Clinic Coder II/Auditor

Darlene L. Shelton

*** ******** **

Home: 985-***-****

Ponchatoula, LA 70454

Cell: 985-***-****

Email: **********@*****.***

SUMMARY

A Certified Registered Medical Manager and Certified Professional Coder with over 16 years experience in health care billing, five years of physician coding, five years of hospital admissions and cashier experience. I have experience with CERNER Information technology system. I have billing and collecting experience with Medicare, Medicaid, and Managed Care. I believe highly in professional customer service. I graduated from the University of Phoenix with a Bachelor’s degree in Health care Administration on March 27, 2010, and I am currently pursuing a second Bachelor’s degree in Health Information Management.

PROFESSIONAL EXPERIENCE

North Oaks Health System Hammond, LA March 1986 - Present

Clinic Coder II

Proficient in most aspects of office management to include: Answering multiple phone lines during peak call times for multiple physician offices. I have keyed in front desk charges in busy physician clinic, including balancing and making daily deposits as well as making appointments for patients calling. I am able to check patients out when appointment is complete. I also have experience in verifying insurance benefits and obtaining referrals.

I was the Senior Insurance Assistant and supervised two employees. I was responsible for training all new employees of Central Billing Office in the position of Sr. Insurance Assistant.

I am extremely qualified in posting all Medicare and Medicaid payments and working all denials for both.

I am experienced with filing secondary claims to Medicare, Medicaid, Medicare supplement plans, and Managed Care. I am familiar with Medicaid Community Care Referrals and how to obtain them.

Worked Aged Trial Balance reports and Collections, including sending out collections letters and turning accounts over to outside collections. Proficient with posting mail payments, making daily deposits as well as answering statement calls from patients. I have knowledge of Managed Care companies, and keying in charges into the Charge Master.

I am familiar with RVUS and how to run RVU reports, and reporting clinic stats.

I can perform Evaluation and Management coding for Family Medicine, ENT, Orthopedics, Pulmonology, OBGYN, Internal Medicine, and Cardiology, including cardiology tests, hospital subsequent care visits, and multi-specialty procedures.

Familiar in most computer applications to include MS Suite to include, MS Word, PowerPoint, and MS Excel.

EDUCATION AND TRAINING

Ponchatoula High School Aug. 1978-May 1981 (Graduated May 1981)

Southeastern Louisianan University Aug. 1981-May 1984

Louisiana Technical College August 1984-Sept. 1985 (Diploma awarded Information Processor Operator)

Baton Rouge Vocational School Feb. 1992-May 1992 (Certification awarded for EMT-June 1992)

University of Phoenix July 2007-February 8, 2010 (Graduated March 27, 2010)

University of Phoenix July 2010-February 2011

Herzing University May 2011-Present

CERTIFICATIONS AND ADVANCED TRAINING

Certified Registered Medical Manager-Certification awarded through Association of Registered Health Care Professionals (January 2010).

Certified Professional Coder – Certification awarded through American Academy of Professional coders. (June 2007).

Emergency Medical Technician – Certificate awarded. (June 1992).

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