Medical Billing Quality Assurance
Resume:
Sherrine Sommerville CPC, CHI, CBCS, CMAA
Philadelphia, PA 19149
********@*****.***
Profile: Experienced, certified, results driven and proven, multifaceted professional with over 15 years progressive experience in
administrative healthcare diverse and settings.
Education: Certifications:
Devry University Certified Professional Coder, CPC
Health Information Technology Certified HealthCare Instructor, CHI
09/13-Current Certified Billing and Coding Specialist, CBCS
Certified Medical Administrative Assistant, CMAA
The Career Institute
Medical Office Administration
Overbrook High School
Diploma
Summary of Skills:
• Microsoft Office
• Medical Terminology and Anatomy
• APC, DRG and per diem reimbursement
• Practice Management software systems
• ICD-9, CPT and HCPCS Coding
• CMS-1500 and UB04 EDI and paper claims submission
• HIPAA Regulations
• Electronic Medical Records
• Medicare Reimbursement Policies
• Recruitment and Professional Development
• Entry Level Management
• Corporate and Postsecondary Training
Experience:
Montgomery Community College
Blue Bell, PA
Medical Billing and Coding Instructor (Adjunct) 05/13-Current
• Effectively managed diverse adult student body in post-secondary education environment
• Train diverse student body in entry level administrative health care procedures including medical billing, coding and HIPAA
Maintained over 90% retention consistently
• Developed daily lesson plans and instructional assignments to promote optional learning and hands on applications
• Accurate record keeping of attendance, grades and student progress
• Received over 85% and above student satisfaction survey results consistently
Star Career Academy
Philadelphia, PA
Externship Coordinator/IHIT Instructor 01/11 to 07/13
• Manage diverse student body externship rotations for high volume (averaging 60-80 students monthly) Medical Assistant and
Cardiology Technician programs
• Increased clinical externship affiliations by over 50%
• Assisted the Career Services Department with developing job leads from Allied Health organizations
• Consistently maintained over 40% externship to hire conversion rates
• Develop and maintain strong relationships with Allied Health organizations and employers
• Oversee the successful placement of students in clinical settings within 10 days from their last day in class
• Conduct site visits to evaluate student’s training and resolve student and site issues effectively and timely
• Coordinate student scheduling and monitor student attendance and professionalism
• Present orientation workshops including resume preparation and interviewing techniques
• Train in house staff on externship policies and protocols
• Assist corporate and other coordinators with placement and tracking of students and site procurement
• Train diverse student body in entry level administrative health care procedures including medical billing, coding and HIPAA
Harris School of Business
Voorhees, NJ 05/10 to 01/11
Medical Billing and Coding Instructor
• Effectively managed diverse adult student body in post-secondary education environment
• Train diverse student body in entry level administrative health care procedures including medical billing, coding and HIPAA
Maintained over 90% retention consistently
• Develop daily lesson plans and instructional assignments in accordance with approved curriculum and syllabi
• Accurate record keeping of attendance, grades and student evaluations
• Received 90% and above student satisfaction survey results consistently
Allied Technical Institute
Philadelphia, PA
Medical Office Administration, Program Director 05/09 to 05/10
• Developed program course content including syllabi, class schedules and policy and procedures manual
• Train diverse student body in entry level administrative health care procedures including medical billing, coding and HIPAA
• Effectively managed diverse adult student body in post-secondary education environment
• Maintained student retention rates at over 90% consistently
• Over 75% of students successfully challenged National Certification exam
• Oversaw admissions, externship coordination and career services placements
Kaplan Institute
Philadelphia, PA
Medical Office Administration, Instructor 05/08 to 06/09
• Effectively managed diverse student body in a post-secondary environment
• Train diverse student body in entry level administrative health care procedures including medical billing, coding and HIPAA
• Maintained student retention rates at over 85% consistently
• Developed lesson plans and teaching assignments in accordance with the approved curriculum and syllabi
• Received 90% and above student satisfaction survey results consistently
Montgomery Hospital
Norristown, PA
Collector-Level II 04/ 07 to 05/08
• Review UB-04underpaid and zero pay accounts for appropriate appeal resolution
• Successfully appealed claim denials according to NCCI edits and third party contractual agreements to generate additional
reimbursement on zero pay or underpaid accounts
Reported trend denials and netting issues and applicable resolutions to management
Consistently exceeded monthly collection amounts for zero pay third party payer and patient
accounts
Medac, Inc.
Philadelphia, PA
Satellite Office Coordinator (Pennsylvania Hospital) 09/04 to 03/07
• Developed and implemented daily work flow process for satellite office
• Managed employees inventory and production standards
• Reviewed and reported trend staff documentation errors for quality assurance and denial reductions
• Daily collection, reconciliation, batching, scanning and record retrieval of all applicable anesthesia records
Philadelphia Dermatology Associates
Philadelphia, PA
Billing Clerk/Receptionist 03/00 to 09/04
• Front Desk reception including registration, insurance verification, copay collection, appointment scheduling, multi-line phone
coverage, Dictaphone transcription and daily ledger reconciliation
• Charge entry, electronic and paper claims submission, payment reconciliation and applicable claims appeals
• Covered dedicated phone line for billing inquiries and payment arrangements
Generated high dollar physician reimbursement with minimal denials consistently
Independence Blue Cross
Philadelphia, PA
Medicare Claims Analyst 06/95 to 12/99
• Developed desk procedures for facility and professional claims adjudication process
• Actively trained and crossed trained new and existing associates on claims desk procedures
• Tracked and reported professional and facility claims processing delay trends on pre and post pay basis
• Exceeded departmental quality and production standards for UB-04 and CMS-1500 claims adjudication for al provider types
• Active team member of MHS-go live program management review group
• Received two internal promotions
• Received five Gold coin recognition awards
References Available Upon Request
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