Claims Processor Inpatient Coder

Demetrius S Green

**** ** **** ** • Gainesville, Fl 32608

352-***-**** Home

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

Summary of Qualifications

Strongly dedicated, enthusiastic, and experienced medical worker.

Experience working with some of mainframe computer applications such as word and excel.

Excellent communication skills, personable, flexible, organized, able to work independently and/or work well and easily with others.

Outstanding hands-on learning.

Highly experienced in patient care.

Successful completion of (Externship program) at the University of Florida

Work Experience

August 2020-2023

Medical Billing Assistant/Accounting Asst.

Facilitates the timely and accurate electronic transmission of claims to third party payers. In cases where electronic transmission is not available, assures that the paper claim is properly completed and submitted in a timely manner. This includes but is not limited to verification of insurance, confirmation of sales orders, providing notification to clients/caregivers regarding coverage and payment responsibilities, posting the receipt of payment in the computer system, transmitting secondary claims and working payment denials.

Assures that all phases of processing client information are in compliance with HIPAA, PHI regulatory and related policies and practices; reports any Compliance issues to the Operations Manager.

Communicates in a professional and positive manner with all clients and referral sources.

Oversees the insurance verification process and ensures that any co-payments due are communicated to the client prior to the order being delivered or shipped.

When applicable may gather credit card or other payment processing information from the client and utilizes the computer system to process payment for third party payers and clients.

Manages the entry of client information into the ERP system (e.g., Brightree) in a timely manner and contact of referral source and/or client to obtain missing information needed to set up the client for service. Reviews the data to ensure that it is accurate and complete.

Confirms all sales orders in the system and ensures that proof of delivery is on file before submitting a claim for payment.

Follows up on all missing sales orders and reconciles payment information on a regular basis.

Corrects and resubmits front-end and back-end rejected claims.

Ensures that all cash is posted to the correct account in a timely manner.

Responsible for the timely follow-up and collection of payments due to the organization. This is accomplished by generating claims and/or following up with clients and/or payers.

Communicates and reports to management monthly on client co-payment analytics.

Develops and updates procedures as required for billing and collection processes.

Conducts testing as necessary related to billing/collections processes within the ERP (e.g., Brightree) system.

Conducts research and uses available resources to maintain current regulatory guidelines and reimbursement information to ensure that the company is obtaining all appropriate information as required for billing and reimbursement.

Works with internal and external auditors as necessary to assure financial compliance.

Performs other duties as needed.

February 2017-2019 (10 years at UF Health)

Claims processor full-time 40hrs weekly

With the knowledge and use of ICD-10-CM, CPT, and HCPCS coding systems, the employee

Researches and reviews bills for completeness and to ensure payer specific guidelines are meet for correct billing to third party payers. Makes collection calls, and checks various payer systems to pursues payment of Third Party claims. Make appropriate determination for contractual adjustments, verifies system balances, calculates and post adjustments. Ensures financial integrity of Shands HealthCare by processing and expediting billing and collection processes.

provides patient medical records and submit Appeals to payers when necessary.

Lab Financial Triage Specialist/Medical Lab Asst.

orders labs, verify insurances, check in patients, enter codes.

Under direct supervision, performs routine laboratory analytical procedures related to preparing and storing human biological samples, blood and body fluids, for microbiological, hematological, immune-hematological and chemical analysis.

Releases and/or places orders in hospital and laboratory computer systems, receives, processes and distributes specimens and/or blood products.

Performs various functions including loading samples onto analyzers, preparing slides for staining and preparing samples for transport to other laboratories.

July 2012-2014 Shands Vista Gainesville, FL

Financial Counselor half-time 48hrs

facilitating established financial processes that enable and expedite the billing and collection of professional services.

This includes: entering charges; applying coding/billing rules; maximizing collections; verifying insurance; obtaining authorizations for services; reviewing patient account detail; and, financial counseling of patients.

June 2009-July2012

Certified Nursing Assistant full-time 80hrs Shands at UF Gainesville, FL

functions as an assistant to the Registered Nurse performing routine procedures under his or her supervision.

Provides excellent care to patient, so patient feels comfort outside of home.

provides nursing support to achieve the organization's mission of excellent patient care.

Duties

Perform active and passive range of motion

Record accurate data related to restorative care activities.

Document resident's responses to interventions.

Communicate resident's status to nursing care partners.

Participate in team conferences.

Use universal precautions.

Understand how to use equipment in designated work area such as trapeze bars, lifts, beds, stretchers, wheelchairs, hypo/hyperthermia blankets and cardiac monitors.

Perform all other duties as assigned.

Jan 2008 full-time 80hrs Tacachale Gainesville, FL

Human support worker 2

Correctly enter database in the computer and taking calls.

Enter resident’s information in program books including, medical problems and leisure activities on a daily basis.

Kept residents home clean and safe at all times.

Helped maintain the resident’s diet as accurate as possible.

Assisted residents by redirecting as needed, making sure they reached their destinations, and kept their safety first.

Education

2006-2015(current) Gainesville high Gainesville, FL

Successful completion of high school with a high school diploma

Currently enrolled in the Certified Inpatient Coder (CIC) course at AAPC.

Completion of Certified Nursing Assistant Program.

Certified Professional Coder-CPC

Successful completion of (Externship program) at the University of Florida

other skills

High endurance, computer literate, adapts to change

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