cell: 312-***-**** email@example.com
Certified ! Professional Coder (CPC)
Microsoft Excel, Microsoft Word, Microsoft Outlook, Ten-Key, Sequel, Dovetail, Exeter, AWD, MEDI, EncoderPro, iCentra Revenue Cycle billing software, Power Chart, Charge Viewer, Meditech, SSI Click-on, Cerner, WebNow, Positive Pro, Apple- works, Adobe Acrobat, Text Edit, Quicken, Medisoft, SharePoint, RingCentral, Jira, Quickbooks. Personal Profile:
• Strong knowledge of analyzing claim related issues on the payer side, medical billing for government, commercial and worker’s comp payers in different states and on different software systems on the provider side.
• Over twelve years with continuous experience in healthcare revenue cycle with focus on claims analysis, billing and coding physician, outpatient and inpatient claims, and some experience with cash-posting and follow-up.
• Motivated professional that respects and appreciates the need for strong teamwork and leadership.
• Able to juggle multiple priorities and meet tight deadlines without compromising quality.
• Highly creative problem solver with talent for mastering technology and troubleshooting.
• Loyal, humble and honest. Strong believer in clear communication to improve workflow.
• Seeking opportunities to expand and enrich my career in the coding realm of this exciting field but open to honing my skills
! in other areas of the healthcare revenue cycle in other positions. Professional ! Experience:
NEXTLEVEL HEALTH, Chicago, IL/ 312-***-****/ Supervisor: Tish Hammick 2017 - 2019 Senior Claims Analyst
• Collect, integrate and analyze AR data from providers and create pivot tables for investigation and/ or commu- nication on scheduled calls for providers. Prepare for such meetings and presentations and keep detailed notes of progress on identified issues. Provide information that is attractive, relevant and useful. Continue to devel- op skills in relevant technologies that assist in this area.
• Create procedures to ensure high quality work and monitor by setting up workflows. Verify information and review work of myself and team. Develop systems to track information for Claims Department and other de- partments (eg. Legal, Provider Services).
• Seek help from and assist teammates in creating and comprehending information and directions so appropriate action can be taken. Communicate openly and clearly to colleagues and superiors with brevity to keep informa- tion streamlined and relevant. Adapt communication style when others have difficulty understanding my mes- sage.
• Introduce new approaches experienced elsewhere if beneficial to current workflow. Think creatively and proactively to problems to overcome barriers. Determine actions that lead to positive outcomes. Use ingenuity and integrity to move solutions along even when all information is not available. Adapt in order to overcome risk and uncertainty. Be open to other solutions than my own and other viewpoints.
• Adapt to shifting priorities and changes in job requirement and workflow to further the company’s and depart- ments primary purpose (eg. audits, HFS issues). Demonstrate determination to meet others objectives and take
! actions that lead to service improvements.
ASTON CARTER, An Aerotek Inc, Company, Chicago, IL / 773-***-**** / Recruiter: Jared Weisberg 2016 - 2017 Business Claims Analyst, NextLevel Health
• Hired as coder, but present focus is heading ongoing priority project involving investigating and processing returned and refund checks from providers. Built on previous process by creating SOP/ workflow documents outlining the various re- quired steps.
• Acting as liaison between Provider Services, Finance and Claims Department with providers concerning payment issues.
• Training other staff members assigned to work on this project.
• Triaging the various priorities regarding the Refund/ Returned payments project to avoid checks expiring and provider dis- satisfaction. ! Keeping Billing Director apprised of progress and issues. Lynne Hurder, LCSW, CSADC, Chicago, IL / 773-***-**** / Supervisor: Lynne Hurder 2007 to Present Coder/Biller/Administrative Assistant
• Billing and following up up on Medicare and commercial payer claims.
• Determining appropriate CPT codes and modifiers for regular and EAP claims.
• Filing, copying, faxing and organizing paperwork and performing postal duties as needed..
• Maintaining account books.
• ! Patient/Payer liaison.
Accretive Health, Chicago, IL / 312-***-**** / Supervisor: Robert Troksa 2010 to 2016 Medical Billing Specialist / Remote from home office Duties included:
• Billed electronic hospital and physician claims for commercial and government payers.
• Added modifiers to CPT codes and corrected CPT codes/ diagnosis code order when appropriate on Intermountain Health Care physician claims.
• Escalated to client issues found in daily workflow.
• Headed cash-posting project which involved business travel/ training in Utah and selected and trained a small team in Chicago. Performed regular team audits.
• Removed duplicate charges or requested Provider Reviews per documentation in the medical records.
• Audited billers in our India offices.
• Created spreadsheets from billing software and faxed requests for Purchase Orders and TARS authorizations for Prison/ US Customs and Border patrol patient accounts and communicated via phone and email with payor representatives.
• Calculated Medicaid outliers and sent medical records to payer.
• Verified claim data with patient records to ensure accuracy.
• Took appropriate action to ensure authorization numbers for inpatient stays and obtained missing patient demographic data required for claim adjudication.
• Contacted departments at provider sites for coding and charge corrections.
• Maintained and utilized NDC / CDM formularies for UB04 and CMS-1500 claims to prevent claim denials.
• Identified and escalated issues regarding productivity and payment barriers.
• Stayed current with field-related training.
• ! Maintained an open, flexible and teachable attitude in order to assist management with any needs that arose.
Stephanie Aldort, Chicago, IL / 773-***-**** / Supervisor: Stephanie Aldort 2010 Personal Assistant
• Filed and organized paperwork.
• Pet care
• ! Postal duties.
LSSI- Behavioral Health Services, Chicago, IL / 847-***-**** / Supervisor: Joseph Paul 1998 to 2006 Administrative Assistant
• Answered phones/switchboard.
• Maintained utility accounts for office cost center.
• Filed, copied, faxed and organized paperwork and performed postal duties as needed.
• Performed administrative duties for all counselors by request.
• ! Ordered and maintained office supplies.
• Associate of Arts (AA) Harold Washington College
• Overview of Medical Billing and Coding Certificate Truman College
Courses included: Medical Terminology, Fundamentals of Medical Billing and Coding, Advanced Medical Billing and Coding, Medical Insurance Billing, Computers in the Medical Office.