Sharon Casanova

Certified Medical Coder, Experienced in Full Revenue Cycle Management and Office

Management

Denver, CO 80230

adp1lj@r.postjobfree.com

+1-210-***-****

Skills and Experience:

• Revenue cycle management

• Long term care

• Critical care

• SNF billing

• Contracting

• Facility and provider based billing.

• Medicare, Medicaid and commercial payers billing.

• Experience in appeals, rejections and denials.

• Preparing, reviewing, and transmitting claims.

• Experience in claims collection, insurance and self pay.

• Knowledge in CPT, ICD-10 and modifiers.

• Knowledge in business and accounting.

• Knowledge in EDI

• Knowledge in different Computer Software

• Tech savvy

• Experienced in Allscripts, eClinicalWorks, NextGen, AthenaHealth, Primesuite, Centricity and Kareo

• Experience in Trends and Root Cause Analysis

• Experience in Microsoft Outlook.

• CMS-1500

• UB04

Willing to relocate: Anywhere

Authorized to work in the US for any employer

Work Experience

Claims Processor II

Innovage Long Term Care - Denver, CO

Present

• Processing professional, and institutional claims.

• Process routine medical, dental, life, Medicare, Medicaid and/or hospital claims in accordance with assigned Plan(s).

• Corresponding with providers on behalf of the members when it comes to claims being billed to the members.

• Conducting research in relation to member/client/management inquiries and document findings.

• Reviewing CPT codes and ICD-10 codes

• Ensuring global periods are followed.

• Consistently meeting established performance standards, including quantity and quality claims processing standards.

• Processing provider appeals and making a profound decision.

• Maintaining current knowledge of assigned Plan(s) and effectively apply knowledge in the payment of claims, customer service, and all other job functions.

• Utilizing multiple operating platforms and portals for research and claims processing.

• Updating Medicare and Medicaid Pricer.

• Perform other related duties as assigned.

Revenue Cycle Specialist - Full cycle management

Orthopedic Centers of Colorado - Denver, CO

October 2020 to May 2021

Duties:

Account Receivables, error-proofing claims prior to submitting to the insurance company, correcting rejected and denied claims, ensuring claims are processed and paid at the contracted rate, corresponding with insurance companies, filing reconsideration requests and appeals, corresponding with patients, utilizing all available provider and payer portals, running weekly reports, corresponding with providers ensuring proper and correct use of codes, corresponding with schedulers ensuring pre-cert/pre-auths are obtained.

Full Cycle Biller/Coder and Office Manager

Douglas Family Medicine - Castle Rock, CO

March 2020 to September 2020

Duties:

Fully cycle billing. From front desk to the back office, scheduling appointments, checking in, checking out patients, collecting copays, coinsurances, out-of-pocket, charge capture, entering and submitting claims, Account Receivables management, payment posting, credentialing, contracting, patient collections, administrative tasks, buying office supplies, operating office machines, faxing, mailing and training new employees. But due the pandemic,

the practice decreased our work time significantly, reason why I resigned because I need a fulltime job. Full Cycle Medical Biller

Spine One - Centennial, CO

October 2019 to March 2020

Duties: Accounts Receivables management, billing audits, Reporting; AR report, Payment report, Collection and Trend report, Key performance Indicators report, Patient payment report, Clearinghouse rejections report.

Reason for Leaving: Unfortunately, the company faced some financial challenges and decided to outsource the entire revenue cycle and laid off our team. Full Cycle Billing and Coding Lead

RCCH PMDS LLC - Greenwood Village, CO

May 2018 to September 2019

Duties: My scope of work includes outpatient, inpatient, and provider-based billing which includes charge entry, full cycle AR for Professional, Facility, DME, auditing, correcting rejected and denied claims, filing appeal, abstracting and verifying accurate HCPCS, ICD-10, and CPT codes, filing clean claims to, adhering to the payer reimbursement guidelines, keeping up with the new coding rules and reimbursement policy guidelines as they change from time to time.

