Medical Biller

Kristin Elliott 716-***-****

** ****** ******, ******* ****, NY 14127 adv8r0@r.postjobfree.com

EDUCATION: Bryant & Stratton College, Amherst, NY Associates Medical Office Management

EMPLOYMENT:

Audubon Women’s Medical Associates – Medical Coder/Biller 3/3/21-present

Medical billing and coding; to include in depth document review, check ordering Provider(s) coding accuracy,, according to ACOG and Medicare guidelines, to ensure clean claims are being sent out, expedited accounts receivable is maintained, and trying to avoid aging accounts

Verify, update, and document insurance information; informing staff of treatment or insurance issues

Answer billing, coverage, or claims questions, for patients or staff, as well as keeping staff aware of the ever-changing insurance coding guideline changes

Payment posting, ledger adjustments, claim appeals/aging

Create procedural cost estimates; based on patient insurance deductibles and benefits, as well as for self-pay, using Rivet EMR

Verify updated fee schedules; mapping, correspondence with insurances regarding using Rivet EMR

Correct ordering Provider procedural coding in the Quanum (Quest) lab system, to keep patient cost responsibility as low as possible; again reminding ordering practitioners of coding guidelines

Abbott Anesthesia – Medical Biller/Coder 9/14/20-11/16/20

COVID shut down elective surgeries, and unemployment was imminent

Compile information and send records when requested to insurance companies for medical necessity

Communicate with staff about treatment, authorizations, or insurance issues

Review EOBs; claim aging/appeals

Run reports as needed

Verify, update, and document insurance information for patients

Enter surgical information, times, type, rendering Anesthesiologist, insurance, codes into system, run and send out claims next day, along with patient statements, collection letters, Worker’s Comp and No fault

RPCI Oncology PC - Medical Biller 9/3/19-9/12/20

Verify, update, and document insurance information for patients

Answer billing, coverage, or claims questions for patients or staff

Sent ECS and paper claims; correcting errors during scrubbing process, utilizing Change Healthcare

Update pharmacy and insurance information in the system and patient’s record

Coordinate cancer assistance/advocacy care between patients, family members, and Cancer care foundations, to discuss balances, treatment costs, and open/available cancer assistance programs

Contact outside physicians or facilities to coordinate care and obtain information

Contact insurance companies to get exact benefits information for patients for estimates and counseling

Compile information and send records when requested to insurance companies for audits

Communicate with staff about treatment, authorizations, or insurance issues; obtain drug authorizations as needed

Verify updated fee schedules

Manually write paper claims for Medicaid, as needed, and send with correct required documentation

Insurance payment posting, patient pay posting; review EOBs, appeals/resubmissions accordingly

Run reports as needed

Canterbury Woods (Williamsville) HIM Coordinator 6/25/18-8/30/19

Chart Assembly, face sheet prep, enter ICD10 codes/allergies for New admissions (SNF Resident Pictures to EMR/ ALR Printed hard-copy) E-mail notification of new admissions, discharges, bed holds

Audit new admission charts (Day 14 & 21)

Alert pharmacy of new admissions and discharges

Censuses, admissions/discharges registers for ALR & SNF (Daily); forward census to business office

MDS in Matrixcare (coverage & assist MDS Coordinator). Opening, completing entry/tracking, death(s) in facility, & submission (Weekly)

Schedule SNF residents to see house physician. Log physician visit notes when received and check that MD visits are completed per schedule (Weekly); keeping track of 30/60/90/annual visits.

Health Commerce System (i.e., HCS) – complete Bed Census report every Thursday (Weekly)

ICD-10 Coding - for ALL residents (Weekly)

Contact hospitals, physician offices and other agencies for medical record requests

Maintaining ALL Oxford Village forms electronically

Fulfill Authorization / Requests for Medical Records

Create Dental List & track (Bi-Weekly)

Medical Record audits ALR & SNF (Monthly), as well as thinning charts

ALR ISP Schedule / attend ISP meetings (Monthly)

QA & Performance Improvement (QAPI) Committee – Report Medical records audits for SNF & ALR at committee meeting. Co-facilitate meeting and prepare/ distribute Agenda & Minutes (Bi-Monthly meetings).

Credentialing of Contracted Staff for CCRC-CARF Accreditation – reported to QAPI Committee

PBJ Submission – submit Contract staff data to Human Resources (Quarterly)

HCS Coordinator (shared role w/ Administrator); to include onboarding staff and role assignments

HIPAA – General Orientation & In-service Education (conducted in June Annually).

