Tammy Cline
Denver
Summary
Results-driven professional with over 20 years in medical billing and insurance claims. Expertise in charge entry, coding compliance, and payer guidelines. Led team mentoring and managed employee benefit funds, ensuring accuracy and compliance with regulations.
Overview
20
20
years of professional experience
Work History
Charge Entry Specialist
HCA
Denver
12.2022 - 07.2026
- Achieved daily charge entry targets of 200+ entries, maintaining high productivity and accuracy
- Enter and code medical charges into billing system for multiple healthcare providers, ensuring 100% accuracy
- Review and verify patient demographic information, insurance details, and procedure codes to ensure accurate charge entry
- Collaborated with physicians, nurses, and other healthcare professionals to obtain missing charge information, reducing billing delays by streamlining communication
- Conducted regular audits on charge entries to ensure compliance with coding guidelines and regulations, minimizing errors and enhancing billing accuracy
- Mentor new team members on proper coding practices, ensuring consistent accuracy across the department
- Monitor payer policies and reimbursement rates to optimize revenue capture during the charge entry process
- Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
- Processed charge entries accurately into electronic health record systems.
- Reviewed billing discrepancies and collaborated with healthcare teams for resolution.
- Ensured compliance with regulatory requirements during charge entry tasks.
Medical Billing Specialist
COLORADO HEART AND VASCULAR, PC
Denver
08.2019 - 08.2022
- Applied healthcare payor guidelines when submitting appeals and reconsiderations to Medicare, Medicaid, Commercial, HMO, and Military Insurance companies, increasing claim acceptance rates
- Reviewed daily EOB/ERAs to ensure accurate billing and timely payments
- Submitted corrected claims per payor guidelines, expediting reimbursement process
- Submitted corrected claims per payor guidelines, expediting reimbursement
- Followed up on unpaid claims within billing cycle, reducing outstanding receivables
Customer Service Specialist
Anthem, Inc.
Denver
02.2017 - 06.2019
- Assisted customers by telephone to provide information about products or services, process orders, cancel accounts, and resolve complaints, achieving high satisfaction rates
- Verified implementation of changes to resolve customer issues, enhancing first-call resolution
- Escalated unresolved customer grievances to appropriate departments for timely follow-up
- Assessed insurance policies to confirm coverage of losses, expediting claims processing
Insurance Specialist
OrthoFi
Denver
01.2016 - 02.2017
- Facilitated insurance benefit verification by processing claims through database, ensuring timely approvals
- Streamlined services for multiple orthodontic offices across the United States, enhancing workflow efficiency
- Collaborated with upper management to ensure appropriate changes were made to improve customer satisfaction
- Partnered with upper management to implement changes that enhanced customer satisfaction
Customer Service Representative
Delta Dental of Colorado
Denver
07.2015 - 01.2016
- Handled inbound calls from patients, brokers, and providers, ensuring accurate information and professional service
- Managed 75-100 calls daily, resolving inquiries promptly to enhance customer satisfaction
- Addressed inquiries on benefits, claims, and eligibility, facilitating effective case management
Benefits Specialist
Biologics, Inc.
Greensboro
12.2014 - 07.2015
- Ran daily reports and supplied data to meet customer report requirements, enabling informed decision-making
- Entered patient insurance information into accounts and used resources to obtain insurance coverage information for ordered services, ensuring accurate billing
- Communicated with providers on payment updates, facilitating quicker claim resolution
- Communicated with patients about pharmacy benefits, verified patient insurance coverage, and managed inbound calls to address issues
Reimbursement Specialist
Express Scripts
Lake Mary
07.2012 - 12.2014
- Addressed customer service inquiries promptly and accurately, enhancing overall customer satisfaction
- Reviewed incoming referrals for completeness, verified benefits and eligibility, and handled rejected claims to submit clean claims.
- Cultivated effective relationships with call center departments through clear communication, fostering improved cross-team collaboration
Support Specialist
CollaborateMD
Orlando
01.2012 - 07.2012
- Accommodated unusual customer requests by making procedure exceptions, improving client satisfaction
- Resolved claims rejections, eligibility issues, and software support inquiries through collaboration with managers, billing specialists, and clearinghouse
- Mastered customer service call script within specified timeframes, delivering consistent service quality
Payroll and Benefits Specialist
Professional Employer Resources
Maitland
12.2010 - 01.2012
- Reconciled insurance billing with reports on a monthly basis, ensuring accurate financial records
- Submitted applications online to insurance companies for clients (Health, Dental, VSP, Life, AFLAC, STD, and LTD), expediting enrollment
- Assisted clients and employees with insurance inquiries, delivering timely and accurate information to resolve concerns
- Prepared and maintained worker's compensation files, ensuring compliance with necessary documentation and case number tracking
- Participated in worker's compensation claims review and management meetings, facilitating informed decision-making
- Prepared workers' compensation certificates for existing and new clients when needed, ensuring regulatory compliance
Office Administrator
Hanger Prosthetics and Orthotics
Orlando
03.2010 - 12.2010
- Managed bookkeeping for patient accounts, processed deposits, maintained office records in QuickBooks and insurance policies to support financial accuracy
- Coordinated with insurance companies, including commercial and government entities, to facilitate timely claim processing and minimize delays
- Scheduled practitioners and patients across 2 locations, optimizing appointment flow to enhance patient access and service delivery
Benefits Specialist
AHS Benefits Service Center / Florida Hospital
Altamonte Springs
11.2007 - 03.2010
- Explained benefits and compensation to all Florida Hospital employees, including doctors, nurses, administration, custodians, and hospitality staff, improving understanding
- Educated Florida Hospital employees, including doctors, nurses, administration, custodians, and hospitality staff, on benefits and compensation, enhancing overall understanding
- Managed reporting and reimbursement processes for all employees' Flexible Spending Accounts, ensuring timely payments and compliance
- Processed medical billing and coding for payment approval determination, minimizing claim denials
Claims Analyst
Hannover Life Reassurance
Orlando
11.2006 - 11.2007
- Managed insurance company accounts for payment using PSF-1, ensuring timely processing
- Oversaw medical contestable claims through thorough policy compliance review, minimizing risk
- Collaborated with Underwriting Department for final claim approvals, expediting client resolution
Education
High school diploma -
Skills
- Claims processing
- Medical claims submission
- Pre-authorization review
- Insurance prior authorization
- Electronic health record (EHR) management
- EMR systems
- Medical coding
- Insurance policy analysis
- Epic
Additional Information
Authorized to work in the US for any employer
Timeline
Charge Entry Specialist
HCA
12.2022 - 07.2026
Medical Billing Specialist
COLORADO HEART AND VASCULAR, PC
08.2019 - 08.2022
Customer Service Specialist
Anthem, Inc.
02.2017 - 06.2019
Insurance Specialist
OrthoFi
01.2016 - 02.2017
Customer Service Representative
Delta Dental of Colorado
07.2015 - 01.2016
Benefits Specialist
Biologics, Inc.
12.2014 - 07.2015
Reimbursement Specialist
Express Scripts
07.2012 - 12.2014
Support Specialist
CollaborateMD
01.2012 - 07.2012
Payroll and Benefits Specialist
Professional Employer Resources
12.2010 - 01.2012
Office Administrator
Hanger Prosthetics and Orthotics
03.2010 - 12.2010
Benefits Specialist
AHS Benefits Service Center / Florida Hospital
11.2007 - 03.2010
Claims Analyst
Hannover Life Reassurance
11.2006 - 11.2007