I am also responsible for training new employees, facilitating a work flow, monitoring and assessing productivity performance of team members, ensuring quality of work and tasks are completed in a timely manner. As a lead my work includes running weekly and monthly reports. Taking the lead in team work. Diffusing disagreements within the staff and other assigned tasks from my supervisor. Full Cycle Medical Biller

San Antonio Kidney Disease Center - San Antonio, TX January 2017 to May 2018

Duties: Managing the revenue cycle, training new employees with the system/software, patient registration, coverage and benefits verification, obtaining prior authorization, credentialing, managing the account receivables, appeals, and payment posting, facilitating a work flow, monitoring and assessing productivity performance, auditing providers when necessary, running weekly and monthly reports, performing the charge entry for hospital, dialysis, office visits and transplant charges, maintaining adherence to company policies and procedures and billing department procedures, auditing, ensuring that the practice is in compliance with healthcare federal law and policies, ensuring that accurate ICD-10, and CPT codes are documented, educating providers with coding rules and regulations. Also did credentialing on top of AR management. Medical Biller and Coder

Ear Nose Throat Clinics of San Antonio, P.A - San Antonio, TX July 2015 to December 2016

Duties: Credentialing, patient registration, verifying insurance coverage and eligibility, corresponding with patients for coordination of benefits, verifying established patient's coverage, eligibility and benefits, educating providers with NCD, LCD guidelines, ensuring that code matches with doctors' dictations and that it meets the payer's guidelines, entering charges, correcting claim denials and rejections, assigning accurate ICD-10, and CPT codes, managing account receivables team, training new employees, auditing. Medical Biller

Kareo Medical Billing Group - San Antonio, TX

January 2014 to June 2015

I worked here as a medical biller while going to college for Medical Coding. My role included but not limited to insurance coverage and eligibility verification, verifying patient's demographics, obtaining prior authorization, referral, credentialing, patient collection, setting up payment arrangements, payer/ insurance collections; correcting and re-billing denied claims for professional, facility and DME, explaining EOB, posting payments, filing appeals and other tasks as assigned. Customer Service Supervisor (Billing for Verizon and AT&T) Calling Solutions Call Center - San Antonio, TX

January 2008 to December 2013

• Responsible for educating customers about organization’s products or services.

• Providing supervision and technical assistance to CSR team to attain goals.

• Preparing documentation and reports on company’s revenue on a weekly basis.

• Handling escalations related to order changes and cancellations to ensure that customer complaints are resolved in a professional manner.

• Conducting meeting with managers to discuss about improvements and issues.

• Evaluating CSR staff activities and providing regular performance-related feedback.

• Training staff.

• Performing additional duties where needed.

Education

Medical Billing and Coding

Southern Careers Institute - San Antonio, TX

December 2013 to January 2015

Bachelor's in Accounting

AB College - Philippines

1996 to 2000

Skills

• CPT coding

• Medical billing

• ICD-10

• Allscripts

• Adobe Acrobat

• eClinicalWorks

• Medical coding

• Medical collection

• Medicare

• Accounts Receivable

• Insurance Verification

• Administrative Experience

• Anatomy Knowledge

• Bilingual

• Epic

• Pivot tables

Assessments

Verbal Communication — Proficient

April 2019

Measures a candidate's ability to effectively convey information when speaking. Full results: Proficient

Electronic Health Records: Best Practices — Highly Proficient April 2019

Knowledge of EMR data, associated privacy regulations, and best practices for EMR use. Full results: Highly Proficient

Medical Billing — Highly Proficient

April 2020

Understanding the procedures and forms used for medical billing. Full results: Highly Proficient

Medical Terminology — Proficient

April 2020

Understanding and using medical terminology

Full results: Proficient

Medical billing — Highly Proficient

April 2020

Understanding the procedures and forms used for medical billing. Full results: Highly Proficient

Protecting patient privacy — Proficient

November 2021

Understanding privacy rules and regulations associated with patient records Full results: Proficient

Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.

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