation and proactive provider education, improving overall billing accuracy.
- Managed online appeals and assisted in resolving escalated billing issues across departments.
- Contribute to process improvements that enhance workflow efficiency, consistency, and team productivity.
Med Pay Bill Processor
Pinnacol Assurance
Denver
01.2000 - 05.2016
- Processed high volumes of medical bills for workers' compensation claims, ensuring accuracy, compliance, and correct application of fee schedules and PPO discounts.
- Resolved billing discrepancies, minimizing re-bill requests and payment delays.
- Maintained up-to-date knowledge of regulatory requirements and billing practices, ensuring consistent and compliant processing.
Education
Certified Professional Coder -
AAPC
03-2018
Bachelor of Arts - Sociology
Metropolitan State University of Denver
Denver, CO12-1997
Associate of Arts - General Studies
Arapahoe Community College
Littleton, CO05-1995
Skills
- CPT/HCPCS Coding and Denial Resolution
- Workers’ Compensation Billing and Compliance
- Claim Processing
- Appeals and Dispute Management
- Quality Assurance and Auditing
- Process Improvement and Workflow Optimization
- Problem Resolution and Escalation Handling
- Provider Relations and Communication
- Team Mentoring and Training
Timeline
Complex Bill Processing Analyst
Pinnacol Assurance
05.2016 - Current
Med Pay Bill Processor
Pinnacol Assurance
01.2000 - 05.2016
Certified Professional Coder -
AAPC
Bachelor of Arts - Sociology
Metropolitan State University of Denver
Associate of Arts - General Studies
Arapahoe Community College