Medical Biller & Coder
Resume:
M.Jessica Monroe, CRC CBCS
Certified Medical Biller and Coder/Risk Adjustment Coder
Houston, TX 77073
adu5n1@r.postjobfree.com
I have the CPC and CRC certifications fro the AAPC, CBCS certification from NHA, 10 years of Medical Billing and Coding experience, 6 years in a leadership role as the Director of Medical and Billing, provider educator and contracting advisor, and 10 years of acting as an Insurance Liaison on the providers side of the Business. I've advanced in my career by utilizing my strengths of analyzing medical terminology and data, ICD coding, revenue cycle guidelines and procedures, HCPCS, CPT codes, payment scales, and Information technologies. Yearly I maintain my credentials and furthering my education in the Medical Field. Texas Medicaid, Medicare, Military, Private Insurance, and self-pay are the insurance types I am experienced with.
Currently looking to expanding my experience and capabilities as a Contractor, Part-time, and/or Full- time employee.
I’m looking to do more in my field, learn more, and get further! Willing to relocate: Anywhere
Authorized to work in the US for any employer
Work Experience
Remote Customer Service Representative/Sales Associate Teleperformance
October 2021 to Present
Using Salesforce, Citrix, a diaper, and Teams daily, I would take incoming calls to aid in the following tasks:
• Assess/access current insurance plan.
• Obtain medications for price comparisons with different pharmacies.
• Obtain current eligibility information.
• Provide an updated plan or benefit option.
• Locate updated or new provider.
• Maintained up-to-date knowledge of customer accounts
• Provided assistance to clients
• Answered phone and assisted clients with changes
• Explained products and benefits
• Scheduled reservations for customers
• Created customer appointments
Owner and Operator
Leave the Billing to Us, LLC - Remote
January 2016 to Present
This is a billing, collections, and coding company that works remotely and assess the needs of the client.
• Eligibility - Verify all of the payers that they are In-Network with and for the Out of-Network I would contact the payer on a case by case basis.
• Compliance - Verify the system, pricing, and coding setup by the fee schedule for each payer.
• Auditing - Data abstraction from records electronically and/or on paperwork.
• Accounts Receivables - Oldest date of service to the newest is how the system is worked.
• Resolutions - Pick a course of action to do a corrected claim, appealed claim, or a new claim.
• Payment posting - Making sure the system reflects exactly what the insurance company has on each EOB.
Medical Billing & Coding Director
Angel Medical Supply /Cy-Fair Medical Supply/Healthcare Services of America - Houston, TX June 2011 to Present
Leading a team of billers in office and a working with an outside collections team to meet daily and monthly matrix.
• Durable equipment being coded with HCPCS and ICD-10 codes.
• Eligibility - Medicaid, Medicare, and private checks monthly.
• Insurance Liaison - Work directly with the insurance company's relations representative special projected when collection trends are an issue.
• Reports - Run daily or monthly reports for account closings, account hold, and stopped accounts.
• Monthly Updates - verify fee schedules, work on corrections, audit accounts, and payment verification. Insurance Sales/Claims Processor/Checks Team
United Healthcare
2013 to 2014
Providing expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims.
• Follow policies and procedures according to the members plan to authorize the appropriate payment or denial.
• Data entry and re-work projects; analyzes and identifies trends to provide reports as necessary.
• Assistance with standard and non-standard requests, resolved routine problems on own, solved complex problems, and was able to prioritizes and organizes my work to meet the agreed upon deadlines.
• Be a team player while maintaining the accurate completion. Education
HCC in Risk Adjustment Coding
OS2U Healthcare HCC Mock Project
January 2022 to June 2022
CPC in Medical Billing and Coding
AAPC - Remote
November 2020 to May 2021
Certification of Completion in Risk Adjustment
Compliant Coding Systems Coding Academy
April 2017 to March 2018
Still Continuing Education in Heatlh Information Technology Houston Community College - Houston, TX
2016 to 2017
Diploma in Medical Insurance Billing and Coding
Everest Institute - Pittsburgh, PA
2011 to 2012
High school diploma or GED
1999 to 1999
Skills
• Medical Terminology (10+ years)
• ICD-9 (10+ years)
• HCPCS (8 years)
• Office Applications (10+ years)
• Medical Billing (10+ years)
• Medical Coding (10+ years)
• Medical Records (10+ years)
• Texas Medicaid (10+ years)
• Medicare (10+ years)
• Private Insurance (10+ years)
• Claims Processing (1 year)
• Hipaa (10+ years)
• Appointment Scheduling (10+ years)
• Collections (10+ years)
• Icd-10 (6 years)
• Time Management
• Leadership Experience
• Office Experience
• CPT Coding (7 years)
• Medical Office (10+ years)
• Teaching (6 years)
• Microsoft Word (10+ years)
• Microsoft Excel (7 years)
• Physiology Knowledge (8 years)
• Anatomy Knowledge (8 years)
• 10 Key Calculator
• Customer Service (10+ years)
• EMR Systems (8 years)
• Insurance Verification (10+ years)
• Medical Scheduling (10+ years)
• Auditing (8 years)
• Accounts Receivable (10+ years)
• Data Entry (10+ years)
• Office Management (6 years)
• Workers' Compensation
• Phone Etiquette
• Quality Assurance
• Microsoft Office
• Microsoft Powerpoint
• Microsoft Outlook
• English
• Medical Accounting
• Typing
• Documentation review
• Information security
• Computer literacy
• Sales
• Medical collection
• Project management
• Data collection
• Managed care
• Medical documentation
• Windows
• Care plans
• Process management
• Analysis skills
• Benefits administration
• Customer relationship management
• DME
• EDI
• Communication skills
• Utilization review
• Employee Orientation
• ICD Coding (10+ years)
