Marlon M.
Senior Medical Claims Resolution Specialist
Open to offersNew to PlatformAbout
Marlon M. is a dedicated Claims Resolution Specialist with a robust background in resolving medical claims, specializing in behavioral health concerning mental health and substance abuse. His professional journey is marked by a series of roles which showcase his extensive experience in claims analysis, denial management, and payer communication. At Connext Global Solutions, Marlon was instrumental in resolving claim denials, navigating EMR systems like KIPU and CollaborateMD. Prior to this, he honed his skills as a Medical Claims Analyst at KMC Mag Solutions, where he facilitated timely claim resolutions through electronic and paper submissions, utilizing systems such as Epic. Earlier positions at Microsourcing Inc. and Armco Healthcare Services further solidified his expertise in managing denials and facilitating payments. Marlon's career inception at Maersk Global Service Center provided him with finance and accounting acumen in the shipping and logistics sector. He holds a Bachelor of Science in Computer Science from Adamson University, complemented by a HIPAA certification and proficiency in Microsoft Office and medical billing software.
Experience
Claims Resolution Specialist – Behavioral Health (Mental Health and Substance Abuse)
Connext Global Solutions · 2024 — 2026Checked claim status through phone calls or payer portals. Verified claim denials by contacting payers to dispute and request reprocessing. Conducted eligibility and authorization verification via calls to insurance or online resources. Utilized EMR tools such as KIPU, CollaborateMD, and Jira/Confluence.Medical Claims Analyst
KMC Mag Solutions · 2023 — 2024Followed up with payers to ensure prompt resolution of medical claims for hospital bills through phone or websites. Submitted electronic and paper claims to various insurance companies. Processed approvals for adjustments or write-off requests to resolve account balances. Verified eligibility, benefits, and authorization via calls or online. Contacted patients for documentation on coverage issues and coordinated benefits. Resolved claim denials by submitting corrected claims and appealed as necessary. Responded to inquiries from patients and insurance companies regarding claims or appeals. Employed Epic for management tasks.Senior Claims Analyst (Medical Claims)
Microsourcing Inc. · 2020 — 2023Coordinated claim submissions and follow-ups with insurance companies. Addressed unpaid claims and underpayments through calls or portals. Handled medical documentation including UB04 and EOBs. Managed denials by initiating appeals and followed up on their status through communications via phone or websites. Engaged with patients for additional documentation and addressed inquiries from both patients and insurance representatives. Utilized Epic, Cerner, Epremis, Nthrive, and RevApp.Medical Claims Denials Analyst II
Armco Healthcare Services · 2018 — 2020Analyzed issues leading to payment delays while identifying trends to reduce denials proactively. Reviewed reasons for claim denials by contacting insurance or checking provider portals. Prepared and sent appeals with supporting documents for claim recovery. Followed up with payers to ensure timely resolution of outstanding claims through various communication methods. Verified posted payments and adjustments. Used Epic for management tasks.Finance & Accounting Analyst – Shipping & Logistics
Maersk Global Service Center · 2017 — 2017Processed payment applications in SAP based on requests from customers or collectors. Validated payments against outstanding invoices and facilitated updates for cargo release. Maintained effective communication with local and global counterparts.Team Leader, Collector – California Workers Compensation Claims
Summit Medical Documentation Services · 2008 — 2017Negotiated and resolved liens filed with the Workers Compensation Appeals Board by contacting insurance adjusters, defense attorneys, and lien representatives. Oversaw the work of subordinates engaged in collections and negotiations, including supervision and performance evaluation. Provided training to new employees on collection methodologies. Conducted reviews of accounts to initiate payment enforcement actions.
Skills & Expertise
Education
- Bachelor of Science in Computer ScienceAdamson University · 2001 — 2005
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