Center Agent Representative

Dianne Boone Walden, BA, MHA

Contact information cell 919-***-****

E-mail ************@*****.***

Retiree

Call Center Program Specialist September 12, 2023-current Lab Corp Durham N.C. Outbound call center agent who called insurance companies 75% of the workday. Commercial, government and state insurance plans to confirm major medical coverage benefits for the drug Ozurdex and its administration fee. The goal is to capture the insurance structure (i.e. patient cost share, deductible, out of pocket expense and prior authorization or pre-determination options). Agents queried the payors as to what requirements was necessary to support prior authorization (i.e. letter of medical necessity, clinical notes/images and completion of any pre-authorization of pre-determination forms). The method of submission (i.e. payor portal or other portals like cover-my-meds, phone, fax ) and timelines for processing any requests. Report back to the provider as to the steps necessary to get the patients prior authorization or pre-determination requirements completed or advise of approval number/effective and termination dates and the number of units approved. Follow-up to authorization is performed by health care provider staff. The remaining 25% of the date was inputting data into the computer which is then transmitted to the provider. Navigating the benefit questionnaire through-out the call is vital to reporting data during the call is vital in communicating information to health care provider and staff.

Call Center Representative January 22-March 22 IBM Durham N.C. Outbound call center agent who call patients, providers, pharmacies, and insurance companies to get or confirm medication policy benefits including verifying co-pays. In this position 80% of the workday is making outbound calls and requires the associate to have empathy when speaking with policy holders, as well as understand the need for efficient turnaround times. The need to navigate applications and programs quickly and efficiently on a computer through-out the call is very important. This was a short-term assignment.

Account Coordinator September 2021-November 2021 REMX Durham, N.C. This role makes outbound calls to Health Care Providers, Insurance Plans and Pharmacies to assist in getting a patients prior authorization completed or confirm approval for our patients to get the medication they need to live a healthy life. This was a short-term contract agreement.

Medical Records Coder March 2021-July 2021 General Dynamic Tech Info (GDIT) Washington, DC This role required the assignment of coding adverse effects/events of the COVID-19 vaccines (Janssen, Pfizer or Moderna). MedDRA was the tool utilized in assigning these codes. This was a six-month contract agreement but due to circumstances beyond our control the contract was terminated early.

Compliance Auditor May 2008-January 31, 2019 Duke Medical Center Durham, N.C. Performed comprehensive audits of outpatient technical and professional charge capture (i.e., Bariatric Surgery, Physical Therapy, Evaluation and Management for Professional Services, Level of Service in Hospital Based Clinics) auditing of departmental processes (i.e. coding and denials) (i.e. documentation improvement) to ensure the organization was adherent to regulatory guidelines through being cognizant of opportunities of risk to the organization. Prepared, and presented written reports of observations and findings with process improvement recommendations to internal customers Departmental Directors, Clinical Operational Directors, and Associate Compliance Office with the expectation of implementation of corrective actions when applicable. Developed and implemented an auditing tool for charge capture audits. CDM review/auditing shaped >5,000 changes in the charge master among three facilities. Developed and presented presentations on topics relevant to coding, clinical documentation, and ICD-9 coding. As a certified coder, these skills were essential in assisting with responding to Office of Internal General (OIG) correspondences and Recovery Audit Program (RAC) letters.

Adjunct Online ICD-9, CPT, Revenue Enhancement Instructor Jan 2010 -2017 DTCC Durham, N.C.

This series of classes were part of a stimulus package to offer individuals who were out of work an opportunity for a new career path. The primary objective was to teach students ICD-9 and CPT-4 coding by focusing on details in preparation to sit and pass the AHIMA, CCA certification exam.

Quality Review Auditor February 2008 -May 2008 Duke Medical Center Durham, N. C.

Responsible for auditing the Ancillary and Surgical Certified Coders ICD-9 and CPT code assignment based on clinical documentation for accuracy. Educational feedback was provided to management of coding findings based on CPT and ICD-9 coding conventions to decrease coding errors.

Coding & Denial Supervisor August 2004-February 2008 Duke Medical Center Durham, N.C.

Supervisor responsible for managing the surgical coders with a dual role of front-end coding analyst and back end third party claim denial analyst with an AR in excess of $5,000,000 monthly. Direct contact with Medicare and private insurance carriers on reconsideration of payment and/or modification to insurance claim. Weekly reports were provided to managers of progress, areas of concern and recommendations. Accountable for employee’s monthly quality audits and annual performance reviews, scheduling vacations, report express

Adjunct Medical Terminology Instructor Jan-2006-May 2006 DTCC Durham, N.C.

Instructor responsible for teaching students’ pronunciation, spelling of numerous medical terms, prefixes, suffixes, meaning, and pathological conditions.

Reimbursement Edit Analyst July 1998-Aug 1004 Duke Medical Center Durham, N.C.

Coding Analyst accountable for resolving professional charges held in CCI edits and professional charges deemed not medically necessary according to Local Medical Review Policies. Outcome resulted in decreasing edits through identification of system issues. Analyzer of physicians documented operative reports/clinical notes to extrapolate billable services, confirmation of services billed, and accuracy of CPT-4, and ICD-9 coding interventions. I performed coding and documentation education to physicians, residents, and other staff members. Development and implementation of an OB-Gyn coding office that captured inpatient/triage missing revenue in excess of $300,000 in 1st quarter of 1st year of implementation.

Adjunct Medical Coding Billing Instructor Jan-2004-May 2004 DTCC Durham, N.C.

The students were taught a basic understanding of the Health Care Billing Cycle. A basic overview of CPT, ICD-9, and HCPCS coding conventions were taught to assist in the completion of third party 1500, 837 claim forms for professional services.

Medical Coding Instructor June 2002-Sept 2002 Duke Medical Center Durham, N.C.

The students including Practice Specialist and other essential staff were taught ICD-9 and CPT coding conventions in preparation to sit for the Certified Professional Coding Exam resulting in a 95% passing rate.

Education:

Master in Health Administration Pfeiffer University May 2004

Bachelor of Science-Business Administration Shaw University May 1999

Accreditation:

CCS -Certified Coding Specialist through AHIMA-1999 (certification expired 2019)

CPC-Certified Procedural Coder through AAPC-1995 (certification expired 2019)

NAII-Durham Technical Community College 1999

ICD-10 Certified (expired)

Member of CMS Listserver

Recognition: Adjunct Teacher of Excellence Award-Durham Technical Community College-2005

Special Studies: International Studies in Healthcare in London with attention on health care in London France

Skills: Micro-soft excel, Micro-soft Word, Internet, Power point, Lotus notes, IDX, PCS, BAR,TES Blue-E, CMS, Web, Federal Register, Cirius,Siemens, SSI, E-browser, Meditech,Medireg,3M, MedDra 24.0 coder, Five9, Slack, Microsoft-Team

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