Data Entry Medical

Mary Hudelston

Phone: 612-***-****

E-mail: ac0fn1@r.postjobfree.com

Objective and Goals

Experienced Insurance & Billing Specialist, Utilization Management Associate and Coder searching for a position where my skills and education will contribute to the success of a facility. I am educated and efficient and possess very good verbal and written communication skills, and I am a very good multi-tasker. I am noted for getting the job done and providing quality work. I enjoy challenging work and am confident that any company would benefit from my experience and skills.

Areas of Expertise

DME, Inpatient and Outpatient Hospital Billing

Primary and Secondary Blue Cross and Medicare Advantage Plans & Commercial Billing

Expertise with payers medical policies

Review denials/ file appeals for reimbursement within timely filing/guidelines

Recognize and communicate denial trends and payer issues appropriately

Understand EOBs (Explanation of Benefits) denials/allowances

Identify, compile, and code patient data, using standard ICD-9-CM + ICD 10, HCPCS codes

also 3M encoder

Utilization review experience with obtaining Prior Authorizations for Hospital Admissions and also

Ambulatory Surgery Procedures.

Review of Medical Policy for Benefit Coverage prior to healthcare event/ equipment.

Understanding and knowledge of Interqual, and Milliman & Robertson Admission Criteria.

Analyze data in the medical record for completeness, accuracy and compliance.

Produce statistical reports relevant to quality assurance functions in accordance with JCAHO

Protect the security of medical records in accordance with HIPAA rules

Assist physicians with record completion activities

Use of Software/Hardware systems to write programs/produce statistical reports for Administration

Supervisory experience for the HIM Department

Chosen by Administration for the Corporate Communications Committee

Recouped over 1 million in 16 mos for DME supplier

Recouped over 75K in Ortho for Outpatient Hospital

Maintain effective working relationships with payers, customers and internal departments

Technical/Computer Skills

AS400, Doc Star, Med force, PCS, EPIC, Outlook, All scripts, Cerner, Meditech, SMS, 3-M Encoder,

Stockamp, Passport, E-care, PC Print, PeopleSoft, Soft Med Chart Fact/ Locator Systems, Care Web,

Lotus Notes, CATS, Folio Views, Avaya, ETRS, Stars, Pega, Microsoft Word, Excel and Crystal Reports

Employment History

*Indicates Contract Employment

*McKesson MedSurg Medimart Revenue Cycle Specialist Aug 2015-Mar 2017

Abbott Northwest Hospital Utilization Management Assoc Aug 2012-Dec 2014

* IOS Staffing Solutions Agency FMLA Claims Assistant Dec 2011-April 2012

* Sedona Agency Payer Implementation Mar 2011-Nov 2011

* Manpower Agency Data Entry Dec 2010-Feb2011

Genesis Hospital Patient Billing Technician Nov 2009-Sep 2010

Methodist Hospital Patient Access Representative Sep 2008-Jun 2009

* Manpower Agency Cardiovascular Records Clerk Mar 2008-Aug 2008

* K-Force Agency HIM Technician Sep 2006-Apr 2007

St. Joseph’s Hospital Radiology Records Clerk Dec 2004-Oct 2005

Oakwood Southshore MC HIM Tech/ Coder/ Supervisor Jul 1980-Aug 2003

Education

Huron High School- Diploma

American Medical Record Association

Coding: The Key to Data Quality

Comprehensive Coding Seminar

ICD-9-CM Coding

ICD9-CM Ambulatory Coding

Advanced ICD-9-CM Coding

AMRA 2 year program completed for Accredited Record Technician

Hospital Learning Centers, Inc.

Code 3/HIS Advanced Data Collection and Reporting System Data Entry Software

Code 3/HIS Comprehensive Chart Management system Data Entry Software

Code 3/HIS Comprehensive Chart Management System Update

3M/HIS Data Collection and Reporting System Reporting Software

3M/HIS Advanced Data Collection and Reporting System Reporting Software

3M Comprehensive Chart Management System Reporter Software

Crystal Reporting Software and program writing.

Contact this candidate