Medical Billing Manager

Scharaza Carmichael

*** ***** ***** **********@*****.***

Stone Mountain, GA 30088 678-***-****

Objective: To secure a position where my knowledge, experience and communication skills as a medical

billing reimbursement specialist can be utilized.

SKILLS AND ABILITIES

• Excellent knowledge and experience in Medicare, Medicaid, Workers’ compensation and commercial

“clean “claims process. Successful track record claims appeals and resubmissions.

• Advanced knowledge and understanding CCI edits, Medicare local coverage determination (LCD’s)

Medicare HMO billing requirements.

• Great expertise in contract negotiations, physician credentialing, employee training and development.

• Comprehensive knowledge CPT, ICD-9-CM, HCPCS CODING and correct use of modifiers.

• Extensive knowledgeable in DME billing, and EMR billing systems.

• Experience billing for Vascular Surgery, Pain Management, Cardiology, Family & Pediatric, Internal

Medicine, Plastic and Reconstruction Surgery, Ophthalmology, Endocrinology, and Neurology.

EXPERIENCE Physician’s Choice Reimbursement Services

Consultant 1991-present

Role as an officer and sole owner for this organization consulting services for medical practices. providing medical

coding, reimbursement and practice management.

Monitor, trace and correct billing and coding errors. Ensure correct coding initiative performed along claims

corrections and refilling. Monitored and analyze the CDM (charge description manager) and performed the

necessary corrections and updates to maximize practice profitability. Research and resolve EOB denials and

other issues with outstanding accounts. Perform insurance carrier payment audits and CCI claims rejections.

Provide billing and coding training for staff and physicians. Post and reconcile insurance and patient payments,

including refunds. Maintain practice billing guidelines and Business Office procedural manual. Prepare daily,

monthly and yearly financial report and coordinate business meetings. Negotiate contract rates with the health

insurance plans and insured compliance guidelines. Assist in identifying and implanting programs to improve

company processes and procedure.

PRACTICE MANAGER

Premier Spine, Pain & Rehabilitation 08/2011 - present

Carolina Pediatric & Family Eye Specialist 07/2011 - present

Barbara L. fields, M.D. 11/1993 – 11/1995

BUSINESS OFFICE MANAGER

Carolina Spine, Pain, & Rehabilitation (consultant) 02/2003 –present

Atlanta Vascular Medicine & Surgery Specialist (consultant) 11/2005 -08/2011

Georgia Pain Physician 01/1998 – 04/2001

Georgia Surgical Center 01/1998 - 04/2001

Atlanta Heart Specialist 4/2001 – 5/2007

Responsible for coding and submitting surgery and surgical center charges. Also Follow up, regulate and

monitor accounts receivables and claims rejections including electronic clearinghouse claims. Monitored and

managed all CDM tracking and information by payer. Performed analysis and correct coding procedures for

denied claims. Developed a coding and reimbursement manual and performed periodic payer audits. Negotiate

pricing and coverage determination with insurance payers. Post and reconcile insurance and patient payments.

Trained and delegated tasks for business office staff to maximize performance time and efficiency. Perform

employee appraisals and promotion recommendations. Served as information and communication coordinator

for billing hardware and software system.

INSTRUCTOR-MEDICAL BILLING & CODING (part time) 09/2000-

04/2007

ASHER INSTITUTE

EVEREST INSTITUTE

BETHEL FAMILY CHURCH

Provided educational training for post secondary students studying medical billing and coding. Courses include

medical terminology, anatomy & physiology, computerized billing, insurance terminology, and medical claims

foundation I, II, III. Prepared lesson plans, examinations preparation and grading, and any additional

instructional material. Assist with placement of student extern sites.

REIMBURSEMENT CONSULTANT 1991/1992

KAISER PERMANENTE: Atlanta Georgia, Dallas Texas, Amherst Mass., Raleigh/Durham North Carolina

As an independent contractor, the assignment required me to orchestrate the Medicare fee for service billing

projects. Duties including A/R projections, staff training and project planning. Onsite recovery was required to

facilitate each endeavor.

COMPUTERIZED/SOFTWARE SKILLS

Medical billing software experience: Allscript (Mysis Tiger), Medisoft, Advance MD, EClicnical Works,

DigiCharts, Navinet, GA Medicaid Software, Microsoft Office Works.

EDUCATION

Certificate Medical Billing and Coding Specialist - Vascular Medicine and Surgery

Certificate –Durable Medical Equipment

Advance Coding

Georgia State University, B.A., Public Address and Rhetoric

PROFESSIONAL REFERENCES

Tim Couch, Operations Director, Thomas Eye Group 678-***-****

Herman Gore, M.D., Carolina Spine, Pain, & Reimbursement 704-***-****

Suresh Shah, M.D., Magnolia Medical Clinic 770-***-****

Fatima Spark, Atlanta Heart Specialist 770-***-****

E. Anthony Overton, D.O., Premier Spine Pain & Rehabilitation 704-***-****

Additional References Available Upon Request

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