# Melissa Buchanan

Melissa Buchanan is a remote worker on Himalayas, Claim Representative/Appeal Specialist at Roundstone/Bywater, based in United States.

Source: https://himalayas.app/@melissabuchanan1

```text
Claim Representative at Roundstone/Bywater handling claim settlements, appeals, denials, and payment inquiries.
```

| Detail | Value |
| --- | --- |
| Availability | Looking for a job |
| Location | United States |
| Authorized to work in | United States |
| Salary expectations | 60k+ USD |
| Job categories | Claims Representative, Appeals Specialist, Billing Specialist |
| Skills | Insurance Claims Processing, Claims Settlement, Insurance Appeals, Denials, Claims Auditing, Grievance Resolution, Revenue Cycle Management, Insurance Verification, Payment Posting, Claims Submission, Claim Correction And Resubmission, Process Improvement, Microsoft Office, Excel, Microsoft Word |
| LinkedIn | https://linkedin.com/in/melissa-buchanan |

## About

```text
At Roundstone/Bywater, I evaluate insurance claims, determine coverage and compensation, negotiate settlements, and authorize payments. I also respond to insurance and patient inquiries and handle claim denials, rejections, and resubmissions.

My experience includes claim work at Performance Health and appeals at Medical Mutual/Mutual Health Services, as well as revenue cycle billing at Saber Health Group. At Saber Health Group, I created and assisted with implementing processing procedures that improved time management by 25%; at Performance Health, procedures I created and helped implement improved turnaround time by 45%.
```

## Experience

### Claim Representative/Appeal Specialist (current)

Roundstone/Bywater. Feb 2024 - Present

```text
Settled insurance claims by evaluating facts, negotiating settlements, and authorizing payments. Responded to inquiries, handled denials, and pursued past due payments.
```

Skills: Claim-Processing, Negotiation, Insurance-Denials, Appeals, Payment-Posting, Customer-Service

### Revenue Cycle Billing Specialist

Saber Health Group. Jan 2022 - Dec 2022

```text
Verified insurance coverage, prepared and submitted medical claims, posted payments, and reviewed accounts for bad debt. Created procedures that improved time management by 25%.
```

Skills: Medical-Billing, Insurance-Verification, Claims-Submission, Payment-Posting, Denial-Management, Process-Improvement

### Claim Representative

Performance Health. Sep 2016 - Dec 2021

```text
Settled insurance claims by evaluating facts, negotiating settlements, and authorizing payments. Created procedures that improved turnaround time by 45%.
```

Skills: Claim-Processing, Negotiation, Insurance-Claims, Process-Improvement

### Appeals Specialist

Medical Mutual/Mutual Health Services. Apr 2006 - Feb 2016

```text
Responded to insurance and patient inquiries, analyzed past due payments, and handled denials and resubmissions. Referred questionable claims to outside agencies for review.
```

Skills: Appeals, Insurance-Denials, Claim-Correction-And-Resubmission, Customer-Service, Payments-Analysis

## Education

### Strongsville High School

Diploma, General Studies

```text
Earned a high school diploma from Strongsville High School.
```

### Bryant & Stratton College

Associate of Science, Business Administration

```text
Studied Business Administration at Bryant & Stratton College.
```

## Tech stack

- Microsoft Excel
- Microsoft Word
- Microsoft Office

To contact Melissa, message them from this profile with a Himalayas employer account: [Hire on Himalayas](https://himalayas.app/hire).

## People also viewed

- [Homeslice213 User](https://himalayas.app/@homeslice213user): Care Coordinator, Quantum Health
- [Kim’E Kim](https://himalayas.app/@kimekim): Provider Payment Reconsideration Analyst II, Anthem, Inc.
- [Erica Jones](https://himalayas.app/@ericajones): Patient Financial Counselor, Guthrie Hospital
- [Alena Alexandre](https://himalayas.app/@alenaalexandre): Medical Claims Resolution Specialist, Convergent Revenue Cycle Management
- [Karine Saintvil](https://himalayas.app/@karinesaintvil): Denial Analyst, Revecore
- [Brittney Janajreh](https://himalayas.app/@brittneyjanajreh): Senior Claims Examiner, United Health Care
- [Shannon Parker](https://himalayas.app/@shannonparker1): Senior Claims Representative, Quest Diagnostics
- [Dodie Minor](https://himalayas.app/@dodieminor): NICU Care Management Operations Admin II / Clinical Care Coordinator, UHG / Alere Health
- [Samantha Hill](https://himalayas.app/@samanthahill): Customer Service Associate, NTT DATA
- [Ieisha Dyer](https://himalayas.app/@ieishadyer): Workers' Compensation Claims Representative I, Selective Insurance