1. Kristi-Rae Garon
43 Andover Rd • Billerica, MA 01821 • 978.996.5252
Experience:
Boston MedFlight, Bedford, MA
Medical Coder/MATRIS Data Analyst January 2016 to Present
• Monitors and reviews daily flow of patient records reporting any discrepancies.
• Reviews and adjusts appropriate HCPCS classification of ambulance trip.
• Performs ICD-10 Medical coding of all ambulance trips with verification for billing.
• Reviews reports daily and weekly to ensure all trips are daily entered into the Massachusetts (DPH) Ambulance Trip
Record
Information System (MATRIS)
• Responsible for daily data entry in to the MATRIS system of current ambulance trip.
• Trained and supervises a data entry clerk responsible for supplemental MATRIS entries.
• Provides weekly, monthly, quarterly and annually any status updates.
• Solitary trainer for the Billing department.
Senior Billing Specialist April 2008 to January 2016
• Performs daily demographic patient registration.
• Assists in bi-weekly claims production for all insurance companies and self pay invoices.
• Fields in-going and out-going phone calls to patients regarding account status and calls to major insurance carriers
for claim status and resolutions.
• Constructs appeals to major insurance carriers for underpayments, inaccurate denials and for other billing issues
with continued success in receiving additional funds.
• Successfully recovered reimbursements due to the organization on “cold case” appeals that were over 2 years old.
• Occasionally coordinates with Case Managers at insurance companies the prior authorization requests for scheduled
air transports.
• Posts payments to accounts; including contractual allowances and secondary payer charges.
• Prepares necessary refunds for review of the Billing Manager.
• Performs the daily deposit for the entire organization electronically through Bank of America and interacts with the
staff accountant to relay accurate deposit information.
• Assists HIPAA trading partners with demographic info upon request.
• Responsible for quarterly collection status reviews to then be sent to collection agency.
• Perform clinical chart reviews on Medical Records following coding guidelines as established by the Center for
Medicare and Medicaid Services (CMS).
• Reviews the complete electronic and paper medical record of patients.
• Previously Assigned ICD-9-CM diagnosis and procedure codes from documentation in the medical record and
currently assist when needed.
Massachusetts Laborer’s Benefits Funds, Burlington, MA
Medical Claims Examiner April 2007 to April 2008
• Process 300 to 350 electronic medical claims daily that come in from Blue Cross and Blue Shield.
• Process 20 to 25 paper claims that must be manually entered into the system on a daily basis.
• Fluent in common medical CPT and HCPC codes as well as ICD-9 codes and proficient in obtaining proper codes to
process claims correctly.
• Sole claims examiner to process COB claims (coordination of benefit) daily.
• Investigate and identify trends in rejected claims from BC/BS and correct when necessary.
• Correspond with BC/BS on troubled claims to help resolve aged claims.
• Correspond with “Wellness Corporation” when needed to obtain proper authorizations for our member’s services.
• Correspond with members via mail or phone when they have issues with any claims that may have been denied.
2. Kristi-Rae Garon Page 2
Schott Solar, Inc, Billerica, MA
Human Resources Administrative Assistant July 2005 to July 2006
• Fielded phone calls from domestic and international clients.
• Assisted the Payroll Department with filing, organizing and producing bi-weekly time cards. ⋅
• Assisted the Human Resources Department with filing and reviewing monthly health insurance bills.
• Coordinate the company annual outing and promotional products for the company.
• Responsible for keeping schedules for multiple conference rooms.
• Researched, organized and chaired the company health program, and developed healthy programs for employees in the
Rocklin CA, Elmsford NY, and Southbridge MA facilities.
• Developed a color ad for charity programs.
• Developed and edited the corporate newsletter.
• Managed first line security and kept running logs of visitors to the facility.
Tufts Associated Health Plan, Watertown, MA
Member Specialist May 2004 to July 2005
• Received and responded to a high volume of incoming telephone calls from members, prospective members, non-English
speaking members, employers, and internal staff.
• Provided orientation regarding HMO, POS and PPO benefits, eligibility and enrollment policies and procedures.
• Interacted with other key departmental staff.
• Responsible for the Explanation of Benefits for members and employers, including COBRA coverage.
• Effectively and accurately interpreted, responded, and resolved customer inquiries and concerns.
• Possessed thorough knowledge of the claims processes, enrollment policies and benefits.
• Managed claims processes, including investigating and adjusting claims, explanation of claim denials, medical authorizations
and referral processes, and resolving enrollment and/or eligibility issues.
• Explained and interpreted state and federal mandates including HIPAA and Appeals and Grievance processes.
• Demonstrated extensive product knowledge to support specialty queues and/or dedicated employer queues.
• Responsible for resolution of customer inquiries, the facilitation of problem resolution, and acting as a member advocate by
meeting or exceeding customers’ expectations.
Tufts Associated Health Plan, Watertown, MA
Team Leader (formerly Customer Relations and Resource Coordinator) July 1996 to June 1998
• Assisted and worked in conjunction with the team supervisor to manage a group of 17 employees; helped to create, maintain,
and enhance procedures.
• Handled escalated calls from members and /or providers and resolve issues at point of contact.
• Prepared documents for review by the Tufts Quality Assurance board; devised notification to members and providers
summarizing investigated issues.
• Performed claim adjustments for 5 to 6 representatives in addition to answering internal queues.
• Assumed control of complex issues – researched; documented and took action to rectify issues.
• Identified call trends and claim issues.
• Acted as a role model and a source of information and support for new employees.
• Answered benefit and claim inquiries from employer groups, members, and providers; and documented all interaction.
• Multi-tasked between applications to locate and retrieve relevant customer information.
Education:
• Middlesex Community College, Bedford, MA - Associates Degree, Criminal Justice - GPA 3.30, Dean’s List
• Middlesex Community College, Bedford, MA - Medical Lab Assisting - GPA 4.0
• Middlesex Community College, Bedford, MA/ ED2GO- Certified Billing and Coding Specialist W/Medical Terminology
Studies- Certificate
• Boston University, Boston, MA- Emergency Medical Technician - Certificate
Computer Skills:
Skills include: Windows platforms including 10, Microsoft Word, Excel, Macess, Reflections, Lotus Notes, ADP, Zoll RescueNet, Optum
Encoder Pro Expert coding software, TeleScan Check Scan system linked with Bank of America.
Other interests:
Former Billerica DARE Committee member; Appointed by Town Manager Richard Montouri, Former Billerica Town Meeting member,
