Customer Service Data Entry

Michelle Simon

303-***-****/************@*****.***

QUALIFICATIONS SUMMARY

Certified Coding Specialist (CCS) Nationally Registered, licensed Medic thru the State of Florida with BLS/AED card. Certified Hyperbarics and Wound Care Tech.

Proven track record of improving office processes in ways that saved the company money as well as brought in more money.

Experience and knowledge of CMS RAF, high risk, CPT II coding, MS-DRG, VBP, HEDIS quality, the disease process, Anatomy and pharmacology.

Working knowledge of data entry systems, several EMR, EHR software, along with standard office equipment.

Possess excellent verbal and written skills, personable, and friendly. Received multiple awards recognizing my work ethic and ability to work as a team.

"Service is the Life blood of any organization, everything flows from it and is nourished by it."

Experience:

CMS/HEDIS Healthcare quality coordinator at Wellmed/United Healthcare, Fort Myers Fl . June/ 2016 to current.

Review and data mine Remotely and on site from physician charts to maintain or obtain HEDIS five star rating and help with SDS/attestation submission. Knowledgeable with many different EMR systems, high risk Coding, RAF, HEDIS guidelines, CMS, DRG, CPT II codes along with Coding guidelines. Our goal is to see that the physician receives all money available to them and to help them provide the best possible healthcare to their patients and we provide training to the offices in the areas where they need help in closing these gaps.

Coder for Florida Heart Assciates Fort Myers Fl. Jan/2016 to March/2016.

Extracted, reviewed and coded procedures using the high risk, RAF, MS-DRG, VBP, HEDIS guidelines for all inpatient visits and out patent testing for highest possible reimbursement. Review all documentation making sure all important information is dictated for billing/insurance review. Work insurance denials. Team player, maintaining current certifications for coding. Reason for leaving: LAID OFF.

Coder/Billing Manager for Dr. M.T. Pally Cardiologist, Lehigh Acres Fl. June/2015 to Jan/2016.

Reviewed, extracted and entered in all correct codes from hospital EMR using MS-DRG, VBP, HEDIS guidelines, for all inpatient procedures and visits/ER admits, coding and charge entry of all out patient testing, in office visits, all Echo's/Vascular, Nuclear stress testing, PET Scan and all nursing home, home health visits. Extraction from hospital medical records, maintaining a high productivity standard with 95%+ accuracy, working denials, letters of appeals. Assisting the front desk whenever needed, answering phones, scheduling appointments, verifying insurance's, obtaining authorizations. EMR Cerner, Epic, checking in/checking out. Applied payments and providing excellent customer service. Reason for leaving: No benefits offered, increase in health care costs had to find job with benefits.

Coder/Front office Coordinator for Tenet Health Piedmont Cardiothorsic and Vascular Surgeon, Rock Hill South Carolina. Sept 2014 to April 2015.

Verified and authorize all insurance, answer phones, schedule appointments, obtain/collect necessary testing, all results to prepare daily charts, check in/out patients, room, vitals, data entry in EMR system, extract codes from hospital EMR using the MS-DRG, VBP, HEDIS guidelines, charge entry, fax medical records, Home health orders, Nursing home order, DME, clean stock rooms, provide excellent customer service. Reason for leaving: Moved to Florida for family.

Coder/insurance verification specialists for Physcian Regional Hospital Mooresville North Carolina Aug/2013 to Sept/2014.

Review, corrected Coding and verify insurance for all high dollar amount of in/out patient surgical procedures as well as price quotes for various different hospitals, obtain authorizations, answered patients questions regarding upcoming procedure and any insurance out of pocket or issues pending, provide daily excel spreadsheet. provide excellent customer service. Reason for leaving: Moved out of town.

Coder/Biller, Patient account Rep II for Centura Health Englewood Colorado Aug/2010 to Feb/2013.

Review and correct coding issues and insurance denials using the HEDIS, CMS high risk, RAF, MS-DRG, CPT II coding and VBP guidelines, answered high volume patient's questions regarding their accounts, performed insurance verification, data entry in Meditech, work insurance collections, performed paper and electronic billing, accounts receivables, and provide excellent customer service. Reason for leaving: Better opportunity.

MA/EMT for Hand Surgery Associates Englewood Colorado Oct/2009 to May 2010.

Triage and room patients, provided assessment of injury/wounds, removed sutures, dressings, applied casts and splints, assisted with surgical procedures, and performed data entry in EMR and provide excellent customer service. Reason for leaving: LAID OFF.

MA/EMT at Otolaryngology Associates of Denver Colorado May/2008 to July/2009.

High volume phone triage, performed data entry in EMR system selected and entered in correct ICD-9 and CPT coding, rooming patients and vitals, in room scribe, assisted with office surgical procedures, injections, biopsy's, Lab, X-ray orders, and performed excellent customer service. Reason for leaving: Moved out area.

Office manager at Presso matic keyless locks, Englewood Colorado Jan/2005 to May/2008

Processed payments, collections, Bookkeeping AR/AP using QuickBooks, Shipping and Purchasing, filing, faxing, coping, maintain and ordering office supplies, scheduling meetings, monthly inventory, coordinating and help managing 5 outside sales associates in different states. Help with the hiring and firing of company employees. Reason for leaving: company partners dissolving

Outpatient and call center scheduling for Lee health Fort Myers FL Nov/2001 to Nov/2005.

Answering high- volume multi line phone calls, scheduling patient's out patient testing, verifying ICD-9 CPT coding, correct data entry, verifying insurance, patient demographics, registered patients, proving excellent customer service. Reason for leaving: Married moved out of town.

Coding/Biller/Payment poster for 21st Century Oncology, Fort Myers Fl Nov/1998 to Nov/2001

Worked 3rd party insurance denials and coding issues, post payments, made financial agreements on patient balances, answered high patient call volume as well as questions regarding billing and accounts, provided the best possible customer experience possible. Reason for leaving: Better Opportunity

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