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Summary
Dedicated and methodical Billing Specialist with 15 years of successful experience in medical billing and coding. Highly knowledgeable of physician billing, Federal and State regulations. Proficient knowledge of professional claims and billing procedures. Working knowledge of computers and demonstrated proficiency in using Email systems, Internet and MS office software application.
Skills
  • Knowledgeable in Medical Terminology
  • Proficient in assigning the appropriate procedure and diagnosis codes to the proper service
  • Proficient knowledge regarding EPO, HMO, PPO, Medicare and Medicaid
  • Proven knowledge regarding co-pays, deductibles, co-insurance, and write-offs
  • Demonstrated ability regarding posting payments
  • Proficient knowledge regarding denials, appeals, and timely filing restrictions
  • Computer Programs: Alliance, PowerPath. Cortex, Macess, Epic, and ABS
  • SELECTED ACCOMPLISHMENTS 
  • Maintains strict confidentiality
  • Filing Pathologist Validations
  • Created procedure manual for training purposes
  • Reviewed all CPT and ICD books for revised, new and deleted codes
  • Deadline-driven
  • Excellent written communication
  • Exercises good judgment
  • Strong work ethic
  • Patient - focused care
Experience
Dignity Health Medical Foundation Patient Account Rep II 02/2017 to Current
  • Recorded and filed patient data and medical records.
  • Carefully reviewed medical records for accuracy and completion as required by insurance companies.
  • Strictly followed all federal and state guidelines for release of information.
  • Monitored shared email in-boxes and ensured inquiries were addressed.
  • Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.
  • Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
  • Confirmed patient information, collected copays and verified insurance.
  • Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.
  • Posted charges, payments and adjustments.
  • Submitted refund requests for claims paid in error.
  • Carefully prepared, reviewed and submitted patient statements.
  • Primary source of information for patients medical bills and answer questions via telephone.
  • Assist patients with repayment terms.
Health Net Claims Examiner I - Ops 04/2016 to 02/2017
  • Responsible for adjudication of Encounter claims with a daily production of 100 claims per day with an error ratio of no greater than 5% Maintain productivity to process claims and meet payment requirements within time constraints Thoroughly review potential duplicate claim submission and claims that have been mistakenly paid, or claims paid at the incorrect reimbursement rate Properly adjudicate claims based on knowledge of covered benefits, insurance and provider contract.
Diagnostic Pathology Medical Group, Inc Billing & Coding Specialist 09/2000 to 04/2016
  • Performed extensive research and validation of all CPT and ICD-9 and 10 codes for accurate billing.
  • Facilitate accurate claims processing by interfacing with providers and patients.
  • Post patient's payments.
  • Verify patient's benefits, eligibility, and coordination of benefits via telephone or insurance's website.
  • Maintained annual coding updates.
  • Verify patient's demographics with referring physician office and updated as necessary.
  • Constant communication with all Pathologist to ensure accurate coding.
  • Handled difficult incoming calls from patients, providers, and clients with urgency.
  • Maintained coding manuals.
  • Analyzed, audit, and assigned appropriate CPT and Diagnosis code that correspond to the level of services provided.
  • Checked all cases to transfer from reporting system to the billing system.
Dignity Health Medical Foundation Children's Center Sacramento, CA Patient Account Rep II 02/2017 to Current
  • Accurately entered procedure codes, diagnosis codes and patient information into billing software.
  • Confirmed patient information, collected copays and verified insurance.
  • Carefully prepared, reviewed and submitted patient statements.
  • Performed quality control of the data entry system to verify that claims and payments were posted correctly.
    Performed quality control of the data entry system to verify that claims and payments were posted correctly.
  • Submitted refund requests for claims paid in error.
  • Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
  • Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.
  • Monitored shared email in-boxes and ensured inquiries were addressed.
  • Primary source of information for patients medical bills answering incoming inquires via telephone
  • Assist patients with repayment terms
Dignity Medical Solutions Los Angeles, CA Test Manager THESE THESE 
Education and Training
Associate of Science Degree: Medical Billing 1999 Carrington College Medical Billing
2017 Medical Coding Academy Certified Professional Coder
Additional Information
  • SPECIAL SKILLS Able to work in a fast-paced office environment. Ability to prioritize tasks and manage time effectively. Continue to be teachable Professional references and letter of recommendation available upon request

