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Coding and Billing Specialist

Location:
Pompano Beach, FL
Posted:
October 12, 2019

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Resume:

Sarah Nachimson CPC

**** **** *****

Margate, FL 33063

561-***-****

adakq5@r.postjobfree.com

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