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Medical Billing

Location:
United States
Salary:
42,000
Posted:
February 16, 2018

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Resume:

Julieanne Crompton

**** ***** *** 267-***-****

Philadelphia, PA 19149 ac4h4m@r.postjobfree.com

OBJECTIVE

Seeking a position where my experiences as a team player, customer satisfaction specialist and recently acquired Medical Billing and Coding training will be fully utilized and expanded.

SKILLS

Properly use and apply CPT, ICD-9, HCPCS and Medisoft

Medical Terminology, Anatomy and Physiology, Pathophysiology

Analyzed/recorded transactions, posted entries, produced computerized accounting programs: QuickBooks & Peachtree

Recorded and deducted employee’s withholding from payroll, calculated and recorded employer’s taxes, reconciled bank statement and checkbook, used various inventory valuation techniques

Created, edited, and formatted business with Microsoft Office Suit of programs-Word, Access, Excel, and PowerPoint

EDUCATION

Sanford-Brown Institute

Diploma, Medical Billing and Coding Technology 07/2012

GPA: 3.0

DPT Business School

Diploma, Computerized Business and Accounting 12/2006

GPA: 3.8

EXTERNSHIP

The Pinnacle Health Group 05/2012-07/2012

Medical Billing & Coding Extern

Determined appropriate CPT, HCPCS and ICD-9 diagnosis codes selected for medical procedures

Collected insurance information necessary to provide precertification for patients

Investigated patient health plan coverage, requirements, and reported findings to provider

WORK EXPERIENCE

Horizon NJ Health 05/2014-Present

Managed Care Coordinator

Handles initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.

Prepare, document and route cases in appropriate system for clinical review

Initiates call backs and correspondence to members and providers to coordinate and clarify benefits.

Upon completion of inquiries initiate call back or correspondence to Physicians/Members to coordinate/clarify case completion.

Reviews professional medical/claim policy related issues or claims in pending status.

Upon collection of clinical and non-clinical information, MCC can authorize services based upon scripts or algorithms used for pre-review screening.

Non-clinical staff members are not responsible for conducting any UM review activities that require interpretation of clinical information.

Perform other relevant tasks as assigned by Management.

Cigna HealthSpring 03/2014-05/2014

Precertification Specialist

Receive request for authorization from hospitals, providers, members and vendors.

Determine authorization requirements based on company policy, member benefit grid and provider status.

Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Pre-cert Nurse or Medical Director).

Process extensions of authorizations as appropriate.

Processes denials including correspondence sent to families, members, facilities and applicable contracted providers.

Notifies responsible parties prior to initiation of denial letter and ensures that member and responsible party understand details of the letter and the appeals processes to follow.

The Pinnacle Health Group 10/2012-11/2013

Reimbursement Case Manager Consultant

Determined appropriate CPT, HCPCS and ICD-9 diagnosis codes selected for medical procedures

Collected insurance information necessary to provide precertification for patients

Investigated patient health plan coverage, requirements, and reported findings to provider

Perform provider, member appeals for claim denials and precertification denials.

Senior Care Centers of America 09/2012- 10/2012

Billing Coordinator

Reviewing previous patient medical claims and benefits

Submitting claims to Medicare

Preauthorization’s

Lowes 09/2009- 09/2012

Cashier/ Customer Services

Handling cash transactions

Handling customer returns

Assisted in resolving customer concerns and complaints

BCG/Dunkin Donuts International 10/2006-02/2008

Shift Leader

Assisted the Store Manager in the interviewing, hiring, training of all new employees using approved HR guidelines

Managing the sales floor during peak hours of operation to ensure courteous, accurate and efficient service

Completed weekly food and paper inventory; maintained databases, and POS systems, ensuring they are up-to-date

CERTIFICATIONS

Medisoft

CPC-A (Pending)



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