Medical Billing

Nancy J. Carey, CPC, CMC, CMOM

*** * ***** ******

Cleveland, Oh 44110

Home: 216-***-****

Cell: 216-***-****

Objective: To obtain a position as a Medical Billing and Contract Negotiation skills.

SUMMARY OF QUALIFICATIONS

Administrative/Coding/Billing

• Over 20 years of experience in the Healthcare field

• Ability to code medical charts abstracting medical documentation using correct

code initiatives

• Trained to Negotiate and Interpret payor fee schedules

• Proficiency in Credentialing and Physician Licensing

• Implementating and evaluating manage care issues

• Resolve Billing discrepancies and review billing statements

Computer

• Experienced in using Word, Excel, Access, PowerPoint

• Comfortable working in Windows and in the Internet environment

• Ability to adapt to new computer programs and applications rapidly

Communication and Interpersonal Skills

• Demonstrate sound writing and speaking skills acquired and polished in business letter writing of reports, graphs and speech classes.

• Interact well with people as evidenced in my successful career in the Coding/Billing field.

• Enjoy working with details and completing assignments accurately and in a timely fashion.

EXPERIENCE

Assistant Business Ofc Mgr., Shaker Clinics 216-***-**** July 2011 – Present

Supervisor of Patient Accounting, responsibilities include: Coding and Processing Encounters for data entry regarding Medicare, Medicaid, Macsis, and Managed Care. Review Revenue Cycle reporting, follow-up with accounts. Collection of all Upfront revenue. Auditing charts, review clinical data to ensure proper documentation is accurate. Manage Care and Third Party contracting of all physicians, updating CAQH. Reconcile/appeal claims process. Verify insurances and obtain pre-authorizations for insurance eligibility. Analyze aging reports and rebill claims. Transmit claims to commercial, government and private insurances health pans.

Payor/Liaison, Radisphere Radiology National Group 216-***-**** 1/2009 – June 2011

Collaborate with all departments within the company on managed care issues; works closely with licensing and credentialing department in matters pertaining to physician credentialing applications and forms as requested by payers. Work closely with billing on payer enrollment issues and resolve discrepancies in billing statements related to physician credentialing and enrollment. Review managed care legal contract language and negotiating language to meet agreed to parameters within finance department and management to lessen risk and improvement operational efficiencies. Complete manage care contracts regarding Group Physicians. Provides feedback on contract renewals renegotiations or termination. Make recommendations regarding participation or non-participation with new or existing agreements. Provide feedback to billing department and managers regarding financial and/or operational issues with payors. Evaluates and recommends financial parameters and reimbursement methologies. Develop and audit payor fee schedule based on negotiated reimbursement rates by contract and/or product line. Acts as liaison with hospitals, other affiliated organizations and managed care organization pertaining to special projects as assigned.

Supervisor Office Services, Applewood Centers, Inc. 12/2007 – 1/2009 216-***-**** Kendra Compton

Responsibilities included preparation of admission/release packets for clients. Interfaced with other agencies for referrals and placement of clients. Supervised administrative staff of (6); which includes Partial Hospitalization Billing, Coding & Auditing of Medical Charts, Credentialing of Medical Staff. Census reports for Residential /Day Treatment clients, Individual Counseling clients. Compilation of divisional reports, correspondence, Memos, Scheduled meeting and Case Conferences. Interfaced with Clinical staff. Writing statistical reports using MS Excel. Responsible for Safety Training of all employees at this facility. Responsibilities included safety facility inspections, and applying for concurrent building licenses. Giving tours of the facility to different state agencies. Monitoring of accident and incident reports of clients.

Medical Billing Group Leader, Consign Data Services 9/2003 – 11/2007 216-***-**** Verna Bailey

Responsibilities included supervising (9) medical data operators, processing medical billing to clearing house. Coding and error corrections.

Office Manager/Coder/Biller/Compliance Officer, Complete Medical Care 216-***-**** 09/2002 – 9/2003

Supervised office staff of (3), responsible for the billing and the daily operations of the office. Coding Medical charts and resolving billing discrepancies. Conducted on site audits of charts monthly. Accounts receivable, making daily deposits. Posting of payments, insurance verifications, and patient registrations. Insurance contract negotiations with Managed Care Organizations payers, credentialing hospital and self-pay accounts for physicians.

Medical Billing Encounter Specialist, Cuyahoga Physician Network 440-***-**** 9/2001 – 9/2002

Encounter charge entry billing for multi specialty: Geriatrics, Pediatrics, Internal Medicine, and Family Medicine. Reconciliation of accounts, and verifying insurance carriers.

Coding Specialist II, Apollo Medical Billing Services 216-***-**** 5/1986 – 08/2001 Camille Hudson

Coding & Auditing Medical Records for billing follow-up, abstracting documentation from Medical charts. Assisted Program Manager with proper coding and compliance issues. Data entry of demographics and research of needed insurance information.

EDUCATION

Cuyahoga Community College (currently enrolled) degree expected June 2010

Major: Business Management (3.0 GPA)

ICS 1988 Business Management

Academy of Professional Coders (AAPC), Certified Professional Coder

Practice Management Institute (PMI), Certified Medical Coder

Practice Management Institute (PMI), Certified Medical Office Manager

Contact this candidate