Sam McClelland
Billing/Denial Specialist at Healthrise- Claim this Profile
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Topline Score
Bio
Credentials
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Security +
CompTIAOct, 2010- Nov, 2024
Experience
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Healthrise
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United States
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Financial Services
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1 - 100 Employee
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Billing/Denial Specialist
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Feb 2021 - Present
• Consistently meet and/or exceed company quotas. • Analyze large amounts of confidential data to determine medical insurance payments. • Record information correctly and quickly regarding claim status. • Work closely with insurance companies, hospitals, physicians, and patients to resolve insurance claims. • Consistently meet and/or exceed company quotas. • Analyze large amounts of confidential data to determine medical insurance payments. • Record information correctly and quickly regarding claim status. • Work closely with insurance companies, hospitals, physicians, and patients to resolve insurance claims.
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SLUCare
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Greater St. Louis Area
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Application System Analyst (Revenue Cycle Department)
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Aug 2017 - Mar 2019
• Created and maintained claim edits utilizing SQL queries. • Generated data reports daily from SLU/SSM interface and insurance crosswalk error reports. • Utilized Epic Ambulatory System. • Created and maintained claim edits utilizing SQL queries. • Generated data reports daily from SLU/SSM interface and insurance crosswalk error reports. • Utilized Epic Ambulatory System.
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MMY Consulting
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United States
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Information Technology & Services
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1 - 100 Employee
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Subcontractor
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Mar 2017 - Apr 2017
Creating Progress notes, OP Note and discharge notes in the Epic HIM TST system to be used as part of training for the end users demo Creating live patient charts in the Epic HIM and Ambulatory TST system for HIM training classes Creating Progress notes, OP Note and discharge notes in the Epic HIM TST system to be used as part of training for the end users demo Creating live patient charts in the Epic HIM and Ambulatory TST system for HIM training classes
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MMY Consulting
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United States
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Information Technology & Services
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1 - 100 Employee
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Senior Health Care Consultant
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Feb 2014 - Jan 2016
• Implemented and supported the ICD-10 program to update a large hospital system. • Established testing scripts to support end-to-end and integrated testing efforts for ICD-10 project implementation. • Updated the workflow process by implementing Best Practices. • Tested software on different payors by submitting claims in order to ensure the ICD-10 codes flowed into the payor’s systems. • Implemented and supported the ICD-10 program to update a large hospital system. • Established testing scripts to support end-to-end and integrated testing efforts for ICD-10 project implementation. • Updated the workflow process by implementing Best Practices. • Tested software on different payors by submitting claims in order to ensure the ICD-10 codes flowed into the payor’s systems.
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SSM Health
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United States
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Hospitals and Health Care
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700 & Above Employee
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ADT/Prelude Epic Product Specialist
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Feb 2010 - Feb 2014
.Part of a team that supported McKesson/STAR while assisting in build , test and go-live support for phases II of EPIC within the SSM network. . I have been involved in validation/build sessions with the SSM network-wide. Interact with end user and other IS entity staff to identify user needs and provide solutions, conjunction with SSMIHT staff, as needed. Respond to user problems in a timely and professional manner including follow-through and careful monitoring of the issue until the issue is resolved.. EPIC certificated for ADT/Prelude in April 2011 and completed NVT 2010 March 2012. Show less
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Information System Analyst
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Sep 2008 - Feb 2011
Major accountable: Interact with end user and other IS entity staff to identify user needs and provide solutions, conjunction with SSMIHT staff, as needed. Respond to user problems in a timely and professional manner including follow-through and careful monitoring of the issue until the issue is resolved. Perform configuration, maintenance, training contents, upgrades and enhancement testing for McKesson/STAR including the financial and clinic environments. Perform troubleshooting and resolution of issue while refining application workflows to maximize efficiency. Also, serve as liaison between the SSM Integrated Health Technologies and the entity to communicate project status through the revenue cycle. Support Medicare Passport Common Working Files include set up, training, trouble shoot issues for end users including password resets and re-activation of security Access Id's for two hundred user throughout all seven facilities of SSM Health Care. Support other applications, Compass, Care Ready, Search America, DataServ and Stockamp's Tools. Also working on self training on the Clinical environment processes with McKesson STAR package. My added responsible is Boston Script monitoring for the revenue cycle. I troubleshooting and resolve issues with current scripts. Show less
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Government Biller/Collector
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Sep 2007 - Sep 2008
Major accountable: Correct and bill MSP claims for six SSM facilities, work VA follow-up for six SSM facilities. Also work a compass report including all SSM facilities for IME/No Pay claims as well as the VA aging compass report. I am responsible to work projects, back up other Billers. Back-up the SSI desk which responsible of making sure all claims from all facilities download from the night before Included billing primary, secondary electronic claims for all SSM facilities.Back-up all billers on the commercial side and help secondary billers with any back log of work and voluntary to work any special projects for our department. Trouble shoots errors to send out clean claims to the payors. Show less
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Medical Biller
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Nov 2005 - Sep 2008
Major accountable: Correct failed claims and electronic claim errors.Work electronic commercial denials from the clearing house which involves using our resources from websites, Dataserv, calling insurance companies and patients to option correct insurance information or to find termination of insurance.Responsible for IME billing for DePaul Hospital worked an unpaid report which was researching accounts looking for the reasons for no payment.Back-up the SSI desk which responsible of making sure all claims from all facilities download from the night before. Also, included billing primary; secondary electronic claims for all SSM facilities. Back-up all billers on the commercial side and help secondary billers with any back log of work and voluntary to work any special projects for our department.Also on H*works Correct Payment Team which involved researching projects, planning and organizing training classes for the CBO staff .Also responsible for the marketing of our team training classes. Received special Team Work Certificate from H*Works team. Show less
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A/R Specialist
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Mar 2005 - Sep 2005
Major accountable: Investigate and resolve any denials or outstanding balances on medical claims. Follow up with insurance carriers and patients by phone, correspondence. Also was responsible for aging reports and appeals. Major accountable: Investigate and resolve any denials or outstanding balances on medical claims. Follow up with insurance carriers and patients by phone, correspondence. Also was responsible for aging reports and appeals.
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Receptionist/Biller
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Jan 2005 - Mar 2005
Major accountable: Greeted patients, scheduled appointments. Edited charts, collected co-pays, Answered phones Major accountable: Greeted patients, scheduled appointments. Edited charts, collected co-pays, Answered phones
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Claim Representative
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Jul 2004 - Jan 2005
Major accountable: Researched claims with outstanding balances. Responsible for contacting insurance companies and patients requesting information needed to resolve the unpaid balance. 160-hourExternship Major accountable: Researched claims with outstanding balances. Responsible for contacting insurance companies and patients requesting information needed to resolve the unpaid balance. 160-hourExternship
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Internship
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May 2004 - Aug 2004
Major accountable: Greeted patients, collected co-pays and filed charts and posted charges. Made appointments, answered phones. Major accountable: Greeted patients, collected co-pays and filed charts and posted charges. Made appointments, answered phones.
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Education
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2018 - 2019
Maryville University of Saint Louis
Master's degree, Cyber Security -
2008 - 2010
Webster University
BA, Healthcare Administration -
1992 - 1995
Jefferson College
Associate, Hotel/Restaurant Management
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