1. Mary E. Gilliam
Chattanooga, TN 37411
Phone: 423-629-5507
Alt: 423-488-7133
marygilliam@epbfi.com
October 13, 2015
To: Whom it may Concern
It is with great enthusiasm to submit my resume for the position within your company.
I am a self-motivated person with excellent interpersonal skills as well as a high standard
of Professional ethics. My strengths are problem solving, research, and resolutions. I
enclosed my resume as the first step in exploring opportunities of becoming a part of
your organization.
My current occupation is Complex Claim Coordinator/ Medical Claims. This position has
allowed me to enhance my skills with auditing accounts and direct billing procedures and
Claim investigative techniques. Other pertinent responsibilities include resolving
complex claims issues; I have excellent exceptional customer service abilities in regards
to providing informative solutions for customers, clients and healthcare professional via
phone or email.
Creative problem solving, critical thinking, empathy and passive listening skills are
essential in this field. My professional interaction allows me the ability to provide
accurate responses to customer inquiries and utilize computer-based resources’ to educate
and respond accurately, along with in innate ability to be compassionate and empathetic
when appropriate when handling complex customers.
. It would be a pleasure to further develop these skills to help fulfill the needs of your
organization.
Thanks in advance for investing your time to review the skills and talents highlighted in
this letter and in my resume. I would very much like to meet with you to discuss how
well my qualifications align with your hiring needs for this position. Thank you for your
consideration and I hope to hear from you soon. Please feel free to contact me via phone
or email.
Sincerely,
Mrs. Mary Gilliam

2. REMOTE, TELECOMMUNITE, OR VIRTUAL
Mary E. Gilliam
Chattanooga, TN 37411
423-629-5507 (Home) (423) 488-7133 (cell)
marygilliam@epbfi.com
Summary of Qualifications
• Dedicated Professional with more than 10 years in Medical Insurance and Administration
experience. Medical Claims Adjuster Unum for several years’ Extensive knowledge in Claims,
Customer Service, Testing, Audit reporting, & Appeals.
• Excellent human relations skills due to dealing with an array of providers, customers, and
employees.
• Computer proficient with Microsoft Excel, Word, Access, Windows Applications, IDX system.
McKesson, Cisco and Meditech & Sage, Invision, Citrix, WGS, Navinet Healthfusion, Intellisys,
Cloud.
• Expert knowledge of the procedures of investigating and resolving fraudulent information from
claims, discrepancies of members plan , and office documentation and medical billing
• Proficient in Medical Terminology, CPT codes, Revenue and Diagnosis codes
• Superior ability to achieve immediate and long-term goals , excellent leadership skills
• Exceptional customer service abilities, Creative problem solving, critical thinking, empathy and
passive listening skills. Ability to analyze, plan, excellent research, problem solving and
investigative skills .Able to manage multiple projects and tasks.
• Solid data entry skills with accuracy and knowledge of claim payment system with UNUM
Insurance as a Medical Claims Examiner for several years. As well as Accounts receivable
collections experience. Denials and adjustments. Excellent Customer Services skills. Self
motivated, hardworking, productive, quick learner, honest & knowledgeable.
Work Experience
• Research complex claims for Commercial, Medicare and Medicaid Insurance carriers.
Exceptional investigative skills, regarding fraudulent billing, claims
• Research and follow-upon complex claim issues, filing Appeals. Work with Providers regarding
proper medical documentation and necessary billing forms needed for CMS and other carriers,
needed for proof of accurate plan of treatment.
• Interact with patient regarding types of insurance and personal information to process medical
claims correctly. Obtain percerts and authorizations. Medical Claims Adjuster/ UNUM for
several years.
Neurosurgical & Spine of Chattanooga, Chattanooga TN November 2013 to Present
Medical Claims Insurance Billing Specialist
• Investigate and research complex claims for billing errors and resolve them in timely manner.
• Claims Examiner experience, Also Billing of UB04 and HCFA 1500
• Previous claims billing and insurance follow experience with Medicare, Commercial, and
Medicaid carriers. Verifying cpt coding errors, such as Diagnosis & modifiers. Correspond with

3. various insurance agencies and providers regarding billing and CPT, ICD 9 coding of Medical
claims for Commercial, Medicaid and Medicare plans. Extensive knowledge of filing Medical
Appeals and Electronic claim filing.
• Resolve reimbursement & denial discrepancies discovered during Monthly Audit and reports.
• Prepare and monitor Appeals, Manage Account Receivable daily, audits and claims follow up;
posting denial and payment:
• Excellent experience and knowledge in all aspect of Medicaid, Tenncare and Managed Care plans
and CMS Medicare.
• Obtain precertification or authorization for surgical procedures, MRI, and ESI.
University Surgical Associates, Chattanooga, TN January 2000 - October 2013
Claims Coordinator / Insurance Follow-up Medical Billing/ Customer Service
• Investigate and research complex claims issues and resolve them in timely manner.
• Monitor claims payment resolution regarding fee schedules compliance.
• Obtain Precertification and or Authorizations for inpatient, outpatient procedures.
• Review medical claims for workers compensation and or private carriers. Verifying cpt coding
errors, such as Diagnosis & modifiers both on HCF 1500 OR UB04 claims. Correspond with
various insurance agencies and providers regarding billing CPT, ICD 9 & RVU coding of Medical
claims for Commercial, Medicaid and Medicare plans. Extensive knowledge of filing Medical
Appeals and Electronic claim filing.
• Interact with certified coders and insurance carriers to resolve reimbursement & denial
discrepancies discovered during Monthly Audit and reports.
• Prepare and monitor Appeals for high dollar claims
• Excellent experience and knowledge in all aspect of Medicaid, Tenncare and Managed Care plans.
• Manage Account Receivable daily, audits and claims follow up; posting denial and payment:
Prelog medical information and Medical Claims processing IDX, Microsoft. Submit
reimbursement of payments.
• Medical Claims Examiner for Unum Ins. Company for several years.
• Call center and Customer Service providing informative solutions for customer, clients and
healthcare professional. Via phone or email. Provide accurate response to customer inquiries. And
also show compassionate and empathetic when appropriate when handling complex customers.
Billing question, collection and payment arrangements. Eligibility verification and assists in
various indigent programs.
References: Attached
References:
Mrs. Dawn Rubin, Office Manager/ RN
(423) 595-3474
Former Co-worker Mrs. Pamela Brown, Team Leader
Clinical Fraud Investigator- Wellpoint
(423) 698-5707
Mrs. Julie Ewing, Former Supervisor
(423) 805-3617

4. Personal Reference: Ms. Agnes Oglesby (615) 995-1505- Office Manager Windsor Medicare