Customer Service Medical

Delbrah Moore, CPC

**** *. ***** * *****, Hawthorne, Ca 90250

Voice: 310-***-****

E-Mail: ********@***.***

S umma ry of Qualifications

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E xperienced in operations, management, t raining and supervision

Experience in a Non-Profit Medical Group

Background includes experience in a Teaching Hospital.

Strong ICD-9CM and CPT-4 coding experience

Extensive knowledge in a hospital based multi-specialty professional billing fee practice.

Background includes conducting Medicare’s yearly chart audit to ensure proper

Compliance, Coding and documentation guidelines were being followed.

Strong ER coding experience

Knowledge of HMO contract billing, Medicare E&M billing and guidelines.

Leadership, communication, staff development and motivational skills

Radiology coding experience.

CPC CERT I F ICAT ION

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Employment H istory:

A-L ife Medical, I nc./Ingenix/OPTU M I NS IG H T

6055 Lusk Blvd., Suite 200

San Diego, CA 92121

6/2006 – 08/10/2012 Radiology Contract Coder

My responsibilities are to code and perform CCI/LCD check and apply applicable ICD-9 and

CPT codes to all Diagnostic Radiology, Mammography, Nuclear Medicine and Diagnostic

U ltrasound reports from various clients worldwide using the Actus Workstation.

Responsibilities also include adhering to guidelines set forth by clients and all insurance

carriers and Medicare. This is a remote position via computer.

Radiology P ractice Management

100 Oceangate. Suite 100

L ong Beach, Ca 90802

03/2004 - 03/2006 Radiology Coding Specialist

Job responsibilities were to code Diagnostic Radiology, Nuclear Medicine, Diagnostic

U ltrasound and Mammograms. Assist in the appeals process for Medicare, Medi-cal, and

P rivate Insurance companies. Complete and return TARS and return to claims department.

T here was a quota of 450 reports coded per day. Coding done on in-house system called the

coding engine and ICD-9 and CPT codes utilized via the Encoder Pro Expert by Ingenix.

B ristol Park Medical Group

2501 Pullman Street

Santa Ana, Ca 92075

08/2003 - 03/2004 I nsurance Billing Specialist

Job responsibilities are to review and correct HCFA claims to ensure all necessary information

is provided to insurance carriers. Respond to inquiries from insurance companies on all filed

claims. Audit age of claims submit ted and work to resolve outstanding balances. Maintain

aging reports and edit list as result of either paper claim or electronic billing. Process denials

f rom insurance companies and initiate appeals. Initiate refunds to insurance companies if an

overpayment is identified.

Maintain a working knowledge of current procedure and diagnosis codes. Keep updated on all

contracted Health Plans and related company polices. Update patient insurance information

on IDX if necessary or required. Provide phone coverage for customer service related calls

w hen needed. Perform any additional/miscellaneous duties (not inclusive of job description) as

requested by the management team within the scope of knowledge/ability. Maintain complete

patient/employee confidentiality at all times. Demonstrate teamwork by assisting co-workers

w ith task/training as directed and attending and participating in mandatory meetings.

Avalon M unicipal Hospital /Rev-Care/Hospital Employee Labor Pool

Avalon, California

6/2003 – 8/2003 Out-Patient Biller

Responsible for Charge Entry and sending them to bill mode for EMC t ransmission.

Responsible for patient demographics. Responsible for quality controls of all ICD-9 and CPT

codes utilized. T h ree month assignment…..owner of billing co. went on cruise .

RevCare

Cypress, California

2003 - 2003 Hospital Collector

Responsible for collecting outstanding unpaid balances from insurance carriers and self-pay

patients. Documenting action taken on patients account. T his was a conversion project.

Cogent Health Care

I r vine, California

2002 – 2002 I n Patient Coder

Responsible for coding In-Patient DRG services for a project called Diagnosis Big Clean.

Contracted Account. Coding done from my home and faxed in on a daily basis.

Reported directly to Judith Macklin. T h ree week project only.

Ha rbor-UC LA Medical Foundation, I nc.

21840 S Normandie

Tor rance, California

1993 – 2000 Physician Coding Analyst

Responsible for initiating all abstract documents. Responsible for abstracting, ICD-9, CPT-4

and HCPCS Coding of p rofessional services for billing to Medicare/Medical, Workers

Compensation and private insurance carriers for out-patient, in-patient, all specialty

surgeries, procedures, ER, neonatal and dialysis p rofessional fees, including some

r adiology for over 200 physicians . Responsible for pinpointing problems and making

recommendations for increased revenue. Maintain current knowledge of the Medicare billing

l imitations and guidelines as it pertains to state and federal laws. Also, responsible for a

monthly quota. A ll specialty services were abstracted from physician’s hand writ ten notes,

excluding operative reports and some procedure notes. Communicating directly with physicians

and their staff on a daily basis. Responsible for out-patient surgery and procedures for GI,

Cardiology and Ophthalmology. Assist in special projects and studies related to

abstracting/coding activities. Also, responsible for concurrent review of in-patient

abstracting/coding activities as one of the projects. I only coded the professional component for

physicians.

1991-1993 Coding Supervisor

Responsibilities same as above, except for the supervision of five (5) coders, yearly reviews and

r aise increases t ime off and vacations. Maintaining a steady and effective work f low, cash f low

and maintain quotas; mine included, and generate month end reports. Educate physicians and

staff. Attend monthly staff meetings. Conduct yearly Medicare Audits.

1989 - 1991 P rofessional Billing/Collecting Representative I I

Responsible for compiling data entry forms for charges, master registration information,

payments, write-offs and adjustments. Follow up with Medicare/Medical programs, worker’s

compensation and private insurance companies on all un-paid/denied claims. Follow-up with

patients on balances due/co-pays and deductibles after claims have been paid/denied. Follow-

up with physicians on certain patient write-offs. Document all pertinent account information.

Assist Billing Manager in special projects and studies related to billing and collecting including

Medicare appeals. Personally dealing with patients in reference to payments, forms and

complaints when they came into the office.

1986 - 1989 P r ivate Billing /Coding Account Supervisor

Responsible for data entry and preparation of month-end reports. Responsible for

maintaining, coding and billing three (3) dialysis centers, Medical Testimonies, Surgeries,

P rocedures, Office Visits done in the doctors private office and outside facilities. Responsible

for billing to Medicare/Medical, Workers Compensation, Private Insurance carriers and self-

pay clients. Responsible for bank deposits. Responsible for t raining and supervision of Patient

Account Clerk. Responsible for Billing, Collecting, posting and write-off’s of all private billing

accounts. Responsible for ICD-9 & CPT-4 coding of all private billing accounts. Responsible

for all private account appeals. Assist in special projects and studies related to billing and

collection activities, such as creating charge tickets for various departments and maintaining

fees and rate schedules for physician. Also, responsible for yearend tax summary when

requested.

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Supplemental Employment H istory

Contracted Community Service Billing Instructor 1995 - 1995

Los Angeles Harbor College

Wilmington, California

In-Patient Coder - Contracted 1992 - 1992

Martin Luther King Medical Center

Los Angeles, California

In-Patient Coder - Contracted 1990 - 1990

Ventura County Medical Center

Ventura, California

B illing Consultant 1990 - 1990

King-Drew Dialysis Center

Los Angeles, California

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Education

U rban League Training Center 1972

B usiness Administration

L. A. Harbor College 1993

M anagement & Organization

Certified Billing Agent 2001

T he Coding Source - CPC Certification Prep. 2006

CPC Certification

References available upon request

Contact this candidate