Louise Mattia aca6bn@r.postjobfree.com

678-***-****

*** ******* ***** *************, ** 30046

SUMMARY OF QUALIFICATIONS

A highly talented, detail oriented, efficient, and organized professional with extensive experience in insurance claims

processing, ICD 9, and CPT coding. Through knowledge in medical terminology, insurance products, policies, procedures,

and insurance information systems. Recognized for excellent customer service and claims resolution. Possesses strong

computer knowledge of Medicare, HMO, PPO, Managed Care, UHC, Worker Comp, Medicaid, Aetna, and other insurances

companies. Pays close attention to details (EOB’s); makes calls to insurance companies.

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● Medicare Credentialing (CMS 855)

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CMS 1500 Physician Billing

• Electronic Remittance (EMR)

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UB 92 DME Billing

• Skilled Nursing Facility Billing

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UB 04 Patient Billing

● Medical Terminology

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HME billing HCPCS Billing

• Hospital Billing/ Facility Coding

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Modifiers HIPAA Guidelines

Exceptional Interpersonal and Communication Skills – Proficient in promoting confidence and maintaining long

term relationships while successfully interfacing with people of diverse backgrounds and cultures.

Problem Solving – Proven ability to troubleshoot and develop creative and innovative solutions to health care

challenges. Successfully manages change for improved performance and greater efficiency.

Work Ethic and Professionalism – Solid professional standards and excellent track record of dependability.

Maintains focus on achieving bottom line results for the organization while ensuring medical claim completion.

PROFESSIONAL EXPERIENCE

Outpatients Infusion System Alpharetta GA

Medical Billing/Coding Supervisor October 2006 – Present

• Supervise and oversaw all aspects for 20employee. Follow up on Insurance and patient aging. Re submit insurance

claims as necessary.

• Knowledgeable in timely filing restrictions, Paper Batching

• Assign ICD 9 to physicians diagnosis and insure correct level of service and various other CPT codes

• Set up practice management software for submission of electronic claims to clearinghouse. Work with

• Clearinghouse to resolve file compatibility issues. monthly payment spread sheets for each company, naming the

lockboxes and in house deposits, recording them in the excel spread sheets, patients refunds, auditing patient

account

• Daily use of Code 3/3M encoder and CPT finder. Verify Patients insurance.

• Efficiently processes and works denied medical claims for major and private insurance carriers, which include:

HMO/PPO and Blue Cross/Medicaid/Medicare by using the designated systems for processing.

• Ensure claims are entered and submitted with 48 hours of receipt. Posting daily charges from super bills,

creating updated charges to be billed to insurance companies, and reconciling payments made to maintain updated

patient ledger demographics.

• Researches and resolves incorrect payments and EOB rejections; follows up on all claim submissions.

• Procedures using ICD 9cm and CPT 4, HCPCS Level II coding. Process 150 200 claims daily while

maintaining 97% accuracy and achieving productivity goals.

● Maximizes updated knowledge of policies and procedures, products, legislation, and claims workflow.

• Receives inbound telephone calls as well as paper and electronic claims from members and providers.

• Performs admin duties such as scheduling meetings and conferences for Doctors and Office Manager.

• General administrative duties include: answering phones, scheduling appointment, checking patient in/out,

faxing and copying documents, verifying patient insurance, and completing Doctor Referrals.

• Processes manual and electronic claims for reimbursement. Performs ICD9/CPT coding of charge slips.

• Manages lockbox/deposit batching and collections; prepares skip trace notices and payment arrangements.

• Proven ability in analyzing and processing out of network and DME claims to ensure patient satisfaction.

• Submits claim to various insurance companies. Corrects and submits claims to third party payers.

• Reviews and sends billing statements, and performs collection actions such as contacting patient’s by phone.

• Performed day to day functions associated with coding abstracting and revenue cycle.

Capital Orthopedics Rockville, MD

Medical Biller/Surgery Scheduler July 2000 – October 2006

Supervise and oversaw all aspects for 15employee.

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Processed claim from, adjudicates for provision of deductibles co pays, co insurance maximums and provider

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settlements.

Resolved problems resulting from claim settlement.

