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Medical Manager

Houston, TX
April 20, 2016

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***** ********* ****, *******, ** 77079 281- 743- 2081 OBJECTIVE

To leverage my 5 years of medical coding and billing experience, client speaking skills, and expertise in the health care industry as a medical billing manager. EXPERIENCE

Metis Healthcare (formerly Capitol Pain Institute) Austin, TX Billing Manager June 2015 – February 2016

§ Leads and manages a team of 5 employees in practicing medical billing and reimbursement for Capitol Pain Institute and Center for Specialty Surgery of Austin.

§ Familiar with public insurance (Medicare and Medicaid), private insurance companies and their plans

(HMOs, PPOs and POS), workers’ compensation and medical lien companies. Practices up- to- date medical coding (CPT and ICD- 10) at a pain management clinic and surgery center using EMR software including consultations, follow- up appointments, spinal injections, spinal cord stimulation procedures, UDS, and DME. Specializes in pre- authorization for out- patient procedures. Familiar with electronic and manual posting of insurance payments, adjustments, write- offs, prompt pay discounts and refunds. Specializes in appeals involving coordination of benefits, medical necessity, pre- authorization, LCD and NCD guidelines, and medical records requests. Skilled in creating insurance aging reports and accounts receivable reports. Skilled in creating end- of- day validation, weekly and monthly billing reports used to analyze practice performance. Knowledge of in- house and outside collection practices.

§ Excellent customer service and communication with patients regarding copayments, account statements, payment plans and billing policies. Superb at multitasking various responsibilities.

§ Conducts interviews and job performance evaluations. Experienced in creating and implementing billing policies in coordination with management staff and CEO. Created billing policies for both Capitol Pain Institute and Center for Specialty Surgery of Austin. Attends management meetings with prepared reports and updates. Contributes ideas for problem- solving.

§ Attended weekly/monthly individual training for new EMR and clearinghouse software with implementation experts at third party entities for Capitol Pain Institute and Center for Specialty Surgery of Austin. With little supervision, was able to complete implementation phases to start product support phases.

Capitol Pain Institute Austin, TX

Billing Manager June 2013 – June 2015

§ Leads and manages a team of 5 employees in practicing medical billing and reimbursement for Capitol Pain Institute.

§ Same as second and third bullets above. Due to increased success of claim reimbursement, Capitol Pain Institute was able to hire 3 new doctors within 2 years. Procedure Pre- Authorization Specialist May 2011 – June 2013

§ Responsible for obtaining pre- authorization of out- patient procedures done in- office and at credentialed hospitals. Obtained PCP referrals for specific plan types. Answered phone calls and emails from patients, 2

insurance companies, in- office staff and hospital staff. Communicated clearly and effectively with billing department and physicians.

Medical Records Specialist February 2011 – May 2011

§ Scanned and uploaded patient medical records into EMR software. Processed medical records requests for patients, medical offices and attorney offices. UT RecSports Austin, TX

Swim Instructor October 2010 – May 2011

§ Taught basic, beginner, intermediate, coached and private swim classes for adults. EDUCATION

The University of Texas at Austin

Bachelor of Science, Exercise Science, Pre- PA GPA: 3.44/4.0 December 2010 Austin Community College

Pre- PA coursework August 2013 – December 2014 SKILLS

§ Proficient in Microsoft Word, Excel, Powerpoint, Google Drive, and EMR Softwares MacPractice, Allegiance MD and HST Pathways. Experienced using Zirmed as a clearinghouse. Experienced using insurance verification online tools with Zirmed, Emdeon, Availity, UHC Online, and Humana Military Tricare. Skilled using PC and Mac computers. AWARDS AND ACKNOWLEDGEMENTS

§ Awarded 5% bonus for successfully appealing and obtaining proper reimbursement for a recouped

$26,000 claim.

§ Graduated Summa Cum Laude from the College of Education at UT in 2010.

§ Ronald McDonald House Charities meal provider program organizer and volunteer in March – April 2010.

§ Health Career Mentorship Program (HCMP) member and coordinator at UT from August 2009 – May 2010.

§ Volunteered minimum 8 hours/week at UMC Brackenridge from August 2008 – April 2009.

§ Completed 4 sprint triathlons.

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