Scott McLeod is seeking a position in insurance or medical claims processing with over 19 years of experience processing various types of medical claims including workers compensation, Medicare, Medicaid, and commercial insurance. He has extensive experience with EDI processing, claims examining, adjusting, and researching as well as managing provider contracts and understanding various coding systems. The resume provides a detailed employment history of his medical claims and billing roles with various insurance companies and healthcare providers.

1. 10708 North Nebraska Ave. # 7, Tampa, Florida. 33612
Telephone: 813-337-9040
Email SCOTTLMCLEOD@YAHOO.COM or SLEEMCLEOD@GMAIL.COM
SCOTT L. MCLEOD
Objective:
To secure an employment position for advancement in the Insurance and Medical Healthcare Claims Processing fields.
To advance in Medical Claims Examining, Medical and Insurance Billing or other areas of employment.
Summary of Qualifications:
Extensive background in Medical Insurance Claims and Healthcare Management. 19 years experience in Medical
Claims, EDI, Claims Examining and Adjusting. EDI Processing, Configuration, Knowledge of Managed Care,
Workman’s Compensation, Medicaid claims field and Knowledge of Workman’s Compensation stat mandate laws,
HIPAA, and Medical re-pricing and reviewing. Validate Claims information. Loss Time, Pharmacy Processing, DME,
Familiar with CPT codes ICD-9, HMO, Networks, HCFA 1500 forms, Team Leader Skills. Etc ..
Special Skills:
EDI Processing, Claims Processing, EOB Research Data Entry Indexing Spreadsheet reviewing Configuration,
Provider Contracts, Medical Terminology , Re-pricing / Fee Scheduling, Workman’s Comp. Claims Managed Care
Claims Fraud Determination Review Duplicates Provider Contracts
Professional Experience:
08/2012- 05/2013 WellCare Healthplans Tampa, Florida.
Claims Specialist
Process Claims, Provider Hospital and Physicians medical billing. EDI Processing, Medicare, Medicaid, Work Comp
and Commercial. Configurations, Investigating and determining authorizations on cover items. Paying claims based on
per contract with each individual provider. Pay per contract allowance. Reviewing contracts on cost per medical
services and treatments. Proper Revenue Codes, CPT Codes, EOB’s, ICD-9, Etc. Investigate and research for
duplicate billings per itemizations. Medical and Hospital Claims UB04 and HCFA 1500 forms. Investigate
overpayments from previous accounts. In charge of Special Projects .Loss Time Verification, Verify all information on
claim before paying or denying claim. (Position was eliminated)
08/2007 – 06/2012 Coventry Healthcare Work Comp Service Center Tampa, Florida.
Technical Claims Specialist
Processes paper claims and electronic work queues, including complex HCFA 1500 and UB04, in accordance with
company policies and procedures. Interprets and processes difficult adjustments in accordance with company policies
and procedures. Reviews basic pended claims to determine the appropriateness of the claim status and takes
necessary action based on status. Researches issues, compiles feedback and drafts corresponding business
requirements documents and business decision documents as needed. (Laid-off)
10/2006 – 02/2007 Tampa Bay Endoscopy Outpatient Center Tampa, Florida.
Medical Billing Patient Monthly Statements for Self Pay, Work Comp, Managed Care, Printing statements. Printing
HCFAs and UB92 Forms. Patient Account Research. Medical terminology, CPT, ICD9, Authorizations, Timely filings,
Assisting Office Director, File Room responsibilities, managed Care, Medicaid, 2nd
and 3rd
party billing. A/R Accounts,
Billing by paper and EDI. Verify patient information. Multi-task duties. (Seasonal work)
07/2004 – 03/2006 Amerigroup Community Care Tampa, Florida.
Claims Analyst III
Research and make benefit determinations for the processing or medical and hospital claims according to contractual
and processing guidelines. Identify and communicate claims processing, Maintain production and quality in
accordance with the departmental standards. Attend and participate in team/training meetings as needed. Organize
and handle individual workload to ensure that all new work and pended are processed basis. Contribute to the overall
success and attainment of team goals by assisting with special projects and working overtime when needed. Coding
and medical terminology. Work in a production and quality oriented environment. EDI. Configuration. (Laid off)
10/2002 – 06/2004 Teamhealth Healthcare, Tampa, Florida.
