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P.O. Box ***** Wauwatosa, WI 53226 414-***-**** ad3vc2@r.postjobfree.com

SUMMARY

Ambitious professional with 14 years of experience in the medical billing, coding, and records field. Expertise in the entire Microsoft Office suite, strong typing and data entry skills. Experience leading a team. Task oriented, professional, and able to adapt to changing business needs quickly.

PROFESSIONAL EXPERIENCE

Account Rep II/Data Retrieval Rep II

Medical College of Wisconsin Wauwatosa, WI

December 2015 – 4/26/2021

Creating payment batches for payments to be entered on spread sheets

Entering payment batches in a timely manner with accuracy on spread sheets

Entering insurance information into the data base

Working on Workers Comp claims while printing Medical Records for these claims to be paid.

Closing Workers Comp claims to be paid within two working days by submitting the necessary information in a timely manner while using dual computer.

Closing ETM’s accounts to be paid within ten days by submitting the necessary information in a timely manner.

Systems used on a daily basis IDX/EPIC

Audit/Pro Setup Credentialing Wauwatosa, WI February 2014 - November 2015

Office Team

Provided administrative assistance to the department manager

Initiated and processed non-participating and participating provider setup forms/APACT/Forms

Audited provider access database for accuracy

Audited claims payment system (Amisys) for setup

Assisted with training of member services and provider relations representatives

Referral Specialist Wauwatosa, WI

July 2013 - January 2014

Office Team

Assisted in monitoring utilization of medical services to assure cost effective use of medical resources through processing Prior Authorizations

Verified eligibility and benefits

Answered phone queues and process faxes within established standards

Approved and authorizations for members to have outpatients’ services render in the hospital or in outpatient health care settings, such as Physical Therapy, Speech Therapy, Eye Clinics

Approved members to see doctors that are Non Par/not in network through the computer via Telephone

Documented resolutions related to authorizations

Utilized current reference material to get authorizations approved

Charge Capture Analyst November 2012 - June 2013

Randstad

Researched reimbursement issues using the Medicare/Medicaid and private insurance company online resources and reference material

Resolved VSUP edits-including bundling issues, duplicate charges, and Eclipsys interface errors - identification of incorrect account

Provided support to service line management, staff and physicians in responding to charging, coding, documentation, reimbursement and compliance questions and inquires

Re-billed insurance companies such as Medicare, T-19, Managed Care, Workers Comp, Humana, and other companies

Completed reports as assigned to provide information on compliance issues, charging and coding accuracy, quality of documentation and appropriateness of reimbursement, by adding charge codes when necessary and reversed and modified codes so that billing is accurate

Accurately posted checks, credits, and charges to accounts to precisely charge accounts as needed.

Used excellent knowledge of healthcare regulations including HIPPA and reimbursement policies

Effectively and efficiently used Microsoft Word and Excel, Epic, SDK, Physician Portal, Horizon Data Entry, Ten Key Calculation, Lab, and Knowledge Source, Patient Inquiry and Order Entry account usage and correction

Assisted in maintaining charging guidelines and/or recommendations on best practices for charge capture and regulatory compliance issues

Completed Billing Transfer log report using CPT Codes without any errors and matched up CPT Codes with the correct Charge Codes

Applied advanced knowledge of CPT4 and ICD-9-CM Coding for immediate resolution

Recognized Medicare accounts on ABN reports and filled out separate reports

Investigated and resolved billing issues within their service line area

Medical Records Lead Milwaukee, WI

August 2001-October 2012

Aurora Healthcare

Responsible for released medical information from the department by verifying and certifying medical records

Participated in quality improvement groups and other multi-department meetings to identify problems, remove barriers, and improve services and operations

Prepared key departmental quality, service, and productivity status reports on a regular basis in conjunction with department leadership, monitors revenue cycle status and works collaboratively with clinicians and physicians to achieve timely completion of records

Mentored new and existing staff to achieve maximum autonomy and education of staff and conducted orientation for new staff and conducted periodic goal review of staff

Monitored workflow and developed/revised department procedures to achieve maximum efficiency, turnaround times and assigned work to ensure timely completion of departmental work

Directed day-to-day operations of the department including staffing, purchasing supplies/equipment and policies

Served as a liaison in problem solving with physicians regarding incomplete records and documentation issues to ensure adherence to accreditation standards and regulatory requirements

Verified timecards and productivity calculations and performed quality checks for feedback and performance monitoring while providing input to performance reviews for clerical staff

Performed record analysis and coding procedures on reports

Medical Records Specialist Milwaukee, WI February 2000 to April 2002

St. Mary’s Hospital

Audited patient charts, made new charts for new patients and maintained discharged patient records

Pulled charts and prepared/organized for studies and released records with authorization

Ensured delivery of patient charts to Doctors in the Emergency Department.

Faxed requested medical records to other medical facilities

EDUCATION & PROFESSIONAL DEVELOPMENT

Concordia University Mequon, WI January 2014-Present

BA/Health Care Management

Sanford - Brown College Milwaukee, WI September 2008 to April 2010

Certificate in Medical Coding and Billing

Highly knowledgeable in HCPCS Coding, HIPAA Laws, Medicare/Medicaid and Medisoft

Advanced knowledge in ICD-9/CPT Coding and Medical Terminology

Contact this candidate