DOH Survey – prepare & maintain Alpha list (Annual)

Complete HIM A/P Invoices and submit to Finance Department

Other: Assist staff with simple computer problems, and assist with coverage at OV reception desk

Required Meetings:

Morning Report – 9AM Daily; ALR ISP Meetings – Monthly, QAPI – Bi Monthly

UB Neurosurgery – Clinical Secretary 3/1/18-6/22/18

Using Medent: Check in/out patients, collect co-pays and balances, post payments, appointment scheduling

On-line insurance verification, e-check, authorizations, heavy Worker’s Comp & NF for two locations, four doctors

Posting payments, ensuring proper modifiers are included

Share the DME load

Set patients up on heat/stimulation

CCS Healthcare – Reception 2/16-11/16

Checking in/out patients using CURE MD EMR, scanning/placing, chart preparation

Check eligibility/copay, post payments, some radiologic authorizations, administrative support

Monitor patient status as they wait in waiting room, alert healthcare staff if adverse changes

Maintain good patient rapport

Great Lakes Physicians (WNY Urology Associates) – Transcription, Radiologic Scheduling 2/03-2/16

Medical transcription

Chart preparation, scan/place documents

Radiology scheduling/authorizations

Maintain good patient rapport.

Buffalo Gastroenterology & Associates - Medical Secretary/Surgery Scheduler 11/01-4/04

Procedural/surgical scheduling, chart preparation for office visits/procedures, some vitals/rooming

Maintain patient recalls, maintain pathology/lab results binder, reception, relay abnormal labs to physicians

Home transcription, assist five other physicians when support staff was needed, other related duties

Catholic Health System Merged with OLV below– Case Management Department Secretary 4/00-11/01

Reception/secretarial duties; heavy data entry of PRI’s (Peer Review)

Letter issuance of level of care changes to next of kin

Reporting insurance discrepancies and forwarding them to the Appeals department, some Appeals department assistance; compile and maintain statistics for Office Manager for subsequent meetings

Newborn pre-certification through insurance companies, using proper ICD-9 and CPT4 codes, filing, other related duties

OLV Hospital/Catholic Health System – Pathology Medical Secretary/Transcriptionist 3/96-4/00

Report directly to Director, Assistant Director, maintain/distribute quality assurance records, statistics, and reports

Follow-up on abnormal cytologies and gynecological specimens, prepare annual correlation study results for the State Department of Health

Extensive transcription, distribute reports in a timely fashion, typing for each individual laboratory department

Log/send material requests, send special cases/specimens to AFIP for review; accession specimens number slides for following day, assist with staining slides and trimming blocks, minorly assist pathologist while grossing, and other related duties

TEMPORARY EMPLOYMENT:

TEMP POSITION Univera Healthcare - Medicare M&B Quality Enrollment Auditor 10/17-1/18

Acts as an information resource to the Membership & Billing Department in clarifying and ensuring existing and new processes are being performed by staff audited, as well as check for proof of data for inaccuracies, and any other missing information

Audit internal processors on Medicare enrollment/disenrollment, LEP’s (late enrollment penalties), Attestations for Medicare part D, TRR’s (transaction reply reports from Medicare), issue findings to respective M&B departmental supervisor and staff for timely correction and resolution according to Medicare guidelines

Remains current with relevant legislative and regulatory mandates to ensure activities are in compliance with these requirements. Also, aware of all local, regulatory, operational, and national policy changes.

Continuously works to identify and remove barriers to increase productivity, quality, cost effectiveness, timeliness of operations, and member satisfaction

Programs used: Marx (CMS database), Wipro, Citrix/Facets, Quick Claims (SDS-Smart data solutions), Green que, Lotus notes, Excel and Access

Performs other functions as assigned by management

TEMP POSITION Roswell Park Cancer Institute - Patient Access Representative 7/17-9/17

Triage calls; take demographics; insurance verification/Radiology authorizations

obtain records, order pathology slides, radiology CD’s

TEMP POSITION Atwal Eye Care & Dr. Sansano’s Office – Reception/Customer Service 2/17-6/17

Check in/out patients, collect co-pays and balances, post payments, appointment scheduling

On-line insurance verification/benefit rider authorizations, chart preparation

Optimize patient satisfaction, provider time, treatment room utilization

Good communication/rapport, and excellent interpersonal interactions with patients, families, and staff

TEMP POSITION Invision Brain and Spine - Authorizations Specialist 1/17-2/17

Radiologic authorizations using Medent EMR, NIA, Univera

Keeping track of stages of the authorizations, i.e: denials, resubmissions, retractions, peer to peer review

Strong knowledge of ICD-10 and CPT4 codes

Forward authorizations to radiologic facility to schedule patient customer service

TEMP POSITION Buffalo Medical Group - Medical Assistant 11/16-1/17

Take vitals, room patients, check in/out patients, schedule ancillary testing/obtain authorizations

Surgical scheduling, both in and out patient; to include obtaining authorizations, post payments

Obtain injection authorizations, order injections for patient appointments; drew up/mixed injections

Heavy workman’s compensation, disability, and no fault case load

Contact this candidate