Emilia Franco Duffy, CPC, CMA
Hawthorne, NJ 07506
Professional Medical Billing NJ PA May 2004 – Present
Over 14 years of insurance carriers work, and ability to perform various billing and collections functions.
Provide accurate and complete information grounded on claim procedures and regulatory time frames.
Senior coder: CPT codes and ICD 10 codes for 15 ASCs: orthopedics, pain management, urology, GI, spine, gyn, general surgery
Review accounts for accuracy. Obtain & verify appropriate insured, policy, claim and billing addresses of each payer and patient eligibility prior to billing.
Handle all aspects of billing including charge entry, payments and A/R management for collections.
Effectively communicate with referring physicians, attorneys, insurance carriers and patients.
Assertively negotiate settlements with Defense Attorneys and Insurance Adjusters for billing and collections.
Communicate proper responses to insurance carriers regarding prior authorizations, denials, revisions and other issues as they arise.
Follow-up on denials, incorrect or underpayments and past due receivables in a timely manner. Send files for reconsideration as needed.
Completing claims for adjusted amounts, and/or corrected with revision for any billing or collection issues.
Experience in No Fault arbitration/litigation cases. Prepare and track arbitration/litigation accounts.
Run weekly and monthly reports and learn the use of our billing systems.
Perform all related duties and special projects as needed.
Follow HIPAA compliance and maintain patient privacy.
Clear understanding of EOB’s, CPT’s and ICD codes.
Possess strong knowledge of Worker’s Compensation
Extensive knowledge in Worker’s Compensation Appeal Board process.
Knowledge of Commercial/HMO insurances.
Knowledge of legal pleadings.
Strong attention to detail and the ability to multi-task in a fast-paced environment.
Excellent written and verbal communication skills.
Must be self motivated and work with minimum supervision.
Strong computer skills with proficiency in Microsoft Office.
Effective organization and time management skills with the ability to work under pressure and adhere to project deadlines
Ability to adapt to new situations and learn quickly
CPT & ICD coding: 14 years
Arbitration process: 5 years
Medical Billing: 14 years
Workers Compensation Claims: 12 years
NJ Personal Injury Protection Claims: 5 years
NY No-Fault Claims: 3 years
Insurance Explanation of Benefits: 14 years)
Medical Collections: 14 years
AAPC member of Woodland Park NJ Chapter
Advanced Surgery Center November 2006 – Present (Part time)
Accurately coding ICD 10 and CPT codes with sequence diagnosis and procedure encounter(s) to various insurance carriers following the rules dictated by the insurance protocol
Michael DiStefano, M.D. Orthopaedic Surgeon June 1999 – 2004
Surgical coding keeping current with AUA/AMA coding changes
Insurance follow up
Appeal letters to insurance carriers; attorney correspondence; follow up telephone activity
Knowledge of insurance contracts with provider in order to establish proper reimbursement is received
Urologic Institute of NJ September 1991 – 1999
Surgical Coding keeping current with AMA/AUA CPT codes as well as ICD 9
Patient follow up
Contact with Insurance companies for proper reimbursement
Office policy for employees