KARLA S. WILLIAMS

***** *********** **. *********: 713-***-**** or 832-***-****

Houston, Texas 77015 Email: acb7lb@r.postjobfree.com

SUMMARY

Certified Coder and Billing Specialist with over 25 years experience in the Managed

Healthcare Industry. HIPAA compliant. Environments include hospital business office,

insurance company, clinical and doctor’s office. Special skills in medical records and

customer include:

• Medicare and Medicaid Biller/Inpatient/Outpatient

• Medical Terminology and Anatomy

• Complete revenue cycle biller/Collector/HMO, PPO, POS

• Long Term/Acute care, SNF Rehab billing

• Claim Processing: Medical, Dental, Vision, Rx, Ambulance

• Workers Compensation Claims

• Detail-oriented and excellent problem solver

• Supervisory experience

COMPUTER SKILLS

• •

Microsoft Office/Power Point Advantix

• •

GP Net/Medicare IVR/Emdeon PILS

• •

DDE Entry-Medicare Trailblazer One Source

• •

Medisoft/Meditech 5.3- Medical

5.6/Affinity/CPSI Management

•

Softaid/Sharepoint/Emdeon/ENS Navinet/Zirmed

Encoder Pro • Avility/Epic /SSI

TDH Connect/TMHP/Medicaid

Auto adjudication claims processing

PBX Operator-backup

PROFESSIONAL EXPERIENCE

KARLA S. WILLIAMS

Kindred Healthcare, Houston, Texas 2011- present

Medicare/Medicaid/Commerical Biller

Responsible for daily submission of all claims thru clearinghouse, direct data entry

correction in Medicare system. Pull CWF daily to verify patient days.Working all T-status,

rejections, denied claims in Trailblazer. Submission of all 2ndry claims. Work aged trial

balance claims daily. Daily adjustments of claims with late charges added. Check CWF in

Medicare system for accurate full days, coins days, lifetime reserve days. Appealing of

denied claims with requested medical records. Daily reporting of claim count to managers,

on an average of 150 accounts daily.

Autimis, LLC-Univesity General Hospital, Houston, Tx 2009-2010

Medicare/Medicaid Biller

Responsible for timely filing of claims thru clearinghouse and DDE entry correction in

Medicare system. Secondary filing and follow up. AR collections and patient billing.

Strong knowledge of Medicare LCD guidelines of Part A & B billing.

Correction of claims in RTP status in Medicare system

Medicaid billing thru clearinghouse and TMHP. Responsible for all follow up and

Adjustments of denied claims. Work aging report weekly

Bay Area Rehabilitation Center, Baytown, Texas 2006-2010

Medical Billing/Coding Specialist

• Medicare/Medicaid billing, adjustment, correction of codes online

Month end balancing and daily reports, Prepare daily deposits and accounts

•

receivables

Prepare and resolve insurance claims, including but not limited to, processing

•

outbound claims

Organize out-patient claims for electronic or hard copy mail and forwards to

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appropriate third party payers

Review claims to make sure that payer specific billing requirements are met, follow-

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up on billing, determine and apply appropriate adjustments, answer inquires in a

professional courteous manner, and update accounts as necessary

Contact the carrier for status on outstanding claims and respond appropriately

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Appeal with insurance companies for reimbursement on denied/underpaid claims

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Interact with physicians office staff and insurance companies or other facilities to

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resolve problems

Reconcile outstanding and aged patient accounts

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Adhere 100% to all HIPAA-related rules and regulations (e.g. patient confidentiality,

•

HIPAA security, etc.)

Sava Senior Care, Houston, Texas 2003-2006

Medicare/Medicaid/Auditor/Adjuster/Cash Posting

KARLA S. WILLIAMS

• Performed routine research and reconciliation functions.

• Received and responded to adjustment request within established guidelines.

• Audited accounts and perform adjustments in system.

• Updated accounts daily with notes and current status.

• Reviewed aged receivables to determine appropriateness of account and required next

steps.

• Posted daily charges, working outstanding account receivable reports.

• Appealed to insurance companies for billing to get claims paid and processed.

• Processed all refunds to appropriate parties.

• Corrected all coding procedures when claims are denied or rejected

Healthsouth Hospital/Rehabilitation, Houston, Texas 2002-2003

Medicare Billing Specialist/Appeal

• Billed daily through clearinghouse transmissions to Mutual Medicare.

• Secondary billing to other pay sources.

• Assisted BOM with audits and credit balance reports and refunds.

• Ensured account resolution, insurance appeals and patient collection.

First Health TPA, Houston, Texas 1995-2002

Senior Claims Examiner

• Processed inpatient and outpatient claims. Medicare/Medicaid/Group Health

• Requested overpayments and processing refunds.

• Obtained certifications for procedures.

• Electronic claims submission/auto adjudication

Hermann Hospital/Rehabilitation, Houston, Texas 1993-1995

ICD-9/CPT Coder/Billing Specialist

• Coded and abstracted all records for billing.

• Collected all payments/daily billing Medicare/Medicaid

• Daily posting of cash.

• Worked outstanding accounts daily.

• Processed all refunds.

Kelsey-Seybold Clinic, Houston, Texas 1988-1993

ICD-9/CPT Coder Specialist

• Coded and billed surgical procedures.

• Processed workers compensation claims.

• Responsible for working all aged receivables

• Maintain daily filing.

• Collected all payments/processed refunds.

KARLA S. WILLIAMS

• Researched and worked unpaid and denied claims.

EDUCATION AND PROFESSIONAL CERTIFICATION

Lee College, 1995-1997/2007-2008 (Health Information Technology)

San Jacinto College 2008 (Health Information Technology)

American Academy of Professional Coders, 2002 -Member

Houston Community College, 1982

(Medical coding course)

ProMed, Continuing Education Course, 2005

Certified Professional Coder/Biller, 2005. (NHA)

Contact this candidate