DARLA M DEAL

ad4cz8@r.postjobfree.com 512-***-**** Austin, TX 78730

Summary

Competent Certified Medical Coder with experience in handling most Specialties. With over 16 years of Revenue Cycle experience. Coordinate with Providers to code to the highest specificity. My expertise in accurately coding from medical notes. Sophisticated and hardworking individual with excellent analytical and multitasking abilities.

Skills

Medical Terminology

Anatomy

Accounts Payable and Accounts Receivable

ICD-10 (International Classification of Disease Systems)

CPT Codes

Coverage Determination

Telephone Etiquette

Excellent Interpersonal Skills

SharePoint

Excellent Phone Skills

Certified Professional Coder

Risk Adjustment Coding

Modifiers

Insurance Billing with all Payers

Records Review

Specialty Billing

Word Processing Software

Teams

Azure DevOps

Experience

Managed Staffing (Conduent), Austin, TX

Reference Files Analyst

11/14/2022-02/28/2024

Worked on State Medicaid Contract for new adjudication and claims payment system.

I collected and entered Medicaid data in databases and maintaining accurate records of changes applied.

I translated business and technical rules into a formal Business Rules Document (BRD) and/or Requirements Traceability Matrix (RTM) to work with the IT team on system design and configurations

I helped create, maintain, and update reference tables with varying Federal Financial Participation (FFP) rates (e.g., procedure or combinations of procedures, modifier or combinations of modifiers, diagnoses, category of service, benefit plan, waivers, rates, Provider type, Provider specialty, Client demographics, trauma indicators, Int'l Classification of Diseases, Tenth Edition (ICD-10) external cause codes, and other indicators used for identifying Third Party Liability (TPL) cases)

I helped update all reimbursement rates and Services by program specific guidelines, or as directed within an approved timeline

I assisted in validating all system configurations to verify requirements have been successfully met, collecting, and entering Medicaid data in databases and maintaining accurate records of changes applied

I helped compile and verify accuracy and sorting of information to prepare source data for data entry

I reviewed data for deficiencies or errors, correct any incompatibilities and validate output

I maintained operations by following policies and procedures and introducing process improvements

I did some process writing and process flows to help new users around the new system.

Austin Regional Clinic Austin, TX

Certified Professional Coder

10/2012 - 07/2022

Administer tasks with Medicaid, Medicare, Commercial

Specialty billing and coding, to Include Orthopedics and many other specialties

Primary Care and Pediatric Coding

Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.

Reviewed denials for coding issues pertaining to CPT and/or ICD-10

Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.

Reviewed patient charts to better understand health histories, diagnoses, and treatments.

Accurately selected proper descriptive code when more than one anatomical location was indicated.

Resourcefully used various coding books, procedure manuals and on-line encoder such as Encoder Pro to assign procedure and diagnostic codes to patient records for billing purposes.

Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.

Correctly coded and billed medical claims for various hospital and nursing facilities.

Other assignments to included: Customer service calls for verifying and registering patient insurance

Assisting patients with their accounts over the phone

Training other employees when and where necessary

Work major projects when payers have issues.

Interacted with physicians and other healthcare staff to ask questions regarding patient services.

Utilized active listening, interpersonal and telephone etiquette skills when communicating with others.

Guarded against fraud and abuse by verifying coded data accurately reflected services provided.

Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services.

Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.

Alamo City Medical Group San Antonio, TX

Account Specialist

11/2007 - 07/2012

Workers Compensation Collections

Review insurance and patient payments

Research and resolve incorrect payments, EOB rejections, and other issues with outstanding accounts A/R entries & analysis

Ensure accuracy of insurance claims

Verify correct ICD-9 and CPT codes for a variety of specialties Follow up on Insurance and patient aging

Re- submit insurance claims as necessary

Coordinated various administrative duties

Handled Greenway Technical Support inbound.

Dynamic Billing Services Mesa, AZ

Administrative Assistant / Billing Specialist

08/2004 - 07/2007

Provided technical support including troubleshooting of proprietary software application

In charge of posting charges and payments to patients' accounts and statement reconciliation

Handled follow up communication with insurance groups verifying patient benefits and eligibility

Prepared detailed A/P and A/R reports for medical groups

Responsible for follow up on unpaid claims electronically or by telephone

Communicated with patients daily regarding account balances and other insurance matters

Administered general office duties and creation of marketing literature

Education and Training

AAPC

Certified Professional Coder in Medical Coding

US Career Institute Fort Collins, CO

No Degree in Medical Billing

Accomplishments

Epic Practice Management

Medical Claims Appeals

Achieved Payment through effectively helping with Project on large number of denials.

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