Accounts Receivable Medical Coding

Kathleen Young

*** ******* **, ******, ** *****

H 775-***-****, C 916-***-****

*********@*****.***

PROFESSIONAL SUMARY

Experience of 40+ years in Billing, Coding, Denial, Appeal, Authorizations, EMR, Credentialing, Contracting. Excellent relationship-building, problem-solving, listening and communication skills.

Self-motivated, Detail-oriented, team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Dependable candidate successful at managing priorities.

Seeking to maintain a full-time remote position that offers professional challenges utilizing my skills, with management and problem-solving.

SKILLS

CPT

ICD-10 & 9

HCPCS

EMR/EHR

CMS 1500

UB04

E&M

DME

Outpatient/Inpatient

Medical Authorizations

Medical Bill

Medical Payment Review

Post EFT & EOB Payments

Accounts Receivable

Accounts Payable

Auditing 1500/UB04 & EOB’s

Review Medical Reports

Research and Analysis

Denials

Appeals

CMS Website Experience

Epic

NextGen

eClinical

Availity

Athena

AdvancedMD

DOS

RMS

Medicare/Medicaid/MediCal/TriCare Programs/DOD

Commercial Insurance

Drug Insurance

Highly Skilled Medical Terminology

Medical Abbreviations

Microsoft Office

Excel

Manager Employees

Organized

Focused

Detailed Oriented

Quality Assurance

Handling Complaints

Credit Card Transaction

Customer Care

Client Satisfaction

Self-motivated

SQL & OTHER AUDITING/REPORTING

WORK HISTORY

Assoc Clinical Data Coder - USBTP2 03 2024 to Sept 2024

IQVIA/POPULAS Bridgewater, NJ (remote)

Utilized CPT, HCPCS, POS and ICD-10 coding

Work Rejection/Denials, used Excel to track progress

Resolve Claims issues, worked with team for correction of issues

Create Authorizations, this was used for Medicare aged patients

Correct Enrollment, used GSK HUB patient file to correct errors

Create Enrollment for Patients, used the GSK website to help patients enroll

EOB Clarification, reviewed for correctness and co-pay information

Create Escalations, when needed sent this to management

SPECIAL Team GSK, worked with Benlysta and Nucala copay assistance program.

Teams CHAT used for communication with those that were on the GSK team.

PAAS Portal

Provider Portal Assistance

GSK HUB

Excel Spread Sheet

WebTrax

Trans-card

Buy & Bill

MEDICAL REMBURSEMENT SPECIALIST 10/2022 to 04/2023

Sleep Medicine Associates Sparks, NV (remote)

EMR evaluation

Submit authorization request to Utilization Review departments.

Updated FAX information for UR Authorization Request.

Excel spreadsheets for authorization request, billing, and scheduling.

Denials & Appeals for payment or write-off.

Entered in insurance payments, refunds to patients, reconciled all accounts.

Optimize and ensured claims are correct CPT, Modifiers & ICD-10 codes with attachments.

Analyzed EOB denials and addressed them accordingly.

Cleared all lingering back log of claims in Athena.

Enrolled providers and Medicaid, Medicare, and private insurance plans.

Obtained NPI numbers for providers and facilities and updated existing profiles.

Resolved issues through active listening and open-ended questioning.

Improved office efficiency by effectively managing internal communications and correspondence.

Create spreadsheets for tasks to administrate support staff

Contacted insurance companies we were not contracted with, created letter of intent, and supporting documents for their contracting department.

Cactus credentialing system or specific knowledge of URAC or NCQA standards

Built a highly efficient administrative team through coaching.

Organized meetings for executives and coordinated availability for participants.

Organized materials, and support for internal and client-focused meetings.

Trained team on new contracted payers/products to support employees

Implemented techniques to overcome obstacles and increase team productivity.

MEDICAL WOUND CARE CODER 01/2017 to 01/2020

DT-Trak Consulting Miller, SD

Utilize three computer program systems for medical coding, DOS RPMS, EHR RPMS, DT-Trek Coder

Translated medical record to CPT and ICD-10 codes.

Audited 1500 format to ensure proper payment.

Analyze request for payment from government insurance.

·Corrected HICFA for correct and quick payment

Read SOAP to ensure correct CPT and ICD codes were used for payment.

Resourcefully used various coding books, procedure manuals, and on-line encoders.

Used classification manuals to gain additional knowledge of disease and diagnoses processes.

Maintained accuracy, completeness, and security for medical records and health information.

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

Generated reports to identify coding trends and discrepancies.

Researched and resolved medical record discrepancies.

Review outpatient record & interpret documentation to identify diagnoses & procedures.

Communicated with insurance companies to research and resolved coding discrepancies.

Monitored changes in coding regulations to provide recommendations for compliance.