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Scheduled surgery and orthopedics procedures for patients

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Maintained surgery schedule and provided all information to physicians

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Ensured authorization for all surgeries from insurance companies and families

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Procedures using ICD 9 CM and CPT 4, HCPCS codes and applying appropriate

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Modifiers for the diagnosis. Using correct E&M codes. Submitting claims to Medicare, Medicaid and third

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parties. Electronic Billing under HIPAA rules

Responsible for daily operations of the clinical coding of diagnoses and procedures for outpatient and same day

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surgery patient. Responsible for 98% and above accuracy and timely coding for all designated

outpatient/Inpatient (work related, orthopedic, and radiology.

Responsibility such as attending the phone calls, arranging the referrals,

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Securing the patients records. Scheduled claims electronic billing and medical/insurance records management,

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which included major carriers, Medicaid and Medicaid. Maximized the use of ICD9/CPT coding and medical

terminology.

• Posted surgeries and coordinated with surgeons schedule; confirmed admitting privileges of Physicians.

• Provided patients with information that explained admission policies and HIPPA privacy guidelines.

• Analyze billing to improve coding data accuracy for Medicare compliance reimbursement.

• Assure the assignment of complete, accurate timely and consistent codes by the medical coding unit.

• Performed extensive follow up and insurance billing of Medicare, State Medicaid, and insurance plans.

• Routinely answered complex phone calls and inquiries for patients, insurance, and other providers.

• Processed hospital medical claims for billing purposes for Medicare D.C. and Maryland Medicaid.

• Trained billing personnel on fundamental processes and procedures for billing and Account Receivables.

• Facilitated and educated billing staff on complex billing issues that require in depth industry knowledge.

• Submitted claims to various insurance companies. Corrected and submitted claims to third party payers.

• Reviewed and sent billing statements and performed collection actions such as contacting patients by phone.

• Demonstrated ability in arranging hospital admissions and recommending referrals from the Physician.

• Managed patient’s account, which included the verifying of insurance benefits and authorizations.

• Provided efficient and detailed processing to ensure updated medical documentation, which included clinical

notes where in order before submitting to pre cert department for authorization.

Urgent Care/ Pediatrics Washington, D.C.

Medical Billing/ Collections June 1997 – July 2000

●Coded inpatient/outpatient, observation, emergency room (trauma), and diagnostic ancillary services.

●Ensured insurance forms were completed and that all necessary information inputted into the database.

●Responsibilities included: processing payments, making deposits, and performing general office duties.

●Communicated with Physicians and other health care professionals to clarify diagnoses and medications.

●Demonstrated ability in abstracting medical records with ICD 9 CM, CPT, and DRG coding, reviewing ●updated

charts for correct admit/discharge dates, and entering in all appropriate surgery dates.

●Performed post charges, co pays, insurance payments, demographics, and contractual adjustments vital.

●Evaluated patient’s financial status and established payment plans. Reported status of delinquent accounts.

●Submitted claim to various insurance companies. Corrected and submitted claims to third party payers.

●Responsibilities included: screening telephone calls, meeting and greeting clients, data entry, and filing.

●Provided knowledge and expertise in providing clients with latest information relating to their claims.

●Actively collected insurance cards and co payments and scheduled appointments for in patients.

●Led the process of initiating and maintaining correspondence with patients and insurance companies.

●Identified business challenges and collaboratively shaped solutions to ensure timely patient billing.

EDUCATION

Gwinnett College of Business Lilburn GA

Bachelor Degree in Accounting – GPA: 4.0 March 2010

SKILLS

QuickBooks, Microsoft Office (Word, Excel with pivot tables, Power Point, Access, Outlook). Internet Explorer,

Bookkeeping, Peachtree, Medical Mastermind, Bright tree Noble direct, Medical Manager, All scripts, Lytec, Medisoft,

AdvanceMD, Eclipse, Encore, Cerner Ambulatory, ADP Software, sage, MAS 90/200 Word Perfect, Medical

Terminology Medical Office Procedures, Medical Software, CPT Coding, ICD 9 Coding, HCPCS Coding, and HIPPA

Confidentiality.

Contact this candidate