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Professional Summary
I worked as a vocational nurse in geriatrics in the early years of my career. I still continue my volunteer work with seniors at memory care facilities as well as working with seniors who want to stay at home in respite or hospice care. My experience in this area provided patients and families with emotional support.Displayed sensitivity to the needs of geriatric patients. Assisted patients with grooming, feeding and ADL'S. Helped patients move in and out of beds,wheelchairs and automobiles.Scheduled and accompanied clients to medical appointments. Compassionate care and communication in dealing with issues of death and dying.
Skills
Work History
Billing and Coding Specialist Jul 2016 - Oct 2017
Salem Occupational Health Clinic Salem, OR
Medical Billing NW Sherwood, OR
  • Performed full-cycle medical billing in a fast-paced medical billing company.Accurately entered procedure codes, diagnosis codes and patient information into billing software.
  • Applied payments, adjustments and denials into medical manager system.Ensured timely and accurate charge submission through electronic charge capture to the clearing house.
  • Completed appeals and filed and submitted claims.Consistently informed patients of their financial responsibilities for services rendered.
Billing Supervisor Jul 2011 - Mar 2013
Dermatology Associates P.C Tigard, OR
  • Provided thorough supervision for day-to-day operations of facility in accordance with set policies and guidelines.Accurately entered procedure codes, diagnosis codes and patient information into billing software.Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.Posted charges, payments and adjustments.Thoroughly reviewed remittance codes from EOBS.
Billing and Coding Specialist Sep 2009 - Jun 2011
Neurosurgical Consultants Beaverton, OR
  • Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.Added modifiers as needed.Meticulously tracked and resolved underpayments.Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
Office Manager Jun 2007 - Sep 2009
Timothy Brown M.D. P.C Portland, OR
  • Carefully selected, developed and retained qualified staff, as well as trained new staff annually.
  • Created annual goals, objectives and budget and made recommendations to reduce costs.
  • Revised policies and procedures in accordance with changes in local, state and federal laws and regulations.
  • Observed strict confidentiality and safeguarded all patient- related information.
Office Manager Feb 2004 - Jun 2007
Lake Oswego Psychiatric Associates Lake Oswego, OR
  • Developed and managed budget and revenue expectations while actively seeking ways to eliminate or reduce expenses.Provided administrative support for two physicians.Accurately entered procedure codes, diagnosis codes and patient information into billing software.Completed appeals and filed and submitted claims.Posted charges, payments and adjustments.
Office Manager Jan 2002 - Feb 2004
Efraim Vela M.D. OB/GYN Milwaukie, OR
  • Created annual goals, objectives and budget and made recommendations to reduce costs.Revised policies and procedures in accordance with changes in local, state and federal laws and regulations.
  • Monitored infection control procedures to ensure facility-wide health and safety.Observed strict confidentiality and safeguarded all patient-related information.
DME Manager May 1988 - Jan 2002
HealthTek Medical Portland, OR
  • Created solutions in the areas of inventory, sales reporting, distribution and product upgrades that led to system improvements and streamlined processes.Described merchandise and explain operation of merchandise to customers.
  • I was also a medical fitter, trained in mastectomy and compression prosthetics.
Education
Associate of Science: Nursing, Health Services Vocational Nurse Chemeketa Community College Salem, Or
Nursing, Health Services Vocational Nurse

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Professional Summary
Quality focused and highly efficient Healthcare Professional. Holds a vocational degree in Medical Insurance Billing and Coding. Licensed by the American Academy of Professional Coders. Possesses a full understanding of ICD-9, ICD-10, and CPT coding procedures. Excellent data entry skills, which allows for accurate coding of medical information and provided care. Demonstrates faultless attention to detail and extensive knowledge of medical terminology.
Skills
  • Allscripts, NextGen, Centricity Type speed 60 WPM
  • Medical Terminology Optimum Financials, EPIC, 3M
  • Microsoft Office Proficient Exceptioanl interpersonal skills
  • ICD-9, ICD-10, CPT, HCPCS Analytical and problem solving skills
  • Attention to detail and high level of accuracy Insurance Verification/ Coding Denials
  • Adept with ROI forms/ HIPPA Compliant Adept with CCI edits/Medicare LCD/NCD Policies
Work History
01/2010 to Current
Senior Clerk MONTEFIORE MEDICAL CENTER Bronx, NY
  • Serves as the point of contact for all interactions with clinical team members, administrative associates, referral sources and patients.
  • Schedules appointments/visits for Infusion, heart Failure, and Med Surg.
  • patients according to care plans and staff availability.
  • Works closely with Intake staff and Liaisons to coordinate and admit referrals daily.
09/2014 to 12/2016
Remote ALTEGRA HEALTH, Risk Adjustment Coder- HCC
  • Abstracted and entered the coded data for hospital statistical and reporting requirements.
  • Ensured services were provided by an acceptable risk adjustment provider type and physician specialty.
  • Selected the correct HCC/RxHCC accurately for each ICD-9-CM and/or ICD-10-CM code for all medical records.
01/2015 to 05/2016
Remote Coding Specialist LEXICODE, Ancillary
  • Highly skilled in abstracting information and assigning codes to describe each documented analysis.
  • Code medical records with ICD-9 and ICD-10 coding, while maintaining 95% accuracy and achieving productivity goals.
  • Consistently ensured proper coding and sequencing of diagnoses.
  • Dealt with coding denials and corresponded with insurance companies daily.
  • Well versed with analyzing claim denials and reviewing LCD and NCD policies.
12/2014 to 12/2016
ISABELLA GERIATRIC CENTER, HIM Coder- Medical Records New York, NY
  • Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature.
  • Assigned additional diagnosis codes based on specific clinical findings (laboratory and psychology reports as well as clinical studies) in support of existing diagnoses.
  • Strong ability to interpret medical information and convert it into code for submission to insurance companies.
Education
12/2015
ICD-10 Proficient:
12/2014
CPC Certification:
11/2014
Health Information Management Certificate:
American Academy of Professional Coders License -
10/2014

