Coding and Billing Specialist
Resume:
Sarah Nachimson CPC
Margate, FL 33063
********@*****.***
Work Experience
Coding Specialist
*/** – 3/19 Edgemed Healthcare Inc Boca Raton, FL
Used Edgemed PM software
Coded E/M services for Internal Medicine (and all other office services), Radiology, office-based Orthopedics, office-based Neurology, and facility-based Wound Care (and procedures)
CPT codes and diagnosis codes using HCC coding hierarchy were coded for 2 Internal Medicine clients using Practice Fusion and Allscripts EMR systems
Recoded surgeries for General Surgery, Trauma Surgery, Cardiac Surgery
Posted all office, hospital, and facility charges from either a scanned superbill, paper superbill, or coded progress note
Posted all scanned mail patient and insurance company payments
Posted all ERA/EFT payments
If client required, posted ERA/EFT payments based on provided bank statement (client was contacted if there were any discrepancies)
Worked insurance company denials that did not require contacting the insurance company (denials for medical necessity by reviewing medical documentation, and eligibility) and forwarded all other denials to Collection Specialist
Submitted electronic and paper insurance claims (used Availity for electronic claims for General Surgery client)
Answered patient and client phone calls regarding patient balances
Assisted one Internal Medicine client in revamping patient forms (several forms to be used for Medicare AWV), creation of a benefit/prior authorization form for in-office ultrasounds, and creation of daily cash log to assist in collection of copays, deductibles, and balances
Assisted one Internal Medicine client's front desk staff in learning how to verify patient office benefits using Availity and UHC's website
At the end of each financial month, the practice management system was balanced to the client’s individual Excel log book and any discrepancies were corrected before the monthly financial reports were prepared
Any services that hadn't been billed were reviewed for missing charges or the client was contacted to resolve the issue
Utilized Encoder Pro to check for CCI edits before submitting claims with multiple surgery CPT codes, utilized RVU values when assigning the order of the surgery CPT codes, and assigned any modifiers as needed
Payment Poster
3/13 – 4/14 Solor Inc (100% remote position)
Used eMDs PM/EMR
Used Zirrmed and Gateway clearinghouse to post ERA/EFT payments
Posted scanned mail patient and insurance company payments
Worked insurance company denials and forwarded more involved denials to Insurance A/R specialist
Reviewed patient progress notes if a claim was denied for medical necessity and refiled claim if an alternate diagnosis code was available
Coding Specialist and Billing Manager
5/08 – 6/12 Cancer Center of South Florida, Lake Worth, FL
Used GE Centricity PM/EMR, and Intellidose
Assisted in training non-clinical and clinical staff on GE Centricity
Created office superbill and hospital card
Coded infusion and injection services from nursing documentation
Posted all office charges
Posted patient and insurance company payments
Utilized hospital portals to obtain facesheet and authorization for hospital patients
Registered hospital patients and posted charges
Submitted electronic and paper insurance claims
Sent patient statements
Used a computer program to create a treatment plan for any new infusion or injection services to ensure that the drug being given was not a loss to the practice
Obtained authorization for infusion and injection services from insurance companies
Obtained insurance benefits for infusion and injection services and advised patient of financial responsibility
Advised patient of any non-covered Medicare infusion and injection services and obtained ABN
Was financial counselor and obtained payment from foundations for eligible services
Met with pharmaceutical reps and obtained reimbursement and billing information for all
newly-approved FDA drugs
Contacted pharmaceutical reimbursement hotlines/companies with insurance company issues
Filed appeals to insurance companies for any incorrectly denied claims
Worked insurance company denials
Followed-up with insurance companies on outstanding AR
Resolved patient accounts and created payment plans when necessary
Created referral form and obtained referrals from PCP for all office services
Obtained authorizations for diagnostic testing done at outside facilities
Created insurance benefit verification form, verified insurance benefits for all new patients, and verified insurance eligibility/benefits monthly for established patients
Performed minor troubleshooting with GE Centricity
Implemented PQRI
Was involved in E-Prescribe
Assisted in credentialing physicians with Medicare and insurance companies
Covered front desk when needed
Remained updated on insurance companies and Medicare policies
Remained updated with Medicare Lab NCDs, gave a copy of the NCDs to each office medical assistant, and assisted with any outside Medicare LCD denials
Billing Specialist (1099 part-time employee)
