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Medical Insurance

Houston, Texas, 77095, United States
May 10, 2019

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

Lufkin, TX 75901


AAPC# 00078451

Career Objectives :" I am a dedicated and dependable individual who has an ambition to make the best of any position given. I am seeking a position within a progressing company which will provide an opportunity for stability and growth."

Summary of Qualifications :Type 50 wpm, MS Word, Excel, Windows, Medisoft, NexGen, Meditech, Epic, Health Smart, ICD-9 & ICD-10 certification, Encoder, 3M Coder

Work History

April 4,2016-Current Cigna HealthSpring

HCC Medical Coder

Maintain 95% accuracy and completeness on all charts as well as meeting 6-8 CPH

Follows CMS risk adjustment guidelines and has a complete understanding of the guidelines.

Queries providers on specificity of coding whenever there is question on specificity level

Review patient encounters to determine the appropriate ICD-10 codes as supported by the provider's documentation, verifying the record abstracted is for the noted member and claim, verifying the claim is for a valid risk adjustment service


Medical Billing & Coding

Process and code claims within a timely matter for all commercial insurances as well as Medicare/Medicaid/Workers Comp

Verified insurance coverage, processed and prepared patient refunds, answered and explained any questions to patients regarding insurance coverage and how claims were paid

Received prior authorization when needed for procedures, filled out predetermination forms when needed, scheduled patients

DEC 01, 2008 - Jan 01,2014 MEMORIAL MEDICAL CENTER

IP/OP Charge Capture

Accurately submitted selection of ICD-9 CM and CPT procedure codes based on EMR to the highest degree of specificity and level of diagnostic work up based upon medical records

Performed line item charge reviews using patient enhanced encounters, assure accuracy of charges captured for insurance and patient billing for both IP/OP services

Validated documentation on all diagnosis codes in chart to capture HCC’s

Jun 01,2006 - AUG, 2008 RADIOLOGY WEST

Medical Claims Processor

Manage insurance claims to determine the validity of all medical claims from patients

Thoroughly reviewing the claim to ensure that there is no missing or incomplete information before submitting the claim

Followed up on medical claims that have been submitted or that might have been lapsed cases

Feb 01,2005 - Nov 01, 2005 Hospice in the Pines

Insurance Verification Specialist

Verified patient insurance coverage, setup durable medical equipment with patient 's insurance according to what was needed

Assists patients with help on choosing the correct medical equipment such as wheelchairs, c-pap machine, crutches, nebulizer for children and adults plus correct fittings for nebulizer, walkers, motorized scooters, bedside portable seats, etc...

Feb 01, 2002 - Sep 01, 2004 Neurocare Network

Outpatient Specialist

Verified the patients insurance coverage, update patient demographics, processed claims using ICD-9 and CPT codes

Scheduled patients for follow up procedures, follow up calls to remind patients of appointments,filed medical records

Feb 01, 2000 - Feb 01, 2002 Aetna U.S. Healthcare

Healthcare Claims Processor

Processed referrals using ICD-9 and CPT codes, verified insurance coverage

Filed medical records, update patient demographics

Processed claims electronically or by fax, follow up calls for all private and commercial insurance


Blinn College:

Major: Registered Health Information Technology

Expected Graduation Date: August 2016

Courses Completed: Anatomy & Physiology 1&2, Medical Terminology, Coding and Classification, Computer Systems for Health Information Technology, Legal and Ethical Aspects of HIM, Human Diseases and Conditions, Pharmacology, Methodology

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