Medical Billing System

TUYET TRAN

**R Ashton St. Everett, MA ***** 617-***-**** ********@***.***

US Citizen

Objective: Medical Coding and Billing position

Qualifications/Skills

. Medical Coding and Billing Specialist Certificate

. 4 years experience in Medical Coding and Billing

. 18+ years computer programming experience

Professional Development and Education

Bunker Hill Community College, Charlestown, MA 2009

Certificate in Database Programming and Administration

. MS Excel, Access, PowerPoint, Office and Oracle.

Clark University CCI, Woburn, MA 2004

Medical Coding and Billing Specialist, Master Certificate

Intensive, 385 hour, instructor lead, hands-on training and curriculum

focused on gaining a foundation in medical terminology, anatomy,

physiology, medical billing and medical coding.

. Developed skills in CPT-4 and HCPCS code selection (surgical and non-

surgical)

. Learned the reporting methodology for ICD-9 code selection of

diagnosis, signs and symptoms

. Gained firm understanding of HIPAA privacy regulation, work practices

and liability

. Obtained fundamentals of medical insurance, insurance terminology,

products, contracts and general procedures

Worcester Polytechnic Institute, Waltham, MA 03/02 - 05/02

Certificate in JAVA Development

Harvard Extension School, Cambridge, MA 09/99 - 05/01

Coursework in Distributed Object Computer System

Senshu University, Tokyo, Japan

BA, Information Management, 1979

Work Experience

Hospital Billing and Collection Service, Interim Biller, Wakefield, MA

04/09 - Present

. Lawrence General Hospital, Lawrence, MA

- Followed up, re-billed and appealed regarding denied claims

. Jordan Physician Association, Jordan Hospital, Plymouth, MA

- Using Athena web-based billing system, billed physician claims

. Saints Medical Center, Lowell, MA

- Followed up, re-billed and appealed regarding denied claims

Neighborhood Health Plan, Boston, MA 01/08 - 04/08

Claim Resolution Specialist (Temp. via Professional Staffing Group)

. Replied to providers' correspondence regarding denied claims

. Resolved providers' problems and issued payments

. Involved in all issues of claim processing, including patient's and

provider's eligibility, authorization for services, coding errors and

timely filing limit

Mass Laborers Health and Well Fund, Burlington, MA 07/06 - 10/06

Medical Claim Examiner (Temp. via Office Team)

. Verified accuracy of information on the CMS-1500 form and keyed data

into the system

. Processed payments for providers in PPO network

Network Health, Cambridge, MA 10/05 - 06/06

Claim Representative (Temp. via Professional Staffing Group)

. Verified accuracy of information on UB92 and CMS-1500 form and keyed

data into the Xpress and Connect systems

. Handled special claims, such as COB, Motor Vehicle Accident and Third

Party Liability, and set up these claims according to the H30 system

procedure

. Trained new temporary personnel on how to key and set up UB92 form

into H30 system

BT Chiropractic, Dorchester, MA 10/05 - 11/07

Medical Billing (Freelance)

. Analysis and resolution of workers compensation, motor vehicle, and

PIP receivables

. Billed auto carrier and third party liability for PIP patients

Athena Health, Waltham, MA 12/01/04 - 12/31/04

Medical Billing (Temp. via Office Team)

. Reviewed the EOB from the primary insurance for accuracy of amounts

. Billed secondary insurance (CMS-1500 form) for coinsurance and

deductible

Partners Health System, Charlestown, MA 08/30/04 - 09/30/04

Medical Billing (Temp. via Office Team)

. Followed up denied claims from Medicare

. Billed secondary insurance for deductible and coinsurance

electronically using BICS system

. Completed write-off and reconciliation of claim amounts if Medicare

and secondary insurance already paid

North Shore Medical Center, Salem, MA 04/01/04 - 04/30/04

Medical Billing Intern

. Involved with EOB for welfare recipients

. Billed Medicaid where Medicare Medicaid crossover program covers the

deductible and coinsurance of eligible program recipients

United Parcel Service, Boston, MA 08/01 - 06/04

Package Inspector (Part Time)

McKesson HBOC, Cambridge, MA 08/00 - 12/00

Software Engineer

. Modified a Health Care Management System using Visual Basic

State Street Bank, North Quincy, MA 07/94 - 11/99

System Analyst

. Developed Equity and Fixed Income System

. Used PL/I, DATACOME, CICS, JCL/TSO and MVS/ESA 9000 operating system

Brown Brothers & Harriman Co., Boston, MA 11/88 - 07/94

Programmer Analyst

. Modified daily refresh of Corporate Action Inventory

. Developed the Cash Availability system

. Used COBOL, VSAM.JCL/TSO and IBM OX/MVS 3090 operating system

Jyoho Shori Kikaku Software Co., Tokyo, Japan 03/82 - 03/88

Programmer Analyst

. Developed iron and steel Order Entry system for Nippon Steel

. Created Bond Management system for Daiichi Kangyo Bank

. Used COBL, VSAM and FACOM operating system

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