BERNICE HARPER 301-***-****

Summary:

Analyzed Health Insurance denials for the following Markets: Iowa, Kentucky, Tennessee, Nebraska, and Kansas.

Possesses solid medical billing and coding education and experience and is poised to offer leadership and support to any established or up and coming healthcare organization.

Managed Care/PPO/HMO, Medicare/Medicaid insurance and Collection Strategies.

Cross mapped ICD-9 to ICD-IO in Electronic Health Records.

Explanation of Benefits (EOB).

CPT/HCPCS coding.

Handles refund/overpayment to determine applicability and accuracy ERA.

Utilizes IDX, Allscripts Practice Management, Touchworks E H R, Soarian, Invision and PPMS reports to analyzed and evaluate billing/collection issues.

Career Profile:

Efficient and knowledgeable in professional medical billing specialist with 18+ years’ experience, leadership and customer service skills.

Have a track record of success in completing timely electronic and manual charge submission.

Possesses solid medical billing and coding education and experience and is poised to offer leadership and support to any established or up and coming healthcare organization.

EDUCATION and CERTIFICATION:

American Academy of Professional Coders 2005

Fosdick-Masten Vocational High School: High school Diploma, Buffalo, NY 1970

Skills:

Qualifications and Systems:

Medical Billing, Coding, Audits, ERA

Electronic Health Records

Managed Care/PPO/HMO

Medicare/Medicaid insurance

Revenue Cycle

Collection Strategies

Explanation of Benefits (EOB)

ICD-I0, CPT/HCPCS coding, RVUs, GE Centricity (IDX) Allscripts PM, Allscripts EHR, Payerpath, Soarian, Invision, Touchworks, Curve analytics tool for operational outcome, Allscripts, Practice Fusion E H R., Collaborate medical billing PM, Practice Velocity E H R medical billing and Change Healthcare.

Professional Experience:

Med-Ped Health Care July 2019-November 2019

Express Health Care-Urgent Care Billing

Professional Billing/Coder

Analysis reviewed medical documentation for medical necessity guideline.

Applied CCI utilizing modifiers, correct ICD10, CPT’s, and HCPCS guideline.

Ran reports analyzing denials year to date.

Reviewed, worked denied, adjudicated electronic billing claims.

Review fee’s possible increase.

Worked with various insurance company due to denied/pending authorizations.

Allscripts – Remote Dec 2018 – Mar 2019

Allscripts Practice Management Consultant/Analysis

Analyzed Health Insurance denials for the following Markets: Iowa, Kentucky, Tennessee, Nebraska, and Kansas.

Provided application solutions for Markets denials analysis.

Possess knowledge of assigned application technology.

Work with Business Analyst to understand the customer’s product-specific requirements.

Ensure programs meet application specifications and requirements.

Maintain application documentation based on standard operating procedures in support of the assigned task.

Howard University, FPP, Washington, D.C Jan 2005 – Mar 2018

Revenue Manager, Supervisors, Team leader

Maintained day to day management billing and coding for a 190+ multi-specialty physician group practice and hospital group practice i.e. Emergency Medicine/Trauma, Radiology, Pathology, Anesthesiology, Neonatology, Mental Health, OB/GYN, Pediatrics, Pain Management, Family Medicine, Internal Medicine, Renal Dialysis, Plastic Surgery, General Surgery, Podiatry Ophthalmology Neurology, Physical Therapy and Dermatology.

Utilizes IDX, Allscripts Practice Management, Touchworks E H R, Soarian and PPMS reports to analyzed and evaluate billing/collection issues.

Provided detailed data and implements solutions affecting billing and reimbursement.

Provides market/price analysis for yearly new HCPCS and procedure codes

Cross mapped ICD-9 to ICD-IO in Electronic Health Records.

Audit review of medical records to verify the completeness.

Handles refund/overpayment to determine applicability and accuracy ERA.

Involved in a variety of client contacts regarding collections, knowledge of the law of right of creditors, assumed force, lien priorities and bankruptcies.

Assisted in the development of the paper charge submission to electronic charge submission via interface between HU hospital and the physician billing office for the department of radiology and pathology

Cross-mapped electronic dictionaries from IDX to Allscripts PM billing system.

Extensive knowledge in manual and electronic health records (EHR) billing and medical coding.

Maintain coding credentials and keeps abreast of coding guidelines.

Maps ICD 10, CPT and modifiers as needed.

Import or entered charges and post payments not placed.

Reconciles imputed payment posting and balance batch reports.

Created claims edits reports for charge entry.

Prep charges; indicate any modifiers needed on CPT codes, notate the codes for any handwritten DX, procedure, etc., return any charges to the Doctors office that require clarification.

Complies and enforces all policies and procedures related to the position, the department and the company.

Strong customer service skills; answering client calls; prompt return and follow up to all interactions.

HIPPA Compliance.

Verisk Health Revenue Division-HCC Coding-Remote July 2013-July 2014

Followed M.E.A.T. criteria.

Obesity and BMI>40 guidelines.

Verify signatures servicing provider and signing providers.

Long term use of insulin documented in medication list coded.

Review entire encounters HPI, Problem list, ROS and PMH.

Coding stenosis vs diseases.

Coding chronic vs acute conditions.

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