5/07 – 11/11 Richard Cappiello, MD, Boynton Beach, FL (Rheumatology practice)
Used of Edgemed Practice Management System
Resolved patient accounts
Posted charges and payments
Submitted electronic and paper claims
Sent patient statements
Followed-up with insurance companies on outstanding AR
Remain updated on changes with insurance companies
Remain updated on Florida Medicare
Implemented PQRI into practice
Billing Specialist (part-time)
1/2005 – 2/08 Donald R Watren, MD, West Palm Beach, FL (Family practice)
Used Intergy Practice Management System
Resolved patient accounts
Help to develop office financial office policies
Posted charges and payments
Yearly update office superbill
Submitted electronic and paper claims
Sent patient statements
Remain updated on changes with insurance companies
Remain updated on Florida Medicare policies
Advised practice and remain updated on NPI
Implemented PQRI into practice
Billing Specialist (part-time)
9/07 – 5/08 Weiss Family Chiropractic Center, Palm Springs, FL (Chiropractic)
Used Medisoft Practice Management System
Resolved patient accounts
Posted payments from patients and insurance companies
Sent patient statements
Remain updated on changes with insurance companies
Coding and Billing Consultant (part-time)
11/07 – 7/08 John Sortino, MD, Boca Raton, FL (Internal Medicine)
Advised practice on purchase of practice management system
Help to develop office financial policies
Posted charges and patient payments
Reformatted superbill
Reviewed insurance contracts
Entered patient demographics into practice management system
Submitted electronic and paper claims
Sent patient statements
Remain updated on changes with insurance companies
Remain updated on Florida Medicare policies
Advised practice on NPI issues
Coding Specialist
10/03 – 3/07 Palm Beach Cancer Institute, West Palm Beach, FL
Used Medical Manager
Participated in committee that yearly updated office superbill
Participated in practice’s internal forms committee
Assisted business office with diagnosis and procedure code denials
Responsible for all aspects (benefit verification, insurance follow-up,
appeals, advised patients of financial responsibility) for a high cost
drug
Assisted outside labs with diagnosis
Assisted in development of Medical Genetics Program
Developed scheduling form and superbill for group's Diagnostic
Radiology department
Heavily involved with implementation of NOPR's PET
registry
Developed scheduling form for group's PET CT department
Involved in training of all clerical new employees
Assisted referral department with questions on diagnosis
and procedure codes
Attended various Oncology teleconferences
Attended training on Pyxis machine
Ran various reports on OTN's computer system
Responsible for updating practice's administration on quarterly updates on Medicare's drug pricing (AWP)
Responsible for updating practice's administration on changes in
Medicare's policies
Responsible for updating practice's administration on changes in Medicaid's reimbursement and policies
Responsible for updating practice's administration on policy changes in major insurance companies (Aetna, Cigna, United Healthcare)
Worked closely with Managed Care Coordinator on CPT changes to ensure that the practice captures all revenue
Assisted Laboratory Manager with development of in-office superbill and remained current in Medicare's reimbursement and diagnosis guidelines
Was interim Financial Counselor during the position search
Assisted Financial Counselor with questions on patient account
Obtained reimbursement and billing information for all
newly-approved FDA oncology drugs
Assisted Pharmacy manager with reimbursement questions on drugs
Coded office superbills for diagnosis code (s)
Reviewed office superbills to ensure that the practice captured all relevant charges
Notified clinical staff of charges that cannot be billed due to diagnosis issues
Notified physicians of changes in consultations (CMS redefined in 2006)
Educated clinical and non-clinical staff on completion and usage of ABNs
Answered questions from practice staff when billing manager was unavailable
Ran monthly financial reports
Was acting supervisor of business office when billing manager was
unavailable
Reviewed all electronic and paper claims before claims were
submitted
Performed end-of-day charge and payment balancing
Posted charges and payments
Responsible for all aspects (billing, developed forms, claims followup,
educated billing staff) of office's portable pumps and anticancer pills (DMERC)
Education
8/1988 - 12/1992 Lock Haven University of PA, Lock Haven, PA
Bachelor's Degree
Majored in Special Education; Minored in Elementary Education, Reading, and Math
Special Skills
Medical Manager, Intergy, EdgeMed, Medisoft, and GE Centricity practice management systems
Microsoft Word and Excel
Type 65 words per minute
References
Available upon request
Professional Associations
Member of American Academy of Professional Coders (AAPC) – Palm Beach County Chapter
Certified Professional Coder
Contact this candidate