Medical Billing Records

Tokethia Watson CPC

**** ********** **. *********, ** 75146

Phone 469-***-**** Email **************@*****.***

SUMMARY:

Self-motivated, goal-oriented professional with 18 years of progressive medical experience, who demonstrates leadership and organizational skills, problem solver, a professional Coder and Biller, a Compliance Auditor, and a medical billing and coding Instructor.

Texas Health Resources Dallas, Tx

Virtual Coder II /January 2020- Current

WORK EXPERIENCE

• Accurately abstracts information from the medical records assigns ICD-9/10-CM, CPT-4, and HCPCS level II codes in compliance with established guidelines. Provides codes to various departments upon request.

• Reviews supporting medical record documentation to ensure accurate code assignment (ICD, CPT, HCPCS) of professional charges in compliance with third party payer, NCCI guidelines and THPG policies. Maintains documentation to record/track coding variance. Performs charge reconciliation.

• Compares hospital charges posted against procedures coded and identifies any discrepancies. Notifies leadership of any discrepancies and collaborated to rectify the same. •Participates in special projects and completes other duties as assigned (e.g., Charge correction requests, research of payor policies, Accounts Receivable & Denials management).

Parkland Hospital Dallas, Texas

Virtual Coder 1 July 2014- Januar/2020

1. Codes and conducts charge quality review of all episodes of care for Community Oriented Primary Care (COPC), Outpatient Clinics (OPC), Maternal and Fetal Medicine (MFM) and Women and Infants Specialty Health (WISH) encounters according to coding and billing guidelines and hospital policy.

2. Assigns appropriate evaluation and management (E/M) level, ICD 10-CM, CPT, HCPCS, HCC and/or HEDIS CAT II code according to the Centers of Medicare & Medicaid Services (CMS), AHA, AMA and other state and federal requirements.

3. Achieve and maintain 95% accuracy on quality reviews and productivity standards.

4. Verify, edit and/or enter charges based on documentation or insurance requirements reporting any discrepancies in a timely manner.

5. Updates, as appropriate, patient database with classification codes to provide sufficient patient health information according to Parkland's standards.

6. Stays abreast of the latest developments, advancements, and trends in the field of health information management by attending seminars/workshops, reading professional journals, actively participating in professional organizations and integrates knowledge gained into current work practices.

7. Identifies ways to improve work processes and improve customer (internal as well as external) satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.

8. Facilitates a positive working relationship with physicians, nurses, and medical staff and hospital employees to ensure that all work related encounters are productive.

9. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the Coding area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.

10. Maintains CE hours and renew annual coding credentials.

Dallas VA Medical Center, Dallas, TX

Medical Record Coder/ September 2012 – July 2014

Analyze the medical record to identify all pertinent diagnoses and procedure for coding.

Evaluate the adequacy of the documentation.

Read and understand the content of the medical record, the terminology, the significance of the comments, and the disease process/path physiology of the patient.

Review medical record documentation and assigning current versions of the classification systems required in the current position, such as ICD AND CPT.

Advanced knowledge of the full scope of coding and abstracting including inpatient discharges, surgical cases, diagnostic studies and procedures, outpatient encounters.

Create PowerPoint presentations and provides coding training for staff and physicians.

UT Southwestern Medical Center, Dallas, TX

Compliance Analyst/ October 2010 – September/2012

Analysis and research for compliance within government hospital guidelines.

Perform quarterly billing compliance audits for a large physician group serving Children’s Medical Center at Dallas, and Parkland Memorial Hospital.

Prepare departmental summaries based on billing compliance audit findings to Division Directors, Billing Compliance Officer and staff. Codes and abstracts relevant information, i.e., onset of symptoms, type of illness or condition, prospective or definitive diagnosis, test, procedures, and other types of services rendered.

Utilize coding resources, i.e., ICD-10, CPT, and department fee schedule, services rendered and enter diagnosis into computer or on billing sheet.

Billing Coordinator/ Pediatrics September 2008- September 2010

Handled high level calls from patient and physician concerning hospital bills.

As a Billing Coordinator, I supervised staff in the areas of charge entry, coding issues, TES edits, EPIC Work queues, time and attendance. Responsibilities include research and finding resolutions for NRA reports, Z-claim edit report, Pedi-Mail, system denials and coding edits. Communicate with patients, insurance carriers, and other departments to resolve billing discrepancies. Department Super User for EPIC and resource person for training of staff on new systems implemented and continuing education of current processes.

Billing Specialist/ Pediatrics January 2006 – September 2008

Handled inbound and outbound calls for patients inquiring about medical statements, making payments and payment arrangements.

As a Billing Specialist, with daily billing operational functions, trained staff and new employees. Responsible for daily billing in IDX System, Corrected TES and Work file edits, resolved denials and billing discrepancies from patients, insurance carriers, and MSRDP to insure proper reimbursement. Reconciled daily missing charges and processed payment posting.

Charlton Methodist Hospital, Dallas, TX

Admitting/ August 2002 – December 2005

Responsible for admitting patients into the inpatient setting.

Verify medical benefits, assuring co-pays were received and posted to patients account.

Registered patients into outpatient and into the emergency room setting.

Call Patients to scheduled patients for radiology test and procedures.

EDUCATION:

Medical Billing Coding Course- Cedar Valley College (2003)

Certified Professional Coder (CPC) – American Academy of Professional Coders (2009)

SKILLS:

EPIC IDX Microsoft Office and Excel

Medical Terminology CPT Coding ICD-9 Coding

Billing Collections Reimbursements

Edits/Rebills Inpatient/Outpatient Medicaid/Medicare

3M Encoder TruEncoder CAC Encoder

TEACHING ENGAGEMENTS:

Cedar Valley College, Lancaster, TX

Instructor I/ June 2010- 5/2015

As the instructor for the college Medical Billing and Coding course responsible for instructing the basic entry level coding to students with little knowledge of the field. Instructed ICD-9, CPT, Medical Terminology, and Medical Laws and Ethics as well as communicated day to day working knowledge of the course as it relates in the career field.

Everest College Campus, Dallas, TX

Instructor I/ December 2009 – May 2010

As an Instructor I was responsible for teaching the guidelines and how to utilize the codes for ICD-9, and CPT, Medical Terminology, and Medical Laws of Ethics, as well as, communicated working knowledge of the course as it related to the career field for the Medical Billing and Coding course. I maintained an exceptional semester student retention rating.

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