Medical Billing Insurance

PAMELA L. PINTO-OEHME, MBA, CPC

**** * **** ****** ***. 2 Burbank, IL. 60459 708-***-**** Mobile

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

Objective To obtain a position in healthcare education and

management. I desire to integrate my knowledge of

health information technology, revenue cycle

Experience management, compliance, auditing, and education,

while incorporating my doctoral studies in

healthcare administration with an organization that

offers the opportunity for longevity.

Online Adjunct Instructor- Medical billing and

coding

02/2012- Contract Bryant & Stratton

New York, NY

Facilitate medical coding courses on the virtual

campus

Prepare students for national coding exam

Maintain student grades through timely feedback on

assignments

Online Adjunct Instructor- Medical billing and

coding

09/2011-Contract Colorado Technical University

Schaumburg, IL.

Facilitate medical coding courses on the virtual

campus

Prepare students for national coding exam

Maintain student grades through timely feedback on

assignments

Assistant Professor- Health Information Technology

03/2011- Present Northwestern College

Bridgeview, IL.

Facilitate medical revenue cycle and non-clinical

health care courses

Prepare students for national coding exam

Maintain student record maintenance

Instruct virtual HIT courses

Maintain student grades through timely feedback on

assignments

Course alignment analysis for ground and virtual

campuses

Syllabi revisions

Teach 3M encoder and Quantim

Field Auditor- HEIDIS & PIA Audits

04/2011- Contract Outcomes Health Solutions

Chicago, IL.

Perform field audits at hospitals, health clinics,

and physician practices

Completed performance measurement tool checklist to

ensure physician assessment & documentation were

present

Scanned into checklist tool and required documents

into the data repository

Review physician chart documentation

Audited for missing & unacceptable signatures

Captured non documentation for chronic conditions

Ensure all quality assessment measurements are met

during patient care

Followed the guideline standards set by Centers of

Medicare & Medicaid

Reported all non-complaint findings

Instructor- Medical billing and coding

07/2010-11/2010 Anthem Institute

Las Vegas, NV.

Facilitated medical billing and coding courses

Prepared students for national coding exam

Maintained student record maintenance

Billing Supervisor

12/2009-03/2010 DoctorsXL

Las Vegas, NV.

Oversaw the daily billing procedures of eight

employees

Charge posting

Payment posting

Accounts receivable

Collections

Monthly meetings with Las Vegas clients to ensure

quality

Revenue cycle management

Presented reports of revenue collection

Provided CMS updates

Monitored insurance contracts to ensure proper

billing

Performed daily billing and coding procedures for

various clients

Coded outpatient surgeries, physician hospital

rounds, & office visits

Posted charges

Performed billing process

Posted payments from remittance advice

Performed follow-up on unpaid claims & patient

accounts

Auditor

09/2009-12/2009 Koplow & Girisen

Las Vegas, NV

Audited optometrist practice

Performed extensive assessment of accounts

receivable

Contacted & documented the reasoning for

non-payment of unpaid claims

Collected reimbursement & payment from payers &

patients

Operations and accounts receivable

Posted reimbursement from remittance advice

Reviewed accounts for patient payment or write/offs

Audited denials for resubmittal, patient

responsibility, or write/off

Trained staff on medical software program

Trained front staff on revenue cycle management

Overviewed the importance of clean claims\

Demonstrated how to ensure demographic data matches

the insurance card

Instructor-Medical Billing and Coding

04/2009-07/2009 Kaplan College

Las Vegas, NV

Facilitated medical billing and coding courses

Prepared students for national coding exam

Maintained student record maintenance

Medical Coder/ Auditor

12/2007-03/2009 Specialty Surgery Center Las

Vegas, NV.

Coded all performed surgeries 1200 cases a month

Gastroenterology

Urology

Nephrology

Ophthalmology

Maxillofacial (pediatrics)

Orthopedics upper body, lower & spine

Pain Management

Plastic (elective)

Neurology

Ears, Nose, & throat

OBGYN

Posted all charges for billing

Coded each case then posted codes in the charge

posting are of the EHR

Made any code, modifier, or payment adjustment

according to insurance payer before final billing

Audited all denials

Reviewed the coding of the claim denial

Contacted insurance payer on denials to submit

documentation

Daily excel report of appointment analysis summary

Documented daily productivity

Research and development projects

Participated in an internal audit on compliant

coding

Prepared & retrieved required charts for review

Performed retrospective claim audits to ensure

compliance

Medical Coder/Auditor

01/2007-04/2007 Dessert Radiology

Las Vegas, NV.

Coded all radiology reports

CT

MRI

X-ray

DEXA Scan

PET Scan

Performed chart audits

Verified the demographic information from insurance

card to ensure correct data entry

Posted billing charges

Prepared coded cases for billing

Performed prospective audits to ensure clean claim

Medical Coder/Auditor

03/2006-08/2006 Steinberg Diagnostic

Las Vegas, NV.

Coded all radiology reports

CT

MRI

X-ray

DEXA Scan

PET Scan

Performed chart audits

Verified the demographic information from insurance

card to ensure correct data entry

Posted billing charges

Prepared coded cases for billing

Performed prospective audits to ensure clean claim

Medicare Specialist/Coder Abstractor

05/2001-03/2006 Northwestern Memorial

Hospital Chicago, IL.

Created a hospital newsletter with current coding

and CMS updates quartely

Verified all HMO replacements, ESRD, & workers

compensation accounts

Secured all Medicare accounts after inpatient

admission

Monitored the ABN process

Coded all radiology reports including GI, CT, MRI,

X-ray and E/M coding

Analyzed LMRP write offs

Analyzed weekly reports including missing 5th

digit, missing ICD-9 code, Invalid V code, and V

code as principal diagnosis

Educated front staff, schedules, & physicians on

documentation and correct data entry input

Emergency room registrar

01/2001-05/2001 Holy Cross Hospital

Chicago, IL.

Registered all ER patient

Collected demographic & insurance card

Collected ER co-payment

Admitted ER patients to respective unit

Presented patient with required documents needing

signature

Applied patient identification bracelet

Emergency room registrar

08/2000-12/2000 Christ Hospital

Oak Lawn, IL.

Registered all ER patient

Collected demographic & insurance card

Collected ER co-payment

Admitted ER patients to respective unit

Presented patient with required documents needing

signature

Applied patient identification bracelet

Education University of Phoenix

Las Vegas, NV.

04/2006-Graduated 05/2010

MBA-Master's degree in Business Administration

BM-Bachelor's degree in Business Management

Doctrine of Healthcare Administration- still

attending

Certificati

on American Academy of Professional Coders

AAPC Salt Lake City, UT.

06/2005-Present

Qualificati Great interaction skills, well adapted to teaching

ons in an online and ground environment, multi tasked,

self-motivated, organized & detailed oriented with

an extensive knowledge of Medicare compliance

regulations, Microsoft word, Excel, Power Point,

SharePoint, and the use of various medical software

and on-line platforms.

Contact this candidate