• DRG
• Athenahealth
• Negotiation
• Computer skills
• 10 key typing
• Process improvement
• Citrix
• EHR systems
• Conflict management
• Analytics
• Microsoft Access
• VPN
Certifications and Licenses
Texas All-Lines Adjuster License
October 2014 to 2016
Property, Casualty & Surety and Workers' Compensation, Employer's Liability & U.S. Longshoremen's and Harbor Workers' Compensation Insurance
CRC - AAPC
March 2018 to Present
*Expertise in reviewing and assigning accurate medical codes for diagnoses performed by physicians and other qualified healthcare providers in the office or facility setting (e.g., inpatient hospital)
*A sound knowledge of medical coding guidelines and regulations including compliance and reimbursement - allowing a CRC to understand the impact of diagnosis coding on risk adjustment payment models
*Understand the audit process for risk adjustment models
*Ability to identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding
*Knowledge of anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses
CBCS - NHA
July 2017 to Present
Gather/review essential patient information
Verify required documentation before patient information is released Prevent fraud/abuse by auditing billing
Support coding and billing process
Assign codes for diagnoses and procedures
Submit claims for reimbursement
Coach healthcare providers to achieve optimal reimbursement Driver's License
November 2003 to November 2024
TEXAS INSURANCE AGENT LIFE & HEALTH
October 2020
LIFE, DEATH, ANNUITIES, UNIVERSAL LIFE, & WILLS
Certified Professional Coder (CPC)
Present
Medical coding accuracy is key to optimal, ethical reimbursement, which makes medical coders integral to the financial resources of every healthcare organization providing treatment and services to patients. For more than three decades, CPCs have established an unwavering reputation of excellence. The title of Certified Professional Coder therefore comes with high expectations, trust, and respect. Passing the CPC exam unequivocally demonstrates to employers that you possess:
• Expertise in assigning accurate medical codes for diagnoses, procedures, and services performed by physicians and other qualified healthcare providers in the office, as well as professional-fee coding as it pertains to facility settings (e.g., inpatient hospital)
• Sound knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity, using modifiers appropriately, and observing bundling rules
• Proficiency across a wide range of services, including E/M, anesthesia, surgery, radiology, pathology, and medicine
• Thorough grasp of anatomy, physiology, and medical terminology to comprehend clinical documentation and code descriptors
• Understanding of how to integrate medical coding and payment policy changes into a practice's reimbursement processes
Medical Coding Certification
Certified Coding Specialist
Certified Coding Associate
CRC
Assessments
Proofreading — Proficient
August 2019
Proofreading written texts.
Full results: Proficient
Medical Billing — Expert
October 2020
Understanding the procedures and forms used for medical billing Full results: Expert
Electronic Health Records: Best Practices — Highly Proficient August 2020
Knowledge of EHR data, associated privacy regulations, and best practices for EHR use. Full results: Highly Proficient
Customer Service Fit — Proficient
March 2020
Measures the traits that are important for high-quality customer service. Full results: Proficient
Sales Skills — Proficient
July 2020
Persuading reluctant customers to buy products or services, and influencing and negotiating with customers to meet sales goals.
Full results: Proficient
Work Style: Conscientiousness — Highly Proficient
July 2020
Tendency to be well-organized, rule-abiding, and hard-working Full results: Highly Proficient
Retail Skills: Shelf Stocking — Expert
June 2020
Receiving and storing merchandise or product.
Full results: Expert
Research — Proficient
October 2020
Following protocols, interpreting statistics and graphs, identifying errors, and choosing research methodology
Full results: Proficient
Medical billing — Highly Proficient
June 2022
Understanding the procedures and forms used for medical billing Full results: Highly Proficient
Attention to detail — Highly Proficient
October 2020
Identifying differences in materials, following instructions, and detecting details among distracting information.
Full results: Highly Proficient
Protecting patient privacy — Expert
June 2022
Understanding privacy rules and regulations associated with patient records Full results: Expert
Basic computer skills — Highly Proficient
October 2020
Performing basic computer operations, navigating a Windows OS, and troubleshooting common computer problems.
Full results: Highly Proficient
Spreadsheets with Microsoft Excel — Proficient
June 2022
Knowledge of various Microsoft Excel features, functions, and formulas Full results: Proficient
Sales skills — Highly Proficient
June 2022
Influencing and negotiating with customers
Full results: Highly Proficient
Attention to detail — Highly Proficient
June 2022
Identifying differences in materials, following instructions, and detecting details among distracting information
Full results: Highly Proficient
Protecting patient privacy — Expert
June 2022
Understanding privacy rules and regulations associated with patient records Full results: Expert
Supervisory skills: Motivating & assessing employees — Proficient June 2022
Motivating others to achieve objectives and identifying improvements or corrective actions Full results: Proficient
Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.
Additional Information
Skills
MS Office (PowerPoint, Word, Excel, etc.)
Medical Insurance (Medicare, Medicaid, Private and Commercial) Medical Software (Brightree, PACWIN, Medisoft, Facets, CSP Facets) Keyboarding
CPR
Medical Billing (Paper/Online claims, reconsiderations, appeals) Internet
10-Key Entry
Xactimate Software
HIPPA educated
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