Customer Service Insurance
Resume:
LATONNA SIMS
***** *. ****** **, ********, AZ ***39
********@*******.***
OBJECTIVE: TO OBTAIN A POSITION WITH A COMPANY WHERE I CAN UTILIZE MY SKILLS AS A
CERTIFIED PROFESSIONAL CODER AND CONTINUE TO GROW.
Hardworking, reliable and responsible with handling everyday job responsibilities. Love learning new
and detailed tasks. Enjoy working in a team setting or independently.
HCC Coding Type 55 wpm
Provider Auditing Legal Aspects of Collections
Provider feedback/Educator Customer Service
in IPA setting OSHA/HIPAA
HCPCs Level II Proficient 10 key by touch
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ICD 9 Coding Proficient Medical Terminology
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CPT 4 Coding Billed primary and secondary payers
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CMS 1500 EMR
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UB 04 Payment Posting
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Medicare/Medicaid 3M Encoder
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Patient Scheduling Hedis Review
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Charge Entry Travel Auditor
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Demographic set up Proficient in Medicare part C plans
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Proficient with NCCI edits
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Skilled in CMS data validation
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EDUCATION
04/2011
Medical Insurance Billing/Coding, Diploma
Everest College Phoenix, Mesa Campus
Mesa, AZ
Certified Nursing Assistant 02/2010
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RSAA Institute
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Mesa, AZ
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Certified Nursing Assistant 10/1997
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Meadowbrook Manor
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Bolingbrook, IL
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COMPUTER SKILLS
Medisoft
Centricity
AS 400
Word/Excel/PowerPoint
Lotus Notes
Access/Outlook
Oracle/Citrix
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Advance PM MD
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Mediconnect
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Raintree
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PROFESSIONAL EXPERIENCE
11/05/2012 to present
HCC Coder/Auditor
AZ PCP, Chandler, AZ
Review charts and prepare provider audits.
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Setup appointments to deliver provider feedback and education
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Promote preventive screenings for Medicare Advantage patients
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Review analyzes, and code diagnostic information that determines
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Medicare Advantage insurance payments.
Perform ICD 9 CM HCC coding for reimbursement
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Promote provider/patient continuity, accurate database information,
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a nd the ability to optimize reimbursement. 10/2011 thru 07/2012
Ensure compliance with established coding guidelines, third party
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reimbursement policies, regulations and accreditation guidelines
Certified Coder/Analyst
Humana Inc., Phoenix, AZ
Reviewed analyzes, and codes diagnostic information that
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determines Medicare Advantage insurance payments.
Participated in collecting HEDIS measures
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Performed ICD 9 CM HCC coding for reimbursement
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Promoted provider/patient continuity, accurate database information,
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and the ability to optimize reimbursement.
Ensured compliance with established coding guidelines, third party
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reimbursement policies, regulations and accreditation guidelines.
07/2010 thru 04/2011
@HomeCSR
Apac Customer Service Rep, Remote Agent
Handled inbound calls for utility customers.
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02/2009 thru 07/2010
Addressed billing and service related issues.
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Set up deferred payment agreements.
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Processed service work orders.
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Customer Resolution Rep II
Convergys, Remote Agent
Evaluated customer’s accounts for updated billing information
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Listened attentively to customer needs and concerns
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Trouble shoot customer’s network connectivity issues
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Referral Coordinator
Concentra Health, Lombard, IL 11/2007 thru 06/2008
Processed all incoming workers compensation claims.
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Obtained prior authorizations from third party insurance companies.
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Scheduled patients for all diagnostic, surgeries and physical therapy appointments.
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Addressed any health concerns with patients, and communicated with in network physicians, as
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well as employers and attorneys.
Customer Service Rep 09/2005 thru 11/2007
Waste Management, Romeoville, IL
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Handled all inbound calls in a timely matter.
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Answered all customer’s billing and service related issues.
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Researched customer’s accounts to up sell and cross sell new products.
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Referred commercial customers to sales department for upgrade of services.
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CERTIFICATIONS
CPC certification AAPC
Certification# 01181198
R EFERENCES AVAILABLE UPON REQUEST
Contact this candidate