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Josemary Negron-Chardon, CPC

**** *. ********* *****

Grand Prairie, TX 75052

Cell: 817-***-****

Email: ac56ii@r.postjobfree.com

Summary:

Trained and driven billing and coding specialist with over 20 years of experience in analysing, auditing and coordinating health insurance claims. Passionate about contributing to the healthcare system. Dedicated to the wellbeing of patients; excellent teamwork with my peers and providers. Highly skilled and experienced in Medical Terminology, Anatomy and Physiology; data management, data entry, conducting bill practices. Experienced in coding and billing programs and electronic health records. Looking to excel in my career and contribute my skills for the benefit of the company. Possess excellent customer service skills and has experience in inbound and outbound calls from/to patients and providers. Looking to further my career and contribute my skills for the benefit of the company. Core Qualifications:

• ICD-9, ICD-10, CPT-4, HCPCS

• HIPAA Compliance (Health Insurance Portability and Accountability Act)

• HRA (Health Risk Assessment)

• HCC (Hierarchical Condition Category) Risk Adjustment Coding (physician, inpatient and outpatient)

• Medical coding (Pro-Fee / Professional)

• Quality Assurance and auditing

• Insurance terminology

• Anatomy, Physiology and Medical terminology

• Data entry, Data management, tipping average 38 to 40 WPM

• Electronic health records, encoder (3M), medical billing softwares (QNXT, AS400)

• Microsoft office systems (Word, Excel, PowerPoint, Outlook, One Note)

• Medicare, Medicaid, and private insurance claims

• Bilingual, proficient in Spanish and English: Speech, reading, and writing

• Star + Plus Texas Waiver Program Knowledge

Education:

• Ponce Paramedical College- Technical Degree in Medical Secretary with Medical Billing and Coding. Graduated with honour: 1996-1998

• Pontifical Catholic University of PR- Commercial Administration in Communications: Completed 93 credits: 1990-1993

Experience:

Cigna Health Spring (3-month assignment), Bedford, Texas 01/2018-03/2018 Care Senior Associate

Responsibilities:

• Inbound and outbound calls to/from members and providers in a support role to service coordination within the health services department regarding Star + Plus waiver clients.

• Makes inquires on authorizations involving services, medical supplies, or medical equipment.

• Confirms delivery and receipt of medical supplies and equipment or initiation of services.

• Gathers, documents and tracks information timely into a tracking and monitoring application daily.

• Maybe required to route messages and information to service coordinators within specified timeframes.

• Data entry of correspondence received via fax regarding services 2

Medical Card System (MCS), San Juan, PR 06/2010-10/2017 Clinical Coding Technician (Risk Adjustment)

Responsibilities:

• Analysing medical records (Inpatient, Outpatient and Physician), identifying medical diagnostics and coding using ICD-9, ICD-10 and 3M encoder

• Classified diagnoses to facilitate billing and reimbursement

• Risk adjustment or Hierarchical Condition Category (HCC) coding (physician, inpatient and outpatient)

• Explored health profiles.

• Analysing and coding CHRA (Comprehensive Health Risk Assessment). First Plus Health Care 2009-2010

Claims Auditing Coordinator, Guaynabo, PR

Responsibilities:

• Auditing claims ready to be paid to providers, verifying codes submitted by providers are correct, and that charges are paid accordingly to contract.

• Referring possible fraud or abuse, and resubmitting bills to the corresponding areas.

• Coordinating special tasks to meet requirements for previous agreements.

• Preparing reports of production, payment errors and projections.

• Personnel supervision

• Released payments to providers

ProSalud HMO, Corp., San Juan, PR 2007-2009

Claims Coordinator

Responsibilities:

• Coordination of the department of claims. Coding and verifying the codes and charges are entered into the system correctly.

• Verifying bills vs contract and adjust payment in the system according to the contract.

• Preparing agreed forms of payment, negotiating contracts with providers, orienting providers on billing and coding, working refunds, and coordinating all things related to claims and relations with providers.

• Coordinating special tasks to meet requirements for previous agreements.

• Personnel supervisor.

Servicios Generales Episcopales, Ponce, PR 2004-2007 Medical Insurance Collection Officer

Responsibilities:

• Visiting health insurances all throughout Puerto Rico to charge pending bills for various hospitals.

• Analysing accounts for their due payments.

• Reopening closed accounts that were left for uncollectable and obtaining payments. Preparing monthly reports of charges, and charge projections.

• Delivering invoices to health insurances. Reconciliation of accounts with health insurance officials and negotiating payments.

• Reconcile EOP and enter payments in the system.

• Follow up on all claims from billing through final resolution.

• Correct and identify billing errors and resubmit claims to insurance carriers.

• Follow up on payment errors, low reimbursement, denials etc.

• Review Insurance EOB and initiate appeals as necessary.

• Ensure maximization of collection dollars from insurance companies in accordance with the respective contracts.

• Obtain corrected information and request rebills.

• Respond to payer’s request for additional information/documentation. 3

• Confer with Billers & Coders, as necessary, to obtain additional information/clarification.

• Co-ordinate requests for medical records.

• Posting account adjustments as a result of written communication from third parties (i.e. certain contractual adjustments, etc.).

• Provides balance breakdown to document the status, i.e., primary payor balance, secondary or credit balance, patient balance.

• Provide clear and concise documentation of every action taken on an account in the system collection notes

ALM & Associates, Oxymed, Ponce, PR 2003-2004

Medical Billing Officer (Durable Medical Equipment) Responsibilities:

• Making/processing bills and claims to insurance companies.

• Reconciling and posting payments, adjusting, resubmitting bills, archiving, creating memos, making billing arrangements to medical insurances, and preparing delivery leads.

• Tending to patients needs and questions.

Dr. Renier D. Gonzalez Cruz (Wound Care), Juana Diaz, PR 2002-2004 Remote Medical Billing and Coding Officer (Pro-Fee) Responsibilities:

• Coding using ICD-9, CPT-4 and HCPCS

• Making/processing bills and claims to insurance companies.

• Reconciling and posting payments, adjusting, resubmitting bills, archiving, creating memos, making billing arrangements to medical insurances, and preparing delivery leads. Dr. Robert A. Engel Ramos (Cardiologist), Juana Diaz, PR 1998-2003 Medical Secretary and Health insurance billing and Coding (Pro-Fee) Responsibilities:

• Coding using ICD-9 and CPT-4, Making/processing bills and claims to insurance companies. Reconciling and posting payments, adjusting, resubmitting bills, archiving, creating memos, making billing arrangements to medical insurances, and preparing delivery leads.

• Tending to patients needs and questions, including taking vitals, assisting the MD, obtaining EKG’s and develop Holter tests.

• Making calls to Insurance companies and coordinating services and authorizations. Medical assistant. Clerical tasks in general.

Licences and Certifications:

• Certified Professional Coder (CPC) #01607107 from AAPC (American Academy of Professional Coders) Highlights:

• Higher grade in ICD-10 coding training

• Anatomy, Physiology and medical terminology Certification

• CPC Completed Course from Medical Coding Academy

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