Biller/Coder

Estrella A. Tacub

**** *. ***** ***** ****** Burbank CA 91504

H 818-***-**** C 818-***-****) *************@*****.***

OBJECTIVE

Looking for a position of medical billing and coding specialist utilizing

my skills and experience in code punching, reconciling insurance and

resolving account related concerns.

MAJOR QUALIFICATIONS

. Over seven years of hands-on experience working in Billing field

. Certified Coding Specialist (CCS)

. Extremely familiar with medical terminology

. Computer - MS Office Suite

. Virtual Lab for 3M Encoder, Quadramed, HER

. Application of appropriate ICD-9-CM and CPT-4 code sets to medical record

documentation for the purpose of reimbursement, research, and compliance

with federal regulations; Attends training for transition to ICD-10 code

set

. Inputs pertinent information from the health record into computer system

for data retrieval, analysis, and claims processing;

. Work with nurses/medical records person to substantiate optimal

assignment of codes for reimbursement

.Under indirect supervision, audits medical charts and records for

compliance with coding regulations and guidelines.

.Uses knowledge of coding and software to provide a second level review of

codes assigned to medical diagnoses and procedures.

.Reviews, develops, and/or modifies procedures, systems, and protocols to

achieve and maintain compatibility with compliance standards.

.Audit medical records to ensure specificity of diagnoses and procedures,

and to ensure appropriate and optimal third party reimbursement.

.Assist in maintaining accurate and complete medical records to comply with

Title XXII, HCFA, OSHPD, and other local, state, or federal regulations or

requirements.

.Utilizes International Classification of Disease (ICD-9-CM) and Physicians

Current Procedural Terminology (CPT) coding systems and other coding

references to ensure accurate coding.

.Analyzes and interprets medical records to ascertain complete and accurate

information for coding and abstracting.

.Determines principle diagnosis(es) and procedure(s) utilizing updated

Medicare coding guidelines and other references.

.Identifies and codes all pertinent comorbid, invasive procedures,required

data and complicating. .Perform concurrent coding on the Nursing units,

Optimizes DRG reimbursement

BILLING AND CODING EXPERTISE

. ICD-9 Coding . CPT-4 Coding . Regulations . Outpatient/Inpatient Facility

Coding . Skilled Nursing Facility Billing

SPECIAL SKILLS

. Highly skilled in translating codes into insurance company' preferred

coding systems

. Able to perform charge review, claim submission, claim follow-up, payment

posting and patient statements

. In depth knowledge of preparing appropriate claim documents

. Proficient in assigning appropriate medical codes to diagnosis and

services

KEY ACCOMPLISHMENTS

. Obtained honors after finishing course for medical coding and billing

program

Estrella Tacub

2500 N. Buena Vista Street Burbank CA 91504

H 818-***-**** C 818-***-****) *************@*****.***

PROFESSIONAL EXPERIENCE

JPH Consulting, Inc - Los Angeles CA

Medical Billing February 2013 - Present

. Assign appropriate medical codes to all diagnosis and services

. Prepare appropriate claim documents

. Follow up with insurance companies and ensure that all claims come to

fruition .Ensure claims are entered and

submitted timely

.Retrieve Electronic Remittance Advice (ERA)

. Send secondary claims upon processing of primary insurance

. Post and reconcile

insurance and patient payments

. Research and resolve incorrect

payments, EOB rejections and other issues with outstanding balances.

Granada Hills Care Center - Granada Hills CA

Business Office Assistant August 2011 - February 2013

. Performed day to day functions associated with billing, i.e assist

residents/family members with billing questions, medical application etc.

revenue cycle, census updates, payroll, answering phones, filing, data

entry

. Review patient records for proper documentation for TAR

requisition

. Assigned ICD-9-CM codes for procedures and diagnoses

. Entered and verified resident information in computer and financial

folders

Olympia Convalescent Hospital - Los Angeles CA

Business Office Manager April 2005 - July 2011

. Ensure claims are entered and submitted timely

. Review

patient records for proper documentation for TAR requisition

. Assigned ICD-9-CM codes for procedures and diagnoses

. Entered and verified resident information in computer and financial

folders . Post and reconcile

insurance and patient payments. Research and resolve incorrect payments,

EOB rejections and other issues with outstanding balances.

. Retrieve Electronic Remittance Advice (ERA)

. Send secondary claims upon processing of primary insurance

. Monthly processing of patient statements. Answer and resolve patient

billing inquiries . Ensures office practices

are in compliance with HIPAA regulations

. Follow-up on Insurance and patient aging. Resubmit insurance claims as

necessary

. Set up new resident accounts

Hancock Park Rehab Center - Los Angeles CA

Business Office Assistant/HMO Biller March 2004 - April 2005

. Entering monthly charges, processing electronic and paper claims

. Checking and verifying claims report and EOB from insurance companies.

. Verifying residents eligibility, entering demographics into the system

. Follow up with insurance companies, does appeals as needed and necessary

Estrella Tacub

2500 N. Buena Vista Street Burbank CA 91504

H 818-***-**** C 818-***-****) *************@*****.***

Beverly Manor Healthcare Center - Burbank CA

.Medical Records Director November 1994 - March 2004

. Protect the security of medical records to ensure that confidentiality is

maintained

. Compiling, processing and maintaining medical records in a manner

consistent with medical, administrative, ethical, legal and regulatory

requirements of the health care system

. Identify, compile and code diagnosis in patient's chart/data

. Resolve/clarify codes and diagnoses with conflicting, missing or unclear

information by consulting nursing staff to get additional information.

. answering the telephone, prepared all new charts with name labels for

proper filing, filed x-ray reports, lab reports, physician orders, nurses

notes and other medical record correspondence in the residents file.

. Prepared necessary correspondence directly related to patient medical

records i.e requesting copies of medical records and making copies of

records when requested to do so.

EDUCATION

Career College Consultants, Inc - Los Angeles, CA

Diploma in Medical Billing and Coding - February 2013

Certified Coding Specialist (CCS)

Certified Coding Associate (CCA)

ADDITIONAL CAPABILITIES

. Excellent written and verbal communication skills

. Highly motivated personality with positive approach

. Proven ability to speak in a confident and assertive manner

Contact this candidate