Medical High School

Emerald Sanford

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

Baton Rouge, LA 70816

225-***-****(home) or 225-***-****(cell)

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

OBJECTIVE

Seeking full time employment in the medical field that offers growth within

a professional healthcare environment.

EDUCATION

Baker High School (Graduate)

Baker, LA

8/1997-5/2001

MedVance Institute of Baton Rouge

Baton Rouge, LA 7/2007-7/2008

Medical Coding/Billing Specialist

Key Courses:

Anatomy and Physiology

ICD-9

Medical Terminology

CPT-4

Law and Ethics

HCPCS

Guidelines for Medicare and Medicaid

WORK EXPERIENCE

Pain Management Billing(Externship)

Baton Rouge, LA 6/2008-8/2008

Medical Coder/Billing Specialist

Duties:

Coded diagnosis using ICD-9

Coded procedures to the highest level using CPT-4

Performed medical office procedures

Billed primary and secondary claims to insurance carriers

Billed primary and secondary claims to insurance carriers

Posted charges and co-pays

Abstracted procedures from operative reports

The Spine Diagnostic and Pain Treatment Center

Baton Rouge, LA 7/2008-Present

Pre-Certification /Reimbursement Clerk

Duties:

Performs medical office procedures

Verify patient's eligibility and benefits

Responsible for obtaining pre-authorization and/or pre-certification to

insure reimbursement at the highest benefit level

for patients surgeries, procedures, medication, and imaging studies to be

done inpatient as well as outpatient. To be performed in a hospital,

outpatient and/or ambulatory surgical setting. The use of ICD-9, CPT-4,

and HCPCS are utilized by contacting various insurance carriers.

Responsible for responding to payor request for additional information

regarding claims. Also request that claims be filed and/or refilled to

resolve any unpaid claims.

Reviews and researches any problems that may occur with claims being filed

for billing/reimbursement issues. Handles

denials and/or appeals for rendered services not covered by submitting a

request for reconsideration of medical necessity via mail.

Responsible for addressing and/or resolving all patient concerns via

incoming phone calls regarding denied and/or incorrect paid claims and/or

accounts.

Responsible for obtaining necessary medical info, billing information, and

patient demographics for correct billing and charting purposes.

Responsible for scheduling and coordinating patients for surgeries and/or

procedures once approval of precertification and/or referral is obtained.

Also informs patients of special instructions prior to surgeries,

procedures, imaging studies, etc.

Skills

MS Word, Excel, Outlook, Type 40-45 WPM, Familiar with Advantx, Bond,

Mediware, and Medisoft Software. Member of AAPC (American Academy of

Professional Coders) since 2010 Have good verbal/written communication

skills.

References available upon request

Contact this candidate