Medical Customer Service

RHONDA WILLIAMS, CPC

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

Stone Mountain, GA 30087

Cell 206-***-****

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

SUMMARY OF QUALIFICATIONS

. A Certified Professional Coder with 18 years of strong comprehensive

experience in medical billing and collections, coding, auditing,

research/analysis and claims processing.

. Extensive background in Medicare/Medicaid (CMS), Commercial and Managed

Care Payors.

. Technical expert in the areas of revenue cycle management, CMS

regulations, superior problem solving and customer service.

. Strong ability to promote a cooperative environment at work to meet

organizational goals.

. Familiar with cash management procedures and principles.

. Knowledge of proper billing and payment cycle for medical accounts.

EMPLOYMENT EXPERIENCE

iHEALTH TECHNOLOGIES

ATLANTA, GA OCT 2009-PRESENT

Medical Policy Research Analyst

. Identify necessary changes to existing library rules and client-custom

rule versions through researching, reviewing and interpreting coding and

billing professional journals/industry publications, periodicals, and

governmental regulations, new medical policy edits and maintenance of

existing edits.

. Assume responsibility for projects, prepare and coordinate reviews with

Medical Directors and physician consultants to ensure the quarterly and

semi-annual HCPCS/CPT updates are posted in a timely manner.

NAVOS formerly WEST SEATTLE PSYCHIATRIC HOSPITAL

SEATTLE, WA JAN 2008-JUL 2009

Medical Billing A/R Supervisor

. Managed and supervised all, manual and electronic, billing/accounts

receivable functions for hospital (CMS 1450 or UB 04) physician (CMS 1500

formerly HCFA 1500); including insurance verification, coding, charge

analysis, high priority appeals, timely billing and cash

collections/adjustments and refunds for Medicare, Medicaid, Commercial,

Managed Care Payors and Private Pay.

. Prepared, created, reviewed and monitored AR/Collections reports.

. Developed and implemented collection procedures and collection goals and

monitored staff adherence to these procedures and goals.

. Participated in financial committee to streamline, outpatient, patient

access, charge entry and billing process.

. Demonstrated service and success in team leadership. Created/implemented

new billing team; organized, delegated, trained and educated staff.

. Properly distributed work flow to maintain positive production and

maximize reimbursement.

. Interviewed, hired and trained employees; appraising performance,

addressing complaints and resolving problems.

HIGHLINE MEDICAL CENTER

TUKWILA, WA OCT 2005- JAN 2008

Lead Homecare Reimbursement Specialist

. Supervised and managed monthly hospice and daily home health billing

process; pre-authorizations, insurance verification, patient

demographics, coding, charge analysis, timely billing and cash

collections for Medicare, Medicaid, Commercial, Managed Care Payors and

Private Pay.

. Performed fee negotiations with DME vendors for hospice patients.

. Reviewed and coded monthly invoices for AP from contract vendors.

. Assigned diagnosis and procedure codes from provider dictation and

reports using ICD-9 and CPT coding.

. Analyzed monthly reimbursement reports for trends and/or problems with

charges and coding.

. Provided training and orientation to new hires.

INTRACORP

NORCROSS, GA MAY 2002- JUL 2005

Senior Worker's Compensation Analyst

. Claims management of assigned caseload of superior and high exposure

claims.

. Analyzed claims, using medical terminology and coding to determine

compensability.

. Performed timely investigations, identified problems and recommended

solutions in accordance to the laws, policies and procedures.

. Acted as a trainer/mentor for less experienced members of the claim

technical staff.

ATLANTA MEDICARE SERVICE CENTER

NORCROSS, GA OCT 2000- MAY 2002

Lead Medicare Specialist

. Electronically coded and billed Medicare claims utilizing local medical

review policies and Medicare guidelines.

. Developed and performed audits for claim denials.

. Worked rejection reports and tracked medical necessity denials sent to

physicians.

. Trained and oriented new hires.

EDUCATION

GEORGIA PERIMETER COLLEGE

CLARKSTON, GA

Medical Coding

HIGHLINE COMMUNITY COLLEGE

DESMOINES, WA

General Studies

AFFILIATIONS

AMERICAN ACADEMY OF PROFESSIONAL CODERS (AAPC)

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