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Administration

Location:
Bel Air, MD
Posted:
March 16, 2019

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Resume:

CORE QUALIFICATIONS

Customer/Client/Patient Service

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

WORK EXPERIENCE

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.

(Continued)

WORK EXPERIENCE

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.

Billing Manager

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.

EDUCATION

Joppatowne Senior High School, Diploma

Medix School, Healthcare Administration, Diploma

CERTIFICATIONS

American Academy of Professional Coders, CPC

Certificate of ICD-10-CM Proficiency

PROFESSIONAL REFERENCES

Stephen Maddock, CEO

Orthopaedic Associates of Central Maryland

910 Frederick Road

Catonsville, MD 21228

410-***-****

Dave Barringer, PT

Drayer Physical Therapy Institute

1401 Conowingo Road

Suite C

Bel Air, MD 21014

410-***-****

Jeff Tucker, CFO

Hart to Heart Ambulance Company

355 Granary Road

Forest Hill, MD 21050

410-***-****



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