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Medical Coder, Medical Insurance specialist

Location:
Wausau, Wisconsin, United States
Salary:
Negotiable
Posted:
September 26, 2018

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Resume:

LISA BLANCHETTE

N**** County Rd E

Merrill, WI **452

Residential: 715-***-**** E-mail: ac66yi@r.postjobfree.com Cellular: 715-***-****

Objective: To acquire a position with the potential for advancement where I can utilize my knowledge and experience.

Profile: A competent, energetic individual with over 25 years of health care billing and insurance experience. Able to effectively multi-task and prioritize, coupled with the ability to work well under pressure in a results-oriented work environment. Conveys strong initiative and good judgment skills. Organized and meticulous with details, maintaining a great degree of accuracy. Learns new skills and methods quickly with the ability to apply immediately. Demonstrates a high level of professionalism at all times. Able to interact and effectively communicate with a variety of internal and external customers, including patients, physicians, clinical staff, and insurance representatives. Committed to modeling and promoting good work ethics and establishing high standards of excellence in service and performance.

Key Strengths & Knowledge:

Ø Medical Terminology Ø Medical Office Procedures

Ø CPT & ICD-9-CM Coding Ø Electronic Medical Records/Billing Systems

Ø Health Insurance Billing Ø Pharmacology

Ø Third Party Reimbursement Ø Analytical Skills, Proof Reading & Spelling

Professional Experience:

UNITED HEALTHCARE – Wausau, Wisconsin

Employer Installation Specialist 2010 - present

Review detailed benefit coding

Configuration of Benefit coding based on the customers sign off and intent.

Use supporting documentation (Install docs & WO’s) to ensure CPS system is coded correctly.

Adhere to departmental guidelines and processes put in place for these tasks.

Work in a Team environment while demonstrating individual accountability.

Perform other duties as assigned (training, mentoring, handling unique special groups and special projects as needed).

Work frequently completed without established procedures.

Become familiar with current policies and procedures and other referenced materials.

Identify program deviance from standards, and suggest modifications to ensure compliance.

My position in this function is responsible for the Installation of assigned accounts.

Benefit coding reviews

Researching and resolving potential coding issues.

Research Installation issues

Auditing contract load for adherence to Quality measure and reporting standards.

SENTRY INSURANCE - Stevens Point, Wisconsin 2007 – 2009

Claims Technician

I have the ability and willingness to remain at the assigned work stations and follow a structured schedule which is necessary to meet customer call volume requirements.

Perform effective listening skills and the ability to identify the specific nature of the inquiry.

Provide good communication and human relations skills to deal effectively with customer issues in a professional manner.

Assisted patients, insurance companies or other healthcare providers in identifying and resolving problems related to billing.

Provided effective Coding reviews in a timely manner.

Helped other areas as needed to provide effective team leadership goals.

ASPIRUS – Wausau, Wisconsin 2006 - 2007

A Central Wisconsin Healthcare Leader in providing professionalism and excellence.

Medical Coder

Performed monthly audits, resulting in improved coding and reimbursement.

Reviewed encounter forms from several units to assign the correct ICD-9/CPT-4 codes for billing purposes, then manually process the claims in the system.

Worked on special projects as needed.

Discussed complex coding issues with providers, interacted with physicians, IPA administration, hospitals, vendors, and office staff to ensure that pertinent requirements for coding are met, resulting in improved coding for appropriate reimbursement.

Provided ongoing feedback and education to physicians and related providers.

MERCY HEALTH SYSTEMS – Janesville, Wisconsin 2000 – 2006

A Health System Network Partner of 50+ facilities across 7 counties in Southern Wisconsin & Northern Illinois

Medical Coding Specialist II

Reviewed medical records, notes, dictation and other related documentation and assigned ICD-9-CM/CPT-4 diagnostic and procedural codes for all patient types for data retrieval, statistical record keeping, medical research, billing, and reimbursement.

Identified coding opportunities and issues and recommended correct coding of medical claims and encounters.

Provided ongoing feedback and education to physicians and related providers.

Discussed complex coding issues with providers, interacted with physicians, IPA administration, hospitals, vendors, and office staff to ensure that pertinent requirements for coding are met, resulting in improved coding for appropriate reimbursement

Performed research on inquiries from physicians or other staff members as required.

Met and exceeded monthly department goals.

UW HEALTH/PHYSICIANS PLUS – Madison, Wisconsin 1999 – 2000

A Comprehensive Health Care Provider

Medical Billing Specialist

Provided quality customer/client service through excellent listening and follow-through skills.

Responded to patient questions regarding insurance coverage and, for surgical services which require prior authorization, submit a preauthorization request.

Assisted patients, insurance companies or other healthcare providers in identifying and resolving problems related to billing.

Obtained, verified and/or updated patient demographic and insurance coverage information, establishing prepayment accounts, collecting co-payments, and time of service payments.

Demonstrated effective leadership and encouraged team concepts.

WPS INSURANCE CORPORATION - Madison, Wisconsin 1991 – 1999

One of the Largest Health Care Benefits Providers in the State of Wisconsin

Claims Rep, Customer Service Rep, Grievance/Appeals Coordinator & Pend/Edit Analyst

Processed medical claims in a timely manner.

Responded to written and telephone requests for WPS Customer Service.

Consulted with insurers to determine their needs and priorities.

Education: Kaplan College – Online (Iowa based campus) 2004

Completed 23 college credits towards an Associates Degree in Criminal Justice

Blackhawk Technical College – Monroe, Illinois Certificate: 2002

Completed Skilled Nursing Assistant Course

Northside High School – Fort Wayne, Indiana Graduated: 1987

Concentrated studies on Business Administration & Computer Science

Certificates: CPC Certified – American Academy of Professional Coders Expired 2007

Takes 18 Continuing Education Credits (CEUs) per year to keep current status.

Foundational Quality Certificate (211505) –- ULearn August 2013

Enterprise Operational Excellence

Six Sigma (Green Belt) - UnitedHealth Groups’s Foundational Quality

Interests: Gardening, exercising, fishing, riding our Harley, listening to music, walking my dogs and most of all spending time with my family.



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