OBJECTIVE

Quality focused, medical billing and coding professional seeking a position with a reputable company that offers opportunity for advancement from within, as well as using my knowledge of medical terminology, anatomy, billing, coding, and accounting procedures to contribute to the continued success of the company.

QUALIFICATIONS

AAPC Certified Professional Coder (CPC), 2009

EXPERIENCE

October 2021 to present

National Medical Management - Coder Spokane, WA

oUsing Optum CAC Pro software to read and interpret medical records to accurately assign the correct procedure code using CPT and principal diagnosis codes using ICD-10 as well as manually coding E&M charges from transcribed reports for optimal reimbursement.

oApplying appropriate modifiers according to CCI edits for accurate payment. Use LCD to identify CPT with ICD-10 validity.

oQuery physicians for clarifications on reports that are incomplete, lacking documentation, have discrepancies and/or need additional information, working with physicians /medical staff and supplying feedback, information and guidelines to improve clinical documentation for accurate coding.

oWork with AR Representatives on medical necessity and bundling denials by supplying documentation for appeal, assisting with formatting appeal letters to insurance companies.

oUsing Epic/Cerner to obtain information from patients EMR for information needed to accurately bill Medicare/ Medicaid as well as third party payers.

oUsing Advanced MD and Imagine software for medical billing and complete revenue cycle management.

oWatching for denial trends, investigating for solutions of trends, verifying insurance specific policies regarding trends and/or denials.

oWorking coding denials in a timely manner for claims to be reprocessed within specific insurance’s allotted time frame for appeals.

oVerifying accuracy of all claims prior to releasing daily.

oAssisting in other departments as needed.

oMaintaining certifications and staying current on coding changes by participation in webinars, insurance newsletters, local chapter meetings and continuing education.

October 2015- April 2020

Occupational Medicine Associates - Results coordinator Spokane, WA

oCollect specimens for drug testing and alcohol testing as required by employers and DOT.

oCoordinate results of tests and mail, fax, or email results to requesting party, as well as mail results to patients.

oAssist in medical records department and reception area as needed.

November 2011- October 2015

Aces Community Health – Medical biller/ Asst accountant Post Falls, ID

oEntered charges for billing using CPT and ICD9-9 as well as Applying appropriate modifiers according to CCI edits for accurate payment. Use LCD to identify CPT with ICD-9 validity.

oFormat appeal letters for denied claims using Word and providing supporting documentation when needed.

oSubmitted corrected claims when a change is made to diagnosis, units, place of service, modifier or any other change that would necessitate a corrected claim.

oQuery physicians for clarifications on reports that are incomplete, lacking documentation, have discrepancies and/or need additional information, working with physicians /medical staff and supplying feedback, information and guidelines to improve clinical documentation for accurate coding.

oPosting insurance payments, contractual adjustments, and write offs to accounts. Posting patient payments made at time of service, over the phone, or by mail to accounts. Verifying daily total balance.

November 2009 – November 2011

Healthy Focus Family Medicine and Wellness- Coder/Biller Spokane, WA

oVerify accuracy of CPT and ICD 9 on super bill/ fee slip prior to manually entering charge into Medisoft.

oSubmit daily claims electronically through Premera and Office Ally.

oCredential new and existing providers with payers by completing applications and submitting documentation when needed.

oPerform chart audits by verifying accuracy of billing team and/or documentation requirements meet or exceed billing standards.

oPerform office compliance audits by verifying everyone has completed HIPAA training as well as testing annually and all sensitive patient information is stored appropriately.

oPosting insurance payments, contractual adjustments, and write offs to accounts. Posting patient payments made at time of service, over the phone, or by mail to accounts. Verifying daily total balance.

oCall insurance companies on unpaid claims in aged report, verify claims are in process and payable. Begin appeals on denied claims if eligible for appeal and verify accuracy of coding for medical necessity denials.

EDUCATION

oMedical Office Specialist A.A.S. – Spokane Community College

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