1. Junelle M. Velez-Adams
1709 Lullwater Lane
Lutz FL. 33549
adamsjunelle@yahoo.com
813-388-6521
Professional Skills
 Proficient with Medical billing, Medical Coding
 Worker Compensation Claims
 Proficient in data-entry procedures
 Highly motivated and experienced in customer service
 Strong experience in Medicare and Medicaid Claims processing, Claims Auditing,
Provider Contracts.
 Thrive in deadline-driven environments.
 Proficient in MS Office Excel, Word, Access, Outlook
 Flexible, Poised, Competent & Versatile
 Provider Contract
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 Claims Processing
 Fee Schedule
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 Members Eligibility
 Medical Insurance
Auditing
 Medical
Terminology
 Insurance Billing
State Specific
Guidelines
 Appeals
 Correspondence
 COB’s
 Patient Medical
Records
 ICD-9-CM
 ICD-10-CM
 HCPCS
 CPT
 CMS-1500
 UB-92
 CMS
 Webstrat
Profile
Seeking a position that will encourage personal and professional growth and expand
on skills developed in medical office administration. Highly motivated and experienced
in customer service. Knowledgeable with Medical billing, Medical Coding and proficient
in data-entry procedures. Medicare and Medicaid Claims processing. Auditing provider
contracts and institutional and professional claims. Worker Compensation claims CMS,
WebStrat.
Professional Experience
USF Health, Tampa FL March 2015
Data Technician
Responsible for the maintenance of GE HealthCare dictionaries for BAR, PCS, TWScan
and EWS applications. Maintains Payer Contract Module and Pricing Module fee
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2. schedules. Revises and creates encounter forms, department request forms, updates the
policy and procedure manuals and work dictionary related claim errors in the Enterprise
Task Manager. Creates and downloads dictionaries and current fee schedules into Excel
spreadsheets for Revenue Cycle, Finance & Accounting and Clinical Operations staff.
Creates rules and reference contracts annually for Medicare and Medicaid. Reviews and
analyzes procedure codes using Excel spreadsheets to determine special characteristics
which require the completion of customized fields designed for proper claim submission
and entry accuracy. Reviews the procedure code categories to match the CPT & HCPCS
books on an annual basis. Responsible for working and resolving the ETM System
Support dictionary related claim errors captured in the ETM view on a daily basis.
Assists in all upcoming GE HealthCare upgrades. Participates in system testing related to
upgrades, enhancement or changes made through requests, needs or requirements.
Travelers Insurance, Tampa FL FEB. 2014 –FEB.2015
Insurance Claims Processor Level II (subject matter expert)
SME over 20 contractor workers. Track daily production numbers. Processes worker
compensation claims on the medical review team. Receives professional and institutional
claims, reviewing, researching, and investigating state specific guidelines by processing,
and pricing, medical, Pharmaceutical, Durable Medical, Supplies and Materials, PT/OT,
Chiropractic.
Freedom Healthcare, Tampa FL Dec. 2012 – Nov. 2013
Configuration Analyst
Configures provider demographics, billing information and payment information in claim
system Configures, tests and documents configuration solutions for the following
functions, processes institutional and professional claims hold codes. Keeps providers
contracts up to date with departmental and corporate policies and procedures. Creates
updates procedure codes, price rules, fee schedules.
WellCare Health Plans, Tampa FL June 2006 – June 2012
Operations Auditor Fin-Audit & Recovery, Jan 2010 – June 2012
Verify and ensure appropriateness and accuracy of departmental processes and
compliance with CMS and state specific guidelines. By reviewing, researching,
investigating, auditing institutional and professional claims processing, pricing,
configuration provider contract loads, members eligibility, enrollment Analyze and
reports any errors found
Configuration Fee Schedules Specialist, July 2008 – Jan 2010
Analyze audit reports, assists in resolving critical errors, loads updates to procedural
codes, research each state's Medicare and Medicaid websites for updates, updates tracking
database, measures progress and evaluates results and reprioritizes as appropriate, takes
ownership for achieving results and meeting deadlines. Loads provider contracts.
Claims Specialist, June 2006 – July 2008
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3. Processes professional and institutional claims, resolves provider issues, researches pended
claims and takes appropriate action to resolve within turnaround time requirements and
quality standards, instrumental in training new employees, analyze provider reports,
provides customers with relevant and accurate information to make informed decisions,
proactively anticipates customers needs and recommends value-added solutions.
Concorde Career Institute Tampa FL, Jan 2005 – June 2006
Coding and Billing
Trained as a subject matter specialist to use accurate ICD-9-CM, ICD-10-CM, CPT,
HCPCS information and standardized codes. Non paid internship job training at local
doctor offices. Processing payments, Insurance Verification, Appointment setting.
Ashburn Family Clinic, Ashburn VA, April 2001 – Jan 2005
Worked back office Insurance Verification, Medical referrals, charge payment
information, Accts payable, Expense reports, general clerical duties.
Education
2005-2006 Concorde Career Institute, Tampa FL
1997 Brewster Technical Center, Tampa FL
1991 Gaither High School, Tampa FL
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