Physician practice front desk operations
Accounts receivable, denial management
Knowledge of anatomy, medical terminology, and the use of HIPAA-compliant medical code sets including CPT-4, ICD-9/10, modifiers, and HCPCS
Payer-specific billing and documentation requirements
Working knowledge of medical billing software: Medical MasterMind, Meditech, Medical Manager, Mysis, Intergy, gMED, and IDX.
Computer skills: Microsoft Word, Outlook, Excel, Access, and PowerPoint
GROUP BENEFIT SERVICES
Claims Adjudicator/Excess Loss Claims
Processed self-insured employer groups’ medical claims, meeting all productivity and quality goals
Researched, prepared, and filed excess loss (stop-loss) claims for three different lines of business
Responded to all excess-loss carrier questions and requests for additional information
MEDSTAR PHYSICIAN BILLING SERVICES
Follow-Up and Appeals Supervisor
Analyze receivables based on financial class
Develop and implement policies and procedures necessary to maintain backlog-free processing, such that claims are followed up and/or appealed within established time frames.
Review all denied appeals for accurate coding of CPT and ICD-10 codes.
Ensure all claims paid below contracted fee schedules, global rates and/or profile amounts are appealed.
Handle patient complaints to satisfactory resolution.
PULMONARY AND CRITICAL CARE ASSOCIATES OF BALTIMORE, PA
Client Implementation Coordinator/Compliance Coding
Serve as liaison for the client and the billing entity.
Responsible for the coordination and completion of third-party coding audits.
Perform weekly audits of physician documentation to ensure proper coding, accurate claims filing, and optimal reimbursement.
Responsible for the successful on-boarding of new clients to the billing platform.
Provide new client services such as monitoring of billing performance, accounts receivable, report analyses, and denial management.
Create and maintain real time “dashboard” which provided at-a-glance lean daily metrics for each client.
Managed 3.2 million in accounts receivable and maintained average AR days of 45.
Reviewed all claim denials for “not medically necessary” to determine if the medical record supports the use of diagnoses included in the LCD.
Increased self-pay revenue by 40% by employing an aggressive telephone campaign.
Primarily instrumental in the implementation and training of EMR/EHR system.
Joppatowne Senior High School, Diploma
Medix School, Healthcare Administration, Diploma
American Academy of Professional Coders, CPC
Certificate of ICD-10-CM Proficiency
Stephen Maddock, CEO
Orthopaedic Associates of Central Maryland
910 Frederick Road
Catonsville, MD 21228
Dave Barringer, PT
Drayer Physical Therapy Institute
1401 Conowingo Road
Bel Air, MD 21014
Jeff Tucker, CFO
Hart to Heart Ambulance Company
355 Granary Road
Forest Hill, MD 21050