December 2018
BACHELOR OF SCIENCE: BUSINESS ADMINISTRATION, Healthcare Administration
Southern New Hampshire University -
2014
HIM CERTIFICATE: MEDICAL INSURANCE BILLING AND CODING:
Allen School of Health Sciences -

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Professional Summary
Certified Medical Biller with 3 years experience in hospital and nursing facilities. Accurate and detail-oriented with knowledge of benefits, eligibility and appeals. Efficient Medical Administrative Assistant skilled in tackling administrative and patient-oriented tasks in a fast-paced environment. Organized Medical Records Clerk with the ability to readily adapt to changing environments and demands.
Skills
  • Medical terminology expert
  • ICD-10 (International Classification of Disease Systems)
  • Billing and collection procedures expert
  • Billing and collection procedures expert
  • Records management professional
  • Records management professional
  • Hospital inpatient and outpatient records
  • Inpatient records coding proficiency
  • DRG and PC grouping
  • Understands insurance benefits
  • Resourceful and reliable worker
  • Close attention to detail
  • Adept m ulti-tasker
  • Office support (phones, faxing, filing)
  • Excellent verbal communication
Work History
Jr. Underwriter, 02/2013 to 08/2013
Freedom Mortgage Mt Laurel, NJ
Complete FHA appraisal logging within FHA Connection.


? Review and underwrite appraisals; apply appropriate guideline
criteria, and update all systems with required appraisal information.
? Clear conditions as needed or by assignment of loans previously underwritten
by the underwriting staff; complexity of condition clearing would increase over
time with knowledge and experience.
? Coordinate closing calendar with the Closing Department for end of the month
conditions review in order to prioritize loan files by closing date and pull
loans to review conditions if needed due to capacity.
? Review/approve and clear the condition for 4506 Tax transcripts return using
knowledge and experience to assure that the tax transcripts are in line with
the income underwriting of the file.
? Provide status of new loan files, and conditions turn times expectations to
sales production staff and internal customers as required and requested.
? Report turns times of conditions and new loan files to Secondary for rate sheet
posting.
? Field and answer all incoming closing questions with regard to conditions
and/or specific files issues to ensure immediate resolution to the closer.
? Assist in Investor suspense loan file review to clear suspense items and
ensure the loan is salable.
? Prepare Rural Housing development packages for mailing to USDA after
underwriting
? Review and clear Fraud Guard conditions and provide information to
underwriter of any required actions necessary for the loan approval.
? Coordinate with Mortgage Insurance companies and/or any other outside vendor
that may need a copy of a file for review/audit.


Charge Entry Coding Specialist, 05/2011 to 07/2012
Concentra Addison, TX
  • Coded inpatient charts at a rate of number per hour or number per day.
  • Precisely completed appropriate claims paperwork, documentation and system entry.
  • Correctly coded and billed medical claims for various hospital and nursing facilities.
  • Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge.
  • Professionally and courteously verified appointment times with patients.
  • Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms).
  • Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms).
  • Adeptly managed a multi-line phone system and pleasantly greeted all patients.
  • Entered orders into the EMR system efficiently and without errors.
  • Diligently filed and followed up on third party claims.
  • Coded APV charts at a rate of number per hour.
  • Coded APV charts at a rate of number per hour.
MEDICAL RECORDS CODER 2, 04/2009 to 05/2011
Methodist Charlton Medical Center Dallas, TX
  • Prepared billing correspondence and maintained database to organize billing information.
  • Prepared billing correspondence and maintained database to organize billing information.
  • Printed and reviewed monthly patient aging report and solicited overdue payments.
  • Printed and reviewed monthly patient aging report and solicited overdue payments.
  • Accurately posted surgeries, hospital visits and payments for assigned carriers.
  • Accurately posted surgeries, hospital visits and payments for assigned carriers.
  • Compiled and tracked outstanding balances owed to medical facilities.
  • Compiled and tracked outstanding balances owed to medical facilities.
  • Responded to correspondence from insurance companies.
  • Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories.
  • Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories.
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
Education
Associate of Arts: Medical Billing and Coding, Current
Dawn Career Institute - Willimington, DE
Certifications
  • Certified Professional Coder (CPC)
  • Microsoft Office Specialist (MOS) Certificate