Insurance Biller / Collections
Medical billing and collections. Claims analyst, EDI Processing, Configurations, Work Comp claims, insurance biller.
2
nd
and 3
rd
party billing. Printing claims to paper on HCFA 1500 forms. Training new employees. Assistant office
manager. Researching past due accounts. Capitations. Authorizations. Loss time verification.

2. ( Page 2 of 2 )
09/2001- 04/2002 WellCare Inc. 6800 N. Dale Mabry Tampa, Florida.
Claims Specialist
Process Claims, Provider Hospital and Physicians medical billing. EDI Processing, Medicare, Medicaid, Work Comp
and Commercial. Configurations, Investigating and determining authorizations on cover items. Paying claims based on
per contract with each individual provider. Pay per contract allowance. Reviewing contracts on cost per medical
services and treatments. Proper Revenue Codes, CPT Codes, EOB’s, ICD-9, Etc. Investigate and research for
duplicate billings per itemizations. Medical and Hospital Claims UB04 and HCFA 1500 forms. Investigate
overpayments from previous accounts. In charge of Special Projects. Verify all information on claim before paying or
denying claim. (laid off)
05/2000 – 06/2001 Florida Claims Solutions / Health Plan Services Tampa, Florida.
Claims Specialist
Reviewing and Processing medical claims EDI Processing, Pay Claims. Verify all information on claims, check for any
duplicate billings. Reviewing contracts on cost of medical services. Check for duplicate billings per itemization. To
verify if provider is in our networks. Check for according to contract coverage. Check for overpayments of previous
accounts. Medical and Hospital claims. UB04 and HCFA 1500 forms. Claims Automation Specialist. Pediatric,
OB/GYN. In charge of Special Projects. Resolving Claim issues. Loss Time Verification. (Laid off
02/1997 – 08/1998 Pediatric HealthcareAlliance Tampa, Florida.
Insurance Biller / Collections
Medical billing and collections. Claims analyst, insurance biller. 2nd and 3rd party billing. Printing claims to paper on
HCFA 1500 forms. Training new employees. Assistant office manager. Researching past due accounts. Capitations.
Authorizations. Training, HMOs, PPOs, Policy interpretation. Reviewing insurance coverage and contracts. Data
Entry. Multiple tasks. Checking patient's information. Using Medical Manager systems. (laid off)
1995 - 1997 Genex Insurance Services / on-site Alexsis Insurance Tampa, Florida.
Medical Bill Reviewer,
Workman's Compensation medical claims health insurance examiner, Configurations, EDI Processing, Data Entry of
medical physician and hospital claims to be certain it is workman's compensation related. Check all information on
claims to be sure of any corrections to be made. Entering data from systems billing, send back denied claims to
providers for any more information or corrections. Using state mandates to re-price, fee schedule claims. Search for
any duplications on incoming claims. Verify all information to be on the proper forms. Knowledge of medical
terminology such as CPT codes, ICD-9, PPO, EOMB's, HCFA 1500 forms. UB-92 forms. Team lead over special
projects. Administrative assistant, enter medical coding on IDX systems, processed incoming and outgoing mails and
claims. FED-EX, UPS, Postal Service Faxing, Training of new employees, multiple tasks. (Laid off)
Education:
1991, Seminole Technical Education, Tampa, Florida
High School Diploma
Computer Skills, Software, Etc:
Microsoft Office 2000, Office XP, Outlook, Excel, WordPerfect, Access, PowerPoint, MS Word, Windows Explorer,
Etc. Medical Manager systems, Diamond, Crystal, SMS, SDI, SSI, Citrix, Excelys, Facets, and more.
Skills:
Medical Terminology, CPT, ICD9, Rev. Codes, HCFA CMS 1500 forms and UB04 Claim Forms.
Revised 2015