JOY SURRATT

***** * ******* ******, ** ***** (C) 720-***-**** ac9el6@r.postjobfree.com

Professional Summary

Medical billing and coding specialist with 30 years providing administrative and patient support in hospital and medical office settings. Advanced knowledge of private insurance processes and codes. Analytical Quality Improvement Coordinator highly effective at clinical care, coding and compliance reviews. Well-versed in latest standards and techniques. Pursuing long-term position with room for growth and career advancement. High-performing Medical Billing/Coding with 30 years of healthcare experience in hospital and medical office environments.

Skills

● Strategic decision making

● Regulatory compliance

● ICD-10 (International Classification

of Disease Systems)

● Excellent problem solver

● Inpatient records coding proficiency

● HCPCS Coding Guidelines

● Familiar with commercial and

private insurance carriers

● Adept multi-tasker

● Insurance and collections

procedures

● DRG and PC grouping

● Ambulance coding familiarity

● Resourceful and reliable worker

● Excellent verbal communication

● Reporting requirements

● Medical terminology expert

● Billing and collection procedures

expert

● Hospital inpatient and outpatient

records

● Outpatient surgery coding specialist

● Understands anesthesia coding

● Patient chart auditing ability

● Behavioral health billing and

collections

● OASIS billing and coding

● Understands insurance benefits

● Research and data analysis

● Close attention to detail

Work History

Customer Care Representative11/2006 to Current

Kaiser Permanente – Aurora, Colorado

● Answered an average of (70 to 80 calls per day) by addressing customer inquiries, solving problems and providing new product information.

● Politely assisted customers in person and via telephone.

● Developed reputation as an efficient service provider with high levels of accuracy.

● Scored in top 10% of employees in successful resolution of issues

● Investigated and resolved customer inquiries and complaints in a timely and empathetic manner.

● Ensured superior customer experience by addressing customer concerns, demonstrating empathy and resolving problems on the spot.

● Managed wide variety of customer service and administrative tasks to resolve customer issues quickly and efficiently.

● Directed calls to appropriate individuals and departments.

● Set up and explained new membership contracts.

● Reviewing and researching professional and institutional claims.

● Extensive knowledge coding policies and procedures.

● Complex provider and member issues.

● Provider Configuration

● Claims processor claims adjuster research and resolution auditor.

● Extensive knowledge of hmos and ppos Medicaid and Medicare CMS guidelines and regulations. Medical Billing Specialist01/1989 to 04/2006

United Healthcare – Lansing, MI

● Coordinated with other internal departments and customers to keep operations running smoothly and solve both routine and complex problems.

● Reviewed documentation for compliance with requirements and accuracy of information.

● Developed and implemented improvements to billing system to maximize efficiency, reduce delinquency and increase accuracy.

● Coded inpatient charts at a rate of 20 per hour .

● Precisely completed appropriate claims paperwork, documentation and system entry.

● Correctly coded and billed medical claims for various hospital and nursing facilities.

● Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge.

● Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms).

● Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.

● Maintained updated knowledge of coding requirements, through continuing education and certification renewal.

● Verified patients' eligibility and claims status with insurance agencies.

● Entered orders into the EMR system efficiently and without errors.

● Diligently filed and followed up on third party claims.

● Prepared patient charts, pre-admissions and consent forms as necessary.

● Compiled necessary documents for surgical billing packages.

● Assigned appropriate medical codes with a 95 percent accuracy rate.

● Determined prior authorizations for medication and outpatient procedures.

● Pre-certified medical and radiology procedures, surgeries and echocardiogram.

● Coded APV charts at a rate of 20 per hour.

● Coded Observation/Inpatient Professional Services at a rate of 11 per hour.

● Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.

● Researched questions and concerns from providers and provided detailed responses.

● Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.

● Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.

● Maintained strict patient and physician confidentiality.

● Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.

● Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories.

● Initiated, performed and documented quarterly coding audits for physicians.

● Managed collections claims for unpaid bills against the estates of debtors.

● Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations.

● Accurately posted and sent out all medical claims.

● Submitted electronic/paper claims documentation for timely filing.

● Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services.

● Precisely evaluated and verified benefits and eligibility.

● Posted and adjusted payments from insurance companies.

● Identified and resolved patient billing and payment issues.

● Confidently and adeptly handled claim denials and/or appeals.

● Maintained and updated collections tracking spreadsheet to help organize payment information.

● Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.

● Treated all patients, their families, visitors, peers, staff and providers in a pleasant and courteous manner.

● Accurately posted surgeries, hospital visits and payments for assigned carriers.

● Prepared billing correspondence and maintained database to organize billing information. Education

Associate of Science: Business Administration1989Washtenaw Community College - Ypsilanti, MI

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