Utilized electronic medical record systems to store, retrieve and process patient data.

Followed up with medical staff regarding missing information in patient records. .

Performed coding audits to determine accuracy and compliance with coding guidelines.

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

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

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

MEDICAL OUTPATIENT WOUND CARE CODER 01/2016 to 12/2016

Aerotek Reno, NV

Use medical program EPIC, 3-M, and more.

Processed medical records CMS, CPT, ICD-10 codes.

Verified procedures and checked medical charts for accuracy and completion.

Monitored changes in coding regulations to provide recommendations for compliance.

Generated and maintained statistical data related to medical records.

Identified new methods to optimize coding from medical records.

Performed on-site coding audits to determine accuracy and compliance with coding guidelines.

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

Utilized electronic medical record systems to store, retrieve and process data.

Followed up with medical staff regarding missing information in patient records.

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

Researched and resolved medical record discrepancies with MD.

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

Correctly coded/billed medical claims for outpatient wound care & hyperbaric chamber.

Maintained accuracy, completeness, & security for medical records & health information.

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

MEDICAL BILLING GOVERNMENT CLAIMS AUDITOR 01/2015 to 11/2015

Robert Half Reno, NV

Coordinated, manage & implemented auditing projects, prepare for evaluation of TriCare.

Obtained and interpreted relevant and authoritative criteria for program or issues under audit for TriCare.

Communicated with audited staff to obtain necessary information for audits.

Examined claims forms and other records to determine insurance coverage for TriCare.

Identified insurance coverage limitations with thorough examinations of claims documentation and related records.

Followed up on potentially fraudulent claims initiated by claims representatives.

Reviewed insurance claims and member eligibility to determine overpayment trends and noncompliance issues.

Finalized 1500 forms for insurance claim payment release.

Corrected CPT & ICD-10 codes to properly verify claims.

Provided high level of professionalism when speaking with customers or responding to emails to promote company's dedication to service.

Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.

Prioritized daily tasks to satisfy workload demands and department's turnaround goals.

Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.

Maintained claims data in Epic systems.

Used Excel, set up functions and enter data for claims.

MEDICAL ELIGIBILITY & AUTHORIZATIONS 08/2014 to 12/2014

Human Resource NetWork Reno, NV

Built relationships with diverse stakeholders to achieve successful program implementation.

Processed and certified documents for accuracy and compliance with government regulations.

Reviewed applications for different aid programs and determined which qualification criteria for individuals.

Communicated with people from various cultures and backgrounds on application process.

Collected pertinent data and calculations to aid physician in interpreting results.

Verified patient insurance coverage and collected required co-payments.

Obtained and documented patient medical history, vital signs and current complaints at intake.

Completed clinical procedures and gathered patient data for interpretation by physician.

Liaised with patients and addressed inquiries, appointment requests and billing questions.

Collaborated with medical and administrative personnel to maintain a patient-focused, engaging, and compassionate environment.

Collected and documented patient medical information such as blood pressure and weight.

Answered telephone calls to offer office information, answer questions, and direct calls to staff.

Called and faxed pharmacies to submit prescriptions and refills.

Obtained client medical history, medication information, symptoms, and allergies.

Performed medical records management, including filing, organizing, and scanning documents.

MEDICAL CODER/BILLER SPECIALIST 01/2014 to 08/2014

Marathon Staffing Carson City, NV

Posted and adjusted payments from insurance companies.

Maintained and updated collections tracking spreadsheet.

Located errors and promptly refiled rejected claims.

Liaised between patients, insurance companies, and billing office.

Precisely evaluated and verified benefits and eligibility.

Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.

Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.

Evaluated patients' financial status and established appropriate payment plans.

Prepared billing correspondence and maintained database to organize billing information.

Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.

Printed and reviewed monthly patient aging report and solicited overdue payments.

Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.

Pre-certified medical and radiology procedures, surgeries and echocardiograms.

Precisely completed appropriate claims paperwork, documentation and system entry.

Identified and resolved patient billing and payment issues.

Communicated effectively, extensively with departments to resolve claims issues.

Communicated with insurance providers to resolve denied.

MEDICAL BILLER ACCOUNTS RECEIVIABLE 09/2013 to 12/2013

Fallon Tribal Health Center Fallon, NV

Audited and corrected billing and posting documents for accuracy.

Maintained accurate records of customer payments.

Used data entry skills to accurately document and input statements.

Reviewed patient records, identified medical codes, and created invoices for billing purposes.

Prepared billing statements for patients and verified correct diagnostic coding.

Generated accounts payable reports for management review to aid in financial and business decision making.

Delivered timely and accurate charge submissions.

Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.

Reviewed patient diagnosis codes to verify accuracy and completeness.

