Reimbursement Specialist Billing
Resume:
Andrea D. Green, BSHA, CPC
Pearland, Texas 77584
Cellular 281-***-****
**********@*****.***
Objective and Professional Highlights
With an overall 21 years of experience in the healthcare field including billing, coding and auditing. I am seeking a responsible and challenging position in healthcare offering new opportunities for professional growth. Detail-oriented individual with excellent written, and oral communication skills, self-motivated and enthusiastic, with a positive and professional demeanor. Demonstrate proficiency in CPT-4 and ICD-9, ICD-10 coding. Attended various educational seminars, to enhance knowledge of coding, billing and compliance. Self motivated, enthusiastic and always presents a positive and professional image of the employer. Strong knowledge of 1995 and 1997 coding guidelines.
Professional Work Experience:
March 2016-present UT Health Science Center
Sr. Certified Coding Specialist
Summary: Reviews, determines accuracy of and applies the correct coding conventions to patient charge encounters, procedural and surgical services, as defined through physician documentation, regulatory agencies and various third-party payers.
Oversight of personnel performing routine correct coding applications utilizing ICD-9-CM, CPT-4, and HCPCS codes required for the patient charge encounters when reviewing physician generated codes, ensuring compliance.
Identifies and reports correct code selection from physician documentation, to include, but Identifies and reports correct code selection from physician documentation to include, but not be limited to; chart notes, abstracting from medical records documentation, medical diagnostic and/or interventional reports, ensuring compliant coding selections are reported, as needed.
Provides periodic assessment and audit to insure quality assurance is provided to assigned department.
Reviews and reports all denials related to coding, by report, assigning and indicating reason codes for coding denials.
Act as a resource in the clinic setting for providers, practitioners and staff for queries related to coding convention and compliance questions.
Liaison with outsourced account managers as related to coding endeavors within their departments.
January 2014 St. Lukes Health System/ CHI
Sr. Revenue Integrity Analyst
Summary: Worked with multiple department Directors, Managers, Clinical Directors, reviewing
And providing education on their department’s Charge Master and monitoring the charge entry and reconciliation process.
Responsible for providing direction in developing and maintaining systems, processes, and work flows for they timely and accurate recording of hospital revenue in regards to charge capture.
Evaluates, researches, and analyzes coding, revenue, and billing to insure compliance with all payor requirements. Determine patterns of charging and ways of increasing payment for the charged services.
Resolve “bill holds” for charge related issues assigned to the work queues.
Assists in review of charges and clinical data from targeted points of care to compare services charged verses services recorded.
Interacts with Nurse Managers, clinical staff, to identify areas of missing charges; ensures compliance of practices and policies and the transfer of expert knowledge of current OPPS rules, CCI edits, and CMS reporting requirements to staff.
Develops expertise in one or more clinical area where charges are complex and varied.
Responds to results and report finding, identifying late, erroneous, or missing charge postings with follow up analysis, development, and implementation of recommendations, action plans to minimize late or missing charges.
November 2007-
December 2013 Univ. of Texas M D Anderson Cancer Center
Clinical Billing Specialist
Summary: Manage the charge capture and documentation for the Gynecologic Oncology department. Support billing for 21 physicians, 23 Advanced Practice Nurses, Residents, and Fellows.
Provides oversight of professional fee capture and impacts the department revenue and associated processes charges via electronic system (Medaptus).
Review Medaptus daily for New Patients, Consults and Inpatient, and Or cases for charged and uncharged. Communicate any documentation issues with faculty.
Review charge capture and rejection data and makes recommendations. Coordinates educational compliance, researches compliance issues, provides recommendations to improve documentation accuracy.
Provides training to new nursing and physician providers and advises regarding appropriate coding and related processes. Assists with researching diagnosis and procedure codes as necessary.
Submit charges for a large volume of inpatient charges, Review outpatient visits, and post-surgical visits to insure charges are posted, and documentation supports charges billed.
Set up new electronic or paper financial files as necessary to support data needs and reporting requirements. Organizes information for systems improvements and assists in implementation. Instructs personnel on processes and procedures and new system applications.
Serves as the liaison between the Gyn department, the clinic, Patient Business Services, and the institutional Compliance office.
Prepare reports and make recommendations on improvement of billing processes.
Communicate best practices of billing and documentation to the faculty, mid-level providers, residents, fellows, administrators and others.
Train staff on the charge captures process and documentation requirements.
November 2005 Kelsey-Seybold Clinic
To October 2007 Coding
Cl Reimbursement Specialist
Summary: Developed and perform audits for denials on claims, and prepare written outcome reports of the audits that were conducted.
Worked assigned PCS Workfile(s) initiating the appeals process including rebilling as necessary. Obtain and submit correct and comprehensive required information to ensure maximum reimbursement.
Analyzed patient accounts and review EOB’s, chart notes, work rejection reports and keep track of medical necessity denials sent to the physicians.
Contact insurance payors regarding inappropriate reimbursements. Prepared and maintain rejection and CPT audit reports.
Act in leadership capacity in the absence of the Manager on issues pertaining to coding patients’ accounts and invoices.
Keep abreast of changes in reimbursement rules via newsletters as well as seminars.
April 2000 Univ. of Texas M.D. Anderson Cancer Center
To October 2006 Professional Coding Specialist
Summary: Six years experience in coding and auditing multiple specialties: Cardiology, Pulmonary, Internal Medicine, and Gastrointestinal Clinics.
Coded governmental charge tickets according to the guidelines set forth by Medicare.
Inpatient and Outpatient CPT4 and ICD9, ICD-10 proficient coding of professional charges. Conducted a high volume of audits based on Medicare rules and regulations.
Initiated high level decision making, communicated in a clear, concise and knowledgeable manner with a variety of professionals including physicians and department administration.
Proficient in working with a large amount of bundled procedures.
Education:
September 2008 Columbia Southern University, Orange Beach, Alabama
To April 2010 Bachelors of Science in Health Care Administration
August 1990 Texas Southern University, Houston, Texas
To May 1992 Major: Health Care Administration
Professional Membership: American Academy of Professional Coders, (CPC)
References: Available upon request
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