Customer Service Medical Billing

ANA ORTEGA, CPC

***** ** **** ****** . *****, FL 33183 . 305-***-****. *******@***.***

MEDICAL BILLING AND CODING SPECIALIST

Highly analytical medical billing/coding professional with a dynamic

background encompassing administrative, leadership, academic, and business

development successes within diverse industries including healthcare.

. Possess expertise in ICD-9, CPT, and HCPCS coding; and advanced

knowledge of medical terminology/procedures.

. Highly focused on ensuring compliance with regulations, laws,

procedures, and high quality standards.

. Merge strong attention to detail with investigative drive to identify

problems and develop/implement solutions.

. Offer solid computing/typing skills encompassing Cerner Power Works,

PEDS application, Cerner/Millennium, AS400, MS Word/Excel, and

ClaimGear.

. Advanced communicator in English, Spanish, and Portuguese.

CERTIFICATION / AREAS OF EXPERTISE

American Academy of Professional Coders: Certified Professional Coder (CPC)

National School of Technology, Miami, Florida: Medical Billing and Coding

Certificate

Areas Expertise: Diagnosis and Coding Procedures, Billing Collection

Strategies, State and Federal Disability Insurance, Manual and Electronic

Claims, Medical Terminology, Human Anatomy, Medicare and Medicaid Claims

Processing, Workers' Compensation Issues, Managed Care and HMOs, Hospital

Billing, etc.

PROFESSIONAL HISTORY

Miami Children's Hospital, Miami, Florida . 2008-2012

Physician Coder II (2008-Present): Promoted to perform coding and auditing

operations in the areas of radiology, ER, and urgent care. Code diagnosis

and CPTs in support of radiology studies and evaluation/management (E/M)

functions encompassing case levels, procedures, and diagnosis.

. Ensured the timely completion of E/M level coding and auditing functions

in compliance with CMS guidelines.

. Selected to manage key projects and to assist other departments when

needed.

. Completed training in Cerner Power Works, PEDS production application,

Cerner/Millennium, and MS Excel/Word.

. Honored with commendations and awards for top performance, efficiency,

and operational quality.

Collector (2008): Administered the collection and reconciliation of

receivables focused on ensuring compliance with policies, procedures,

regulations, and legalities. Provided overall management of assigned

accounts and worked collaboratively with team members in the completion of

daily tasks. Liaised with 3rd party payer as well as managed care companies

focused on requesting/securing payment. Implemented advanced knowledge of

CCI edits throughout appeals of denied claims. Monitored denials to

identify and report trends.

Documented collection processes with a strong focus on accuracy and

thoroughness. Communicated with guarantor to secure comprehensive

information regarding payment. Managed correspondence with Benefits

Coordinator. Performed the effective maintenance of A/R reports in

compliance with quality standards. Implemented advanced understanding of

contract reimbursement matrix, managed care contract information, and

managed care governmental regulations.

. Achieved and maintained superior levels of customer service quality.

. Continuously met and/or surpassed quotas.

First Service Realty, Miami, Florida . 1993-2008

Real Estate Agent: Orchestrated the sale and acquisition of real estate

properties ranging from residential to commercial listings. Provided

clients with expert representation throughout all phases of transactions.

. Achieved top commendations for top quality services, resulting in

numerous referrals and agency revenue growth.

. Honored with awards for top performance and contributions.

. Developed/cultivated productive relationships with clients/industry

professionals through effective networking.

DiPietro Corporation . Prior to 1993

Vice President: Spearheaded the start-up and development of this business

focused on the sale of costume jewelry imported from Brazil. Directed all

aspects of business operations

. Successfully established this organization into a revenue generating

business.

EDUCATION/LICENSE/AFFILIATION

Systems Engineering Coursework, Universidad Nacional Abierta, Maracay,

Venezuela

Real Estate Agent License (Florida) . Member of the Realtors Association

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