Medical Insurance

Objective: To pursue a career in Medical Coding.

Skills

Medicare/Medi-cal/PPO/HMO

Electronic Medical Records (EMR)

Correspondence

Billing out third party claims

Corrective actions for denied claims

Patient Eligibility

Knowledge of Patient Management information system applications

Experience analyzing and interpreting various types of Explanation of benefits (EOB) and Remittance Advice (RA)

Follow -up/Collections

CPT/ICD10/HCPCS

Strong accuracy, Attentiveness to detail and time management skills

Knowledge of UB04/CMS1500/PM160

Experience

Nivano Health Medical Group Sacramento, CA August 2017 – Current

Review physician notes for any errors before billing out claim to payers

Abstract physician notes in order to code the highest level for reimbursement

Assign modifiers according to certain payers and rural areas

Verify any missing information before submitting claim out in order to avoid multiple submission of claims.

Argyll/Hopson Skincare Telecommute July 2016 – August 2017

Medical Billing Specialist

Generate primary and secondary billing claims

Resolve patient credit balance accounts

Follows up on submitted claims; monitors unpaid claims, resubmit claims as necessary

Assign modifiers, procedures, and ICD10 to claim form before submitting

Run aging reports bi-weekly along with claims to review with Manager

Dignity Health Medical Foundation Rancho Cordova, CA Oct 2013 – April 2015

Apply payments per the explanation of benefits to the appropriate invoices.

Take adjustments and 2% sequestrations from Medicare payments in order to balance out invoice.

Research on miscellaneous money in order to balance out batch.

Office Team – Sutter Physician Services Sacramento, CA Jan 2012 – Nov 2012

Follow up on unpaid claims with Medicare, Medi-Cal, PPO, HMO, and third party insurances.

Send appeals to insurance companies accordingly to Sutter’s contracts in order to get payment.

Make outbound calls to insurance companies on claim/appeal status.

Apply payments to invoices accordingly to explanation of benefits.

Work in IDX software to ensure appropriate claim submission.

Check patient eligibility for correct billing of insurance groups.

River City Medical Group Sacramento, CA Oct 2010 – Nov 2011

Responsible for applying capitations to appropriate invoices.

Appeal denied claims using RCMG’s policies and contracts.

Check on patient eligibility through Medi-Cal or other insurance groups for accurate billing.

Make changes to Medi-Cal TAR’s and resubmit form for reprocessing.

Apply payments accordingly to explanation of benefits.

Post charges to HCFA’s and PM160’s per the chart notes.

Generate patient statements after careful review of account balances and send out patient statements every month.

Education

AAPC – Certified Professional Coder (CPC) Feb 2016 – December 2016

Heald College Rancho Cordova, CA Diploma July 2010

Major: Medical Insurance Billing and Coding

River Valley High School Yuba City, CA Diploma May 2008

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