Healthcare

Rosalyn C. Reid, BA, CPC, CBCS, NRCCS

• Bachelors in Journalism ( impeccable written and verbal communication skills) double major

• Political Science (analytical, articulate, diplomatic and effective team-builder & conflict resolution specialist able to manage expectations for a workable solution)

• Certified Professional Coder (CPC) American Academy of Professional Coders

• Nationally Registered Certified Coding Specialist (NRCCS) National Assc for Health Professionals

• Technical Expert in Medicare, Managed Care, Private and Third-Party reimbursement policies/contracts

• Broad and comprehensive understanding of US health care system

• Proficient Coding and Billing expert on EPIC/IDX/Medisoft/Claimsgear/ Billing Systems

• 10+ years direct experience with proven management and organizational leadership skills

• Critical thinking skills, problem solving skills, follow-through skills, and the ability to see "the big picture" and prowess managing multiple projects with competing priorities

• Superior medical terminology, anatomy and physiology discipline

• Ability to manage a prodigious workload.

Regional Reimbursement Manager TranS1, Inc - Wilmington, NC - May 2009 to April 2011 Work with the Director of Reimbursement to track and report on trends within my geographic region. Abstract and coded ICD-9 & CPT-4 neuro/ortho surgical spine cases to ensure proper code assignment and ensure coverage and reimbursement. Trouble shooter on key strategic initiatives as assigned. Effectively managed territory planning and time management by covering my geographic area of responsibility with Area Directors, Clinical Sales Managers and their respective accounts to provide coding and consultative reimbursement support and strategies of the organization. * Provided regional support and executed tactical plans related to reimbursement that drove acceptance of TranS1 product lines by key hospitals, physicians and payer organizations. * Demonstrated keen knowledge of the US coverage, product coding and reimbursement systems and methodologies that lead to recommendation for promotion to Asst Reimbursement Director by the Director of Reimbursement. * Detailed understanding of biotech medical device (for neuro and ortho surgeons) reimbursement and coding through a keen knowledge of hospital financial systems and management practices. * Assisted in developing company message, reimbursement documents and educational materials and resources for the customers and sales organization. * Used as a trouble-shooter across all regions by Director to facilitate coding and complex payer and customer issues to remove reimbursement and access barriers as well as partner with providers and their staff to identify, define and create provider and hospital economic success.

Medical Insurance Coding Instructor Everest College - Houston, TX - June 2005 to May 2009 Motivated Educator performed daily onsite abstract coding procedures from medical records and patient charts from anesthesia/E&M as well as surgical cases. Taught hundreds of tomorrow's coders to expertly and accurately assign and sequence ICD-9 diagnostic and CPT abstract procedural codes to patient records of moderate to high complexity levels using ICD-9-CM, CPT-4 and HCPCS codes in accordance with HIPAA compliance and coding rules and regulations. Empower and motivate students. Promote trustworthiness and honesty. Excellent conflict resolution management skills of divergent personalities. Authoritative/ informative training techniques. * Taught health care compliance, CMS- 1500 form completion and billing, EOB calculations and interpretation. * Taught UB-04 revenue codes, UB-04 field locators, charge master interpretation and EMR electronic billing * Expertly taught prior authorization methodologies, Medicare fraud, rules and guidelines. * Taught extensive anatomy and physiology in preparation for national coding credentials. * Taught appeals procedures as well as A/R and collection processes. Benefit Specialist Supervisor RSI Securities - Houston, TX - May 2003 to June 2005 Implemented company quality assurance procedures to assess and audit Health & Welfare employee benefit plan contracts to assure compliance with policy coverage. Interpreted complex or unusual policies to determine whether claims submitted to third-party carriers warranted escalating attention. Trained new employees. Assigned work to be accomplished by subordinate staff members. Helped staff with appeals/grievances.

• Claims Operation Manager 03-2001 to- 05-2003 Administaff Houston, TX Managed physician payment policy and contracts for two major health plans. Ensured claims were paid or denied in compliance with physician contracts. Authorized payments within the scope of my authority for incorrectly adjudicated claims. Set and adjust short-term priorities, prepared work schedules, assigned workload to subordinates, developed performance standards and evaluated work performance of subordinates. Gave instruction to employees on both work and administrative matters. Interviewed job candidates. Analyzed claims activities, prepared and presented reports to CEO. Liaised closely with Texas Department of Insurance preparing and presenting reports on corporate compliance.

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