Utilization Review Medical Billing

Teresa Ross

Glenn Heights, TX *****

682-***-**** ********@***.***

PROFILE

Detail-oriented Medical Billing and Coding Specialist with extensive experience as a Utilization Review Licensed Vocational Nurse

(LVN). Demonstrated expertise in medical coding, billing procedures, and claims management, coupled with a strong background in utilization review and patient care. Adept at ensuring accurate documentation, compliance with healthcare regulations, and efficient revenue cycle management. Known for strong analytical skills, effective communication, and a commitment to improving healthcare operations and patient satisfaction. Seeking to leverage clinical and administrative experience to contribute to a dynamic healthcare team. SKILLS

Comprehension of CPT, ICD-10-CM, HCPCS/Modifiers and Auditing

Current Procedural Terminology (CPT-4) Coding

Familiar with CMS-1500, EOB, SOAP Notes and office procedures

Medical Records Abstracting

Competent in insurance claims processing for outpatient professional services as well as inpatient facility services

Understanding of Medical Insurance, Billing, Collections and Reimbursement EDUCATION

College of Health Care Professions, Dallas, TX June 2024 Medical Coding and Billing

Amarillo Junior College, Amarillo, TX

Nursing

80 College hours

West Texas A & M University (formerly West Texas State University), Canyon, TX Nursing

80 College hours

Amarillo College of Vocational Arts, Amarillo, TX

Vocational Nursing

Anatomy, Physiology and Pathophysiology

Vocational Nursing skills

WORK EXPERIENCE

GatesCo Medical Supply, Dallas, TX April 2024 - June 2024 Medical Coding and Billing Extern

Leveraged advanced billing software to accurately generate, process, and submit insurance claims, ensuring timely reimbursement and adherence to regulatory requirements

Conducted meticulous data entry to maintain and update spreadsheets and comprehensive reports, ensuring accuracy and consistency in record-keeping and financial documentation

Provided administrative support by managing phone calls, organizing and filing documents, and scheduling appointments, contributing to the efficient operation of the office

Expertly assigned and verified diagnostic and procedural codes using ICD-10, CPT, and other relevant coding systems, ensuring precise coding for accurate billing and compliance with healthcare regulations Anthem/AMERIGROUP Community Care, Grand Prairie, TX January 2006 - November 2020 Utilization Review LVN

Evaluated and processed treatment and procedure authorization requests, ensuring compliance with medical necessity criteria and consulting with the Medical Director as needed

Created detailed guidelines and cheat sheets for Medical Director Reviews, streamlining processes and improving efficiency

Initiated and analyzed a Customer Service Satisfaction Survey for therapy providers, leading to enhanced service quality

Conducted thorough training and orientation for new associates, including one-on-one sessions, WebEx conferences, classroom instruction, and on-the-job training

Authored instructional materials for therapy providers and maintained an up-to-date contact list, ensuring accurate and effective communication

CERTIFICATIONS

National Associate for Health Professionals April 2024 Medical Billing and Coding - NRCS

American Red Cross December 2023 - December 2023

CPR/AED

HIPAA September 2023 - September 2023

LICENSES

Vocational Nursing License September 1988 - September 1989 Vocational Nursing License

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