CPC, Medical Billing Special Education

CLAIRE MITCHELL

Cold Spring, NY ***** 917-***-****

********@*****.***

Certified Professional Coder, Medical Billing Specialist, Skilled in E/M auditing, Medical Terminology and Anatomy, CPT, ICD-10, HCPCS guidelines, Word, Excel, Power Point, knowledgeable of CMS guidelines, NCD’s, LCD’s, NCCI Edits

EXPERIENCE

OCTOBER 2019-JULY 2020

REGULATORY AFFAIRS ASSOCIATE, ENT AND ALLERGY ASSOCIATES, INC/ QMMS, TARRYTOWN, NY

Performed monthly audits for providers in all 48 offices across the NY and NJ area

Worked closely with the Director of Regulatory Affairs to report all findings of the monthly audits which include office visits, in-patient hospital visits, audiological testing, allergy testing, and surgical procedures

Discussed audit results with individual providers regarding CPT, ICD-10, and CMS guidelines

Completed tasks regarding CPT/ICD-10/ CMS Guidelines, Medicare ADR’s, insurance denials, and provider inquiries

Responsible for keeping current with CMS NCD’s, LCD’s, and NCCI Edits

JULY 2016-OCTOBER 2019

MEDICAL CODING SPECIALIST, ACCN BILLING INC., WOODCLIFF LAKE, NJ

Performed all coding for multiple Skilled Nursing Home, Nursing Home, and Hospice facilities in NYC

Performed all internal audits for multiple Skilled Nursing and Nursing Homes in NYC

Assisted VP of Operations in providing on-site training regarding E/M documentation guidelines to the physicians at the facilities we work with

Scrubbed claims to ensure clean claims submissions

Responsible for keeping current with the CMS Fee Schedule, CMS NCD’s, LCD’s, and NCCI Edits and updating all facilities on all changes to guidelines

Responsible for entering claims, payment posting, and all claims follow up including appeals

JULY 2015-JUNE 2016

CODING AND COMPLIANCE SPECIALIST, Jawonio, New City, NY

Performed internal audits of patient medical charts for the Health Center which includes Primary Care, Podiatry, Audiology, Psychiatry, Social Work, PT/OT, Speech Therapy, and Dental

Responsible for training all physicians on the guidelines for ICD-10 and documentation requirements

Provided education to the PSR’s on insurance eligibility

Provided training to the Medical Billing Specialist on Charge Entry and Claims Follow-Up

Scrub Physical Therapy, Occupational Therapy, and Speech claims on Optimus PT Billing System

Responsible for Charge Entry using Accumedic Billing Software

Followed up on all Medicare, Medicaid, and Commercial Insurance claims

Created spreadsheets to identify denial trends within each specialty

Converted all superbills to current CPT, ICD-10, and HCPCS coding for all specialties

Responsible for keeping current on all CPT, ICD-10, and HCPCS coding guidelines and annual changes

JUNE 2013-JUNE 2015

MEDICAL BILLING SPECIALIST, Endocrine Associates, Pomona, NY

Followed up on all Medicare and GHI claims

Post all Medicare and GHI payments and sent out corrected claims and appeals

Completed Weekly Aging Reports for Medicare and GHI claims

Assisted patients with their accounts

Verified patient eligibility using web portals and IVR

Reviewed and entered Billing Alerts – which assisted with patient check-in

Completed NYS spreadsheet for The Office of Unclaimed Funds

2012-2013

MEDICAL BILLING SPECIALIST, MEDSTAR CONSULTING POMONA, NY

Performed all follow up work on 4 accounts, which included OB/GYN and ENT practices

Posted payments for Physical Therapy Groups

Worked on weekly reports for each account including sending corrected claims and appeals

Assisted patients with their accounts

2011-2012

MEDICAL BILLING SPECIALIST, ARC OF ROCKLAND, CONGERS, NY

Reviewed all Special Education Attendance Sheets and progress notes for services rendered to the students at Primetime for Kids

Entered all charges for Special Education services on the Fund EZ Program and NYEIS website

Mailed out all billing for all Special Education services which includes Early Intervention, Pre-School, and

Compiled monthly spreadsheets in Excel to document all school billing to the county and the school districts

Reviewed and entered all charges for Medicaid billing of IRA claims, Day Habilitation, Pre-Vocational, and Senior Programs

Entered charges to be billed on the Voucher to NYS for these programs

Posted all payments into the Fund EZ program

Posted all Financial and Sales batches into the Great Plains software program

Reviewed and rebilled unpaid claims to Medicaid

Ran monthly Food Stamps which included entering charges and posting the payments for each consumer

Worked with the Director of Finance to keep her informed of any issues that came up regarding School Billing and Day Program Billing

2009-2010

INSURANCE FOLLOW-UP REPRESENTATIVE, MediTab, NANUET, NY

Followed up on all outstanding commercial claims in the Ovation system for the group OB/GYN of SLR

Verified patient eligibility using web portals and IVR’s

Checked claims status using web portals and IVR’s

Ran and worked on reports for outstanding claims

Compiled daily and weekly spreadsheets of all reviewed claims in Excel

Entered patient insurance information

Attended weekly meetings with the President and Billing Manager to update on any issues regarding OB/GYN of SLR

EDUCATION

New York University, 2000-2002

CERTIFICATIONS

CPC

AAPC, January 2013-present

VOLUNTEER

Cold Spring Food Pantry

December 2018-present

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