Medical Insurance
Resume:
SHANIYA HAMILTON, CPC
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
Jan 01,2014- Feb 11,2015 COMPREHENSIVE SLEEP MEDICINE ASSOCIATES
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
Education:
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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