Medical Insurance
Resume:
Melanie Sebastian, CPC
Cincinnati, Ohio 45213
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OBJECTIVE
Aspire to obtain gainful employment in the healthcare industry that will allow for continued
personal and professional growth commensurate with achievements.
PROFESSIONAL EXPERIENCE
TCI Healthcare Service, Cincinnati, OH 04/13-present
Certified Coding Specialist
• Accurately code claims directly from operative reports.
• Assist with research of denied claims.
• Review medical records and assign accurate codes for diagnostic and procedure codes to
patient records using ICD-9, CPT-4 and HCPCS.
• Ensure coded data accurately reflects services provided, based on documentation, guarding
against fraud and abuse.
• Communicate documentation improvement opportunities and coding issues to appropriate
personnel for follow up and resolutions.
• Assist with research for denied claims.
• Coding medical specialties include Anesthesiology, Infusion, Radiology, Emergency Room
Evaluation and Management, and Vascular.
Children’s Eye Physicians, Cincinnati, OH 01/12 – 12/12
Certified Professional Coder
Reviewed, analyzes, and code diagnostic and procedural information that determines
Medicare, Medicaid and third party reimbursement guidelines.
Assured the final diagnoses and operative procedures as stated by the physician are valid
and complete necessary to assign accurate ICD-9, CPT-4, HCPCS codes and modifiers.
Abstracted all necessary information to code surgical procedures and assigns codes that
most accurately describe each documented diagnosis, surgical procedure according to
established guidelines.
Performed daily tasks of sending claims electronically to establish clearinghouse and
correcting edit report to submit clean and accurate claim for reimbursement.
Closed out month end to balance all accounts receivable and analyze reimbursement.
Served as an advocate in the appeal process for denied claims.
Posted primary, secondary insurance electronic insurance payments.
Collected on outstanding accounts receivable for Government and Commercial carriers.
Transmitted and mail out electronic patient statements.
Performed collection procedures on unpaid patient accounts.
McGrath Billing Services, Cincinnati, OH 03/07 -12/11
Billing Specialist
Assisted with medical billing duties including follow-up on outstanding account receivable
accounts,
Posted insurance and personal payments.
Posted surgery, office and hospital charges.
Transmitted electronic patient statements.
Researched claims denied for non-payment by resubmitting, appealing, or processing
accounts for bad debt.
Prepared accounts receivable adjustments for processing and approval.
Collect self-pay account balances, work off A/R, review EOBs and establish payment
plans.
Internal Medicine Associates, Edgewood, KY 01/02-02/07
Coding and Billing Specialist
Followed up with government and commercial insurance companies on outstanding
accounts receivables.
Assigned codes on all diagnoses, procedures and supplies with the most accurate and
descriptive ICD-9, CPT-4, Evaluation and Management and HCPCS codes for all patient
encounters for reimbursement..
Electronically submitted claims to insurance companies.
Edited and revised edit reports as well as daily activity and month end reports.
Posted primary and secondary insurance payments to patient accounts.
Issued refunds and adjustments on overpaid accounts.
Served as advocate in the appeal process.
Performed collection duties on patient balances.
PROFESSIONAL CERTIFICATION
2012-Certified Professional Coder (CPC)
American Academy of Professional Coders (AAPC)
Member ID# 01229373
EDUCATION
University of Cincinnati Blue Ash 01/11-present
Associate of Science in Medical Coding and Billing
Expected Gradation Date: 05/2015
Accumulate Credit Hours: 40
Coursework includes: Medical Terminology, Anatomy and Physiology, Advanced Medical
Coding, ICD-9, CPT-4, and HCPCS coding.
Gateway Technical College, 08/98 - 05/99
Medical Insurance Billing and Coding Specialist. (Certificate)
SKILLS
• ICD-9, CPT-4, and HCPCS coding
• Healthcare Reimbursement
• Physician Quality and Reporting System(PQRS)
• Billing and Accounts Receivable
• Knowledge of HIPPA and patient confidentiality
Contact this candidate