Medical High School

Margaret I. Mock

Email: ********@**********.***

Address:

City: Pottstown

State: PA

Zip: 19464

Country: USA

Phone: 610-***-****

Skill Level: Any

Salary Range:

Primary Skills/Experience:

Medical and Dental billing and coding specialist. Strong insurance company follow up. Working knowledge of CPT, CDT, ICD-9 and familiar with ICD-10. Expertise includes Navinet, verifying insurance coverage and eligibility, familiar with all commercial and private carriers, workers compensation, auto insurance, Medicare, and Medicade. Coding operative reports and pathology reports. Posting payments, adjustments and charges. Seeks position of increased responsibility.

Educational Background:

High School Dipolma from Pottstgrove Senior High School, Pottstown PA 1/2001 to 6/1984 (Health Assistance)

Job History / Details:

Professional Summary

Medical and Dental billing and coding specialist. Strong insurance company follow up. Working knowledge of CPT, CDT, ICD-9 and familiar with ICD-10.

Expertise includes Navinet, verifying insurance coverage and eligibility, familiar with all commercial and private carriers, workers compensation, auto insurance, Medicare, and Medicade. Coding operative reports and pathology reports. Posting payments, adjustments and charges. Seeks position of increased responsibility.

Skill Highlights

Maintains strict confidentiality

Knowledge of HMOs, Medicare and MedicadeExtensive anatomy/physiology knowledge

Computer literate Managed care contract knowledge

Electronic Medical Record (EMR) software

ICD-9 coding

CPT and HCPCS coding

Interpreting instruction

Quality assessment of coded data

HIPAA compliance

Medical billing software

Patient-focused care

Strong work ethic

Team player with positive attitude

Deadline-driven

Good written communication

Exercises good judgment

Professional Experience

April 1999 to 12/2/2012 12:00:00 AM

Pottstown Oral & Maxillofacial Surgery Pottstown, Pa

Account Receivable, Medical and Dental Billing and Coding, Claim follow up, Secondary Insurance

Thoroughly investigated past due invoices and minimized number of unpaid accounts.Carefully reviewed medical records for accuracy and completion as required by insurance companies.Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.Strictly followed all federal and state guidelines for release of information.Wrote clear and detailed clinical phone messages for physicians.Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.Scheduled surgeries and procedures in conjunction with Surgical Coordinator.Scheduled patient appointments.Provided administrative support for three physicians.Accurately entered procedure codes, diagnosis codes and patient information into billing software.Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature.Consistently ensured proper coding, sequencing of diagnoses and procedures.Quickly responded to staff and client inquiries regarding CPT codes.Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.Received, organized and maintained all coding and reimbursement periodicals and updates.Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.Analyzed and interpreted patient medical and surgical records to determine billable services.Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes.Thoroughly reviewed remittance codes from EOBS/AR's.Confirmed patient information, collected copays and verified insurance.Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.Completed appeals and filed and submitted claims.Communicated with medical transcriptionists regarding patient medical records.Posted charges, payments and adjustments.Applied payments, adjustments and denials into medical manager system.Submitted refund requests for claims paid in error.Carefully prepared, reviewed and submitted patient statements.Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house.Consistently informed patients of their financial responsibilities prior to services being rendered.Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.Performed quality control of the data entry system to verify that claims and payments were posted correctly.Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.Performed full-cycle medical billing in a fast-paced medical billing company.

Education and Training

1984 Pottstgrove Senior High School Pottstown, Pa

High School Diploma Health Assistance

4.0 GPA

Graduated with distinguished honors

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