Karla Almazan

Tucson, AZ *****

ad386p@r.postjobfree.com

+1-520-***-****

Experienced medical coding and billing specialist seeks position in a medical office in order to gain valuable experience and provide necessary coding skills to the practice. Work Experience

Medical Claims Analyst

Wollborg Michelson Recruiting - Tucson, AZ

July 2022 to Present

• Responsible for validating disputes presented on Explanation of Benefits (EOB), entering denied claim into the DMT database, and escalating payment /variance trends to Management and generating appeals for denied or underpaid claims

• Validate denial reasons and ensures coding is accurate and reflects the denial reasons

• Coordinate with the Clinical Resource Center (CRC) for clinical consultations or account referrals when necessary

• Generate an appeal based on the dispute reason and contract terms specific to the payor

• Escalate exhausted appeal efforts for resolution

• Work payer projects as directed

• Research contract terms/interpretation and compile necessary supporting documentation for appeals, Terms & Conditions for Internet enabled Managed Care System (IMaCS) adjudication issues, and referral to refund unit on overpaymentsPerform research and makes determination of corrective actions and takes appropriate steps to code the system and route account appropriately

• Escalate denial or payment variance trends to NIC leadership team for payor escalation Front Desk Receptionist

Family Vision Care - Tucson, AZ

October 2021 to January 2022

Schedule new appointments

Call for appointment verification

Cashier

Registration

Eye exam

Chiropractic Receptionist

Panchesin Chiropractic Center - Tucson, AZ

January 2020 to January 2022

Greet all patients and visitors with courtesy whether in person and on the telephone, answer to all their inquiries. Manage all customer request and schedule appointments for the visitors. Ensure that the treatment room is available before giving appointment to the patients.

● In-depth knowledge of accounting and billing procedures

● Extensive knowledge of medical terminology, principles and business etiquettes

● Comprehensive knowledge of spreadsheet and word-processing software

● Ability to work effectively, accurately and efficiently under pressure

● Possess excellent telephone etiquette and organizational skills

● Ability to communicate effectively in a in caring and supportive manner

● Knowledge of handling and operating office equipment

● Responsible for collecting and entering treatment charges in the system

● Perform responsibilities of explaining insurance coverage plans to patients

● Handle the tasks of filing medical reports and insurance forms

● Schedule patient appointments, explain clinic policy to patients, process incoming and outgoing mails

● Perform coding of diagnoses and procedures, opening the office in the morning, and maintaining the reception area

● Provided administrative support to physicians and interpret data to assign ICD-9.

● Entered CPT codes and patient information into billing software.

● Reviewed and validated accuracy of charges including dates of service, services provided, location and provider signature.

● Completed and submitted CMS-1500 Forms.

● Assigned ICD-10 to physicians’ diagnosis and insured the correct level of service and various other CPT codes.

● Connected with Insurance and patient aging to resubmit insurance claims when necessary. Medical Coder / New Patient Care Coordinator

Organization: Pima Lung and Sleep

June 2021 to December 2021

● Making sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations

● Complying with medical coding guidelines and policies

● Receiving and reviewing patients’ charts and documents for verification and accuracy

● Following up and clarifying any information that is not clear to other staff members

● Collecting information made by the Physician from different sources to prepare monthly reports

● Implementing strategic procedures and choosing strategies and evaluation methods that provide correct results

● Examining any medical malpractice that has been reported by analyzing and identifying the medical procedures, diagnoses or events that lead to the negligence Paradigm Laboratory

November 2020 to June 2021

Designation: Covid Testing- Data Entry

An important part of the accessioning process is to identify incomplete or missing information and/ or unacceptable specimens received, and to initiate outreach to physicians and other stakeholders for clarification in a timely manner to minimize impact on test turn-around-time.

● Sample Accessioning Technician may act as a back-up to the Data Entry Specialist team to ensure the quality and integrity of the data received into Exact Sciences Laboratories.

● Responsible for handling and recording patient and study specimens sent to Exact Sciences for testing.

● order processing,

● sample processing,

● management of associated documents and records

● Perform timely and accurate data entry and verification of incoming orders and patient samples according to standard operating procedures (SOP)

● Identify and accurately document incomplete information necessary for laboratory testing.

● Meet and maintain required metrics as determined by the supervisor. Technician

Comcast - Tucson, AZ

March 2018 to January 2020

Call Center Agent

● Answer Phone calls as they come in

● Selling new equipment

● Upgrades

● Selling new line of business

● Comcast residential and business accounts

● Troubleshoot equipment

● Send proper level 2 techs

Technician

Organization: Cyracom Spanish Interpreter - Tucson, AZ November 2017 to March 2018

● Spanish Interpreter in Call Center

● Interpreting court calls,

● Interpreting Doctors calls, surgeries, procedures, office visits, etc

● Lawyer calls

● Medicaid calls

● 911 calls

● Simultaneous Interpretation on some days I would be at the Tucson City court to do some interpretation Sodexo (Chino Valley School District Food Service) - Prescott, AZ January 2014 to November 2017

Designation: Food Service/ Head Cook

● Head Cook

● Inventory

● Made menus

● Cleaning

● Dishwasher

● Unloaded commodities

● Delivered breakfast to each classroom

● Ordered lunch supplies, drinks, all foods etc

● Scheduling of employees

● Payroll

Education

MEDICAL BILLING AND CODING

CARRINGTON COLLEGE

September 2020

HIGH SCHOOL DIPLOMA

DESERT VIEW HIGH SCHOOL

May 2005

Skills

• Simultaneous interpretation

• ICD-10/ ICD-9 and medical terminology

• Rapport building proficient

• Productivity

• Claim entry and payment posting

• Communication

• Organizational skills

• Teamwork

• Medical Billing

• CPT Coding

• Interpretation

• EMR Systems

• Medical Coding

• Insurance Verification

• Translation

• Medical Office Experience

• Clerical Experience

• HIPAA

• Medical Scheduling

• Telemarketing

• Vital Signs

• ICD Coding

• Help Desk

• Phone Etiquette

• Medical Records

• Computer Operation

• Hospital Experience

• Microsoft Powerpoint

• QuickBooks

• Medical records

• ICD-9

• ICD-10

• HIPAA

• Documentation review

• Laboratory experience

• Medical coding

• Medical terminology

• ICD coding

• Hospital experience

• Specimen collection / processing

• Translation

• Customer service

• Payroll

• Help desk

• Clerical experience

• Vital signs

• Telemarketing

• Front desk

• Cooking

• Cash register

• Google Suite

• Accounting

• Software troubleshooting

• Typing

• EMR systems

• Epic

• QuickBooks

• Data Entry

Certifications and Licenses

Medical Billing Certification

Medical Coding Certification

Assessments

Customer focus & orientation — Proficient

May 2021

Responding to customer situations with sensitivity Full results: Proficient

Filing & organization — Proficient

December 2020

Arranging and managing information or materials using a set of rules. Full results: Proficient

Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.

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