Adhered to established standards to safeguard patients' health information.

Collected payments and applied to patient accounts.

Verified insurance of patients to determine eligibility.

Communicated with insurance providers to resolve denied claims and resubmitted.

Liaised between patients, insurance companies, and billing office.

Generated monthly billing and posting reports for management review.

Utilized various software programs to process customer payments.

Encoded and canceled checks using bank machines.

Posted payments and collections on regular basis.

Monitored outstanding invoices and performed collections duties.

MEDICAL BILLER CODER 06/2012 to 08/2013

Janiga MD's Reno, NV

Audited and corrected billing and posting documents for accuracy.

Generated accounts payable reports for management review to aid in financial and business decision making. .

Monitored outstanding invoices and performed collections duties.

Verified insurance of patients to determine eligibility.

Prepared billing statements for patients and verified correct diagnostic coding.

Posted payments and collections on regular basis.

Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.

Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.

Adhered to established standards to safeguard patients' health information.

Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.

Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.

Reviewed patient diagnosis codes to verify accuracy and completeness.

Responded to customer concerns and questions on daily basis.

Processed payment via telephone and in person with focus on accuracy and efficiency.

Communicated with insurance providers to resolve denied claims and resubmitted.

Reviewed patient records, identified medical codes, and created invoices for billing purposes.

MEDICAL BILLER THIRD PARTY 01/2012 to 06/2012

Washoe Tribal Health Center Gardnerville, NV

Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.

Reviewed patient diagnosis codes to verify accuracy and completeness.

Responded to customer concerns and questions on daily basis.

Prepared billing statements for patients and verified correct diagnostic coding.

Monitored outstanding invoices and performed collections duties.

Collaborated with customers to resolve disputes.

Processed vendor and supplier payments on weekly basis.

Delivered timely and accurate charge submissions.

Utilized various software programs to process customer payments.

Audited and corrected billing and posting documents for accuracy.

Maintained accurate records of customer payments.

Communicated with insurance providers to resolve denied claims and resubmitted.

Adhered to established standards to safeguard patients' health information.

Posted payments and collections on regular basis.

Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.

Verified insurance of patients to determine eligibility.

Produced monthly mailed statements to customers.

Reconciled accounts receivable to general ledger.

Used data entry skills to accurately document and input statements.

Filed and updated patient information and medical records.

Liaised between patients, insurance companies, and billing office.

Generated monthly billing and posting reports for management review.

MEDICAL BILLING DATA ADJUDICATION LEAD 02/1996 to 08/2000

Foundation Health/HealthNet Rancho Cordova, CA

Audited and corrected billing documents for accuracy.

Audited 1500 input for correctness

Utilized CMS, CPT, ICD-9 medical coding.

Maintained accurate records.

Analyzed denials for appropriate action.

Used data entry skills to accurately document and input statements.

Created an improved system to maintain secure client data.

Utilized various software programs to process patient claims.

Collaborated with payers to resolve disputes.

MEDICAL BILLING WC SUPERVISOR 08/1978 to 02/1996

O.U.C.H. West Sacramento, CA

Filed and updated patient information and medical records.

Followed up on legal claims.

Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.

Reviewed services rendered and completed to reconcile codes.

Delivered timely and accurate charge submissions.

Participated in workshops and other training opportunities to remain current on billing procedures, regulations, and industry updates.

Reviewed patient diagnosis codes to verify accuracy and completeness.

Enforced operational compliance with state and federal laws and Joint Commission standards.

Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.

Reviewed patient records, identified medical codes, for billing purposes.

Analyzed medical records to satisfy insurance company mandates.

Complied with HIPAA privacy and security regulations to protect patients' medical records and information.

Adhered to established standards to safeguard patients' health information.

Reviewed outgoing bills for eligibility and accuracy.

Oversaw billing for Medicaid PCA, waiver and skilled claims, commercial insurance, and private pay clients.

Verified proper ICD-9 coding on claims.

Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.

Devised new methods to improve billing workflows.

Assisted patients by determining financial assistance available and setting up payment plans.

Prepared billing statements for patients and verified correct diagnostic coding.

Confirmed backup and proper storage of sensitive information in event of data breach or outage.

EDUCATION

Certification Certified Medical Biller Coder Specialist

NSCI, Carson City, NV

Certification RHIT

AHIMA, Nevada

Certification COC, CPC, CPB, CBCS

AAPC, Sacramento, CA

Bachelor of Science Veterinary Medicine (Pre-Veterinarian) & Zoology

University of California At Davis, Davis, CA

Associate of Science Veterinary Technologies

Western Career Collage, Sacramento, CA

BBA Business Management

Cosumnes River College, Sacramento, CA

High School Diploma 06/1973

Hiram W Johnson, Sacramento, CA

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