Toni Bethune

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

Raleigh,NC *****

908-***-****

ab9o3g@r.postjobfree.com

Education

CPO

Certified Paraoptometric Raleigh, NC

**/****

Centura College Virginia Beach, VA

Associates Degree of Occupational Science in Medical Assisting 09/2012

Concentration: Management

Miller -Motte Technical School Cary, NC

Certificate of Medical Assisting 01/2007

Experience

Duke University Health System Durham, NC

Clinical Billing Specialist 6/2013-Present

• Reviewed bills for patients that are identified and flagged as participating in a

clinical trial.

• Educated providers regarding compliance with government regulations with

special attention to CMS guidelines as they pertain to billing for patients enrolled

in clinical trials.

• Reviewed grants and clinical trials to ensure it is still within compliance.

• Ensured that charges are associated with grants and clinical trials are being billed

appropriately for both physician and hospital services.

• Created a central database for grants and provided instruction to all new users.

MCM Occidental Fire & Casualty Raleigh, NC

COA Medical Review Technician 8/2012-3/2013

Reviewed bodily injuries from the demand package for entry into the COA system.

Entry of the injuries sustained by the claimant or insured.

Entry of the treatment received by the claimant or insured.

Processed the medical treatments and injuries report for a settlement evaluation.

Compared the COA settlement evaluations with settlement evaluations done by

claims adjusters from different offices.

Eye Care Associates Raleigh, NC

Medical Claims Specialist 05/2008 – 03/2012

Manage medical record files for reimbursement and compliance purposes, entering

cpt codes and diagnosis for billing purposes, or compiling and summarizing the data into

usable report form

Process patient accounts for billing and discharge including preparation of charges,

collection of monies, and issuance of receipts for monies collected

Communicate with patients about insurance issues; calculate medical bills and

identifying insurance payments versus patient obligation

Reduced department’s accounts receivable numbers by $200,000 within ninety

days

Increased departmental productivity 25% by implementing electronic reporting

procedures

University of North Carolina Hospital Chapel Hill, NC

Medical Coder/Biller 02/2008 – 09/2008

Researched missing or absent documentation reported and cross referencing

procedures with CPT codes and Medicare guidelines

Compiled excel and access reports for processing through Navigant Consulting

Provided clerical support by filing, creating memorandums and establishing office

automation

Processed upwards of 1400 claims weekly, recoding for insurance and billing

accuracy

Fidelity Cary, NC

H&W Customer Service Representative 07/2007 – 11/2007

Created statistical reports for all call center employees

Processed benefit transactions accurately for employees and employers

Effectively utilized and navigated Internal Resources application to determine the

appropriate solution for the client

Answered customer inquiries concerning healthcare plans and benefits while

adhering to measurable departmental goals

Blue Cross Blue Shield of North Carolina Durham, NC

Claims Specialist 02/2002 - 01/2007

Processed customer transactions including suspended claims, adjustments, and

other customer inquiries

Researched claims with providers to reach a billing agreement in lieu of timely

filing

Processed claims that could be handled at the first point of contact

Returned standard Medicaid/Medicare and private payor claims forms to providers

and subscribers for corrections

Kelly Services Durham, NC

Front End Specialist 11/2001 – 02/2002

Entered insurance claims prior to payment processing, ensuring demographic

information was complete and accurate

Handled complex claims by converting insurance documents within electronic

medical records to paper forms for return to providers for corrections

Trained new employees on electronic medical records applications and proper

procedures for processing insurance claims

Processed complex or difficult to resolve claims and transporting them to the

appropriate department for further research and correction

Computer Skills

MS Office Suite 2007, Mobisys, Misys EMR-All Scripts, Siemens A2k and WebCIS,

Officemate, Epic, Legacy

Contact this candidate