Customer Service Medical Record
Resume:
CH Cheryl Hellbusch
Helena, MT ***** 406-***-**** ***********@*****.***
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PROFESSIONAL
SUMMARY
Excellent customer service and problem resolution skills. Knowledgeable medical office professional talented at correcting and resubmitting claims, preparing patient charts and reviewing health records to identify proper diagnosis codes for billing. Offers background in reviewing, analyzing and managing medical record information to obtain prior authorizations from insurance companies and ensure payment. Polished professional manages multiple tasks, utilizes electronic medical record systems, and provides excellent customer service to patients and staff. Adheres to medical records policies and procedures to comply with HIPAA regulations. Track record of effectively troubleshooting issues and maintaining patient confidentiality.
SKILLS Excellent Customer Service &
Problem Solving Skills
Medical History Recording
Report Preparation
Data Security Procedures
Record Assessment
Insurance Claims Analysis
Outpatient Records Coding
Medical Record Security
Documentation Oversight
Data Verification
Medical Claims Coding
Data Entry
Medical Terminology
WORK HISTORY MEDICAL CODER 11/2017 to CURRENT
St. Peter's Hospital 3330 Ptarmigan Lane, Helena, MT 59601 Reviewed patient charts to better understand health histories, diagnoses, and treatments.
Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
Resourcefully used various coding books, procedure manuals, and on-line encoders.
Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records. Monitored changes in coding regulations to provide recommendations for compliance.
Verified signatures and checked medical charts for accuracy and completion.
Input data into computer programs and filing systems. Followed up with medical staff regarding missing information in patient records.
INSURANCE PRIOR AUTHORIZATION SPECIALIST 11/2013 to 11/2017 St Peter's Health 3330 Ptarmigan Lane, Helena, MT 59601 Responded to inquiries from healthcare providers regarding prior authorization requests.
Input all patient data regarding claims and prior authorizations into system accurately.
Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
Analyzed medical records and other documents to determine approval of requests for authorization.
Verified eligibility and compliance with authorization requirements for service providers.
Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
Reached out to insurance carriers to obtain prior authorization for testing and procedures.
Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
Fielded telephone inquiries on authorization details from plan members and medical staff.
Researched denied claims and contacted insurance companies to resolve these issues.
CLAIM EXAMINER 06/2002 to 06/2013
Montana State Fund Helena, MT 59601
Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues. Examined claims forms and other records to determine insurance coverage.
Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials. Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Determined claim compensability after a recorded statement with the policyholder and claimant
Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
Payment schedule set up to pay claim payments to the injured worker. Settlement determination and payment when the claimant reached maximum medical improvement
Researched claims and incident information to deliver solutions and resolve problems.
EDUCATION High School Diploma 06/1984
Capital High School, Helena, MT 59601
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