Billing Coordinator Licensed Practical
Resume:
MONA SMITH
Licensed Practical Nurse/ Skill Nursing Billing Coordinator
Chester, VA 23831
**********@*****.***
Authorized to work in the US for any employer
Work Experience
Home and Community Based Authorization/ Billing Coordinator Welcome Home Care-Richmond, VA
May 2008 to Present
A Home and Community Based (HCBS) Authorization and Billing Coordinator is responsible for ensuring accurate and timely authorization for HCBS services, as well as managing the billing process for those services. This role involves interacting with various parties, including clients, providers, and payers, to verify eligibility, request and maintain authorizations for services rendered as well as resolve billing issues.
Responsibilities:
• Authorization Management:
• Verify client eligibility and benefits for HCBS services.
• Process and track authorization requests for HCBS services.
• Communicate with payers to obtain necessary authorizations.
• Maintain accurate records of authorizations and denials.
• Appeal denied authorizations as needed
• Billing and Reimbursement:
• Prepare and submit accurate bills for HCBS services to payers.
• Monitor and track payments from payers.
• Resolve billing discrepancies and denials.
• Investigate and resolve payment disputes.
• Maintain accurate records of billing and payment information.
• Communication and Coordination:
• Communicate with clients, providers, and payers regarding authorization and billing matters.
• Collaborate with internal teams, such as case management and finance.
• Provide support to clients and families regarding billing and payment information.
• Compliance and Documentation:
• Adhere to relevant regulations and guidelines for HCBS authorization and billing.
• Maintain accurate and organized documentation of all activities.
• Ensure compliance with payer requirements and billing standards. Skills and Qualifications:
• Knowledge of HCBS regulations and guidelines: Understanding of Medicaid and other relevant funding sources.
• Familiarity with billing and coding: Experience with CPT, HCPCS, and ICD-10 codes.
• Strong communication and interpersonal skills: Ability to interact effectively with clients, providers, and payers.
• Attention to detail and accuracy: Ability to process information accurately and efficiently.
• Problem-solving skills: Ability to identify and resolve billing and authorization issues.
• Computer proficiency: Experience with billing software and other relevant systems.
• Experience in healthcare or social services: Preferred, but not always required. LTSS FIELD SERVICE COORDINATOR
Anthem Blue Cross BlueShield-Richmond, VA
June 2017 to April 2018
A LTSS Field Service Coordinator in Virginia, like the one at Elevance Health, would be responsible for managing member cases, conducting face-to-face assessments, and coordinating care plans to meet individuals' long-term services and supports (LTSS) needs, including behavioral health and social services. This role involves developing individualized care plans, managing member histories, and ensuring cost-effective utilization of health benefits. They also collaborate with healthcare teams, including RNs and non-RN clinicians, to provide comprehensive and integrated care. Key Responsibilities:
• Assessment and Planning:
Conducting comprehensive assessments of individual needs, developing personalized service plans, and setting goals for care.
• Service Coordination:
Identifying appropriate services (e.g., home health, day care, adult day care), coordinating with providers, and ensuring timely and efficient service delivery.
• Collaboration:
Working with interdisciplinary teams, caregivers, and other stakeholders to ensure integrated care.
• Field Visits:
Making home visits to assess needs, provide support, and monitor service delivery.
• Communication:
Maintaining clear communication with individuals, families, and service providers.
• Documentation:
Keeping accurate records of assessments, service plans, and interactions.
• Advocacy:
Advocating for individuals' needs and rights within the system.
• Problem-solving:
Identifying and resolving barriers to care, such as transportation issues or access to services. Patient Educator/ Lifestyle Coach/Case Management
Central Virginia Health Services, Inc.-New Canton, VA January 2015 to June 2017
The Virginia Center for Diabetes Prevention & Education (VCDPE) programs primarily focus on providing support and education for individuals at risk of or with prediabetes, aiming to help them make lifestyle changes to reduce their risk of developing type 2 diabetes. The VCDPE utilizes the National Diabetes Prevention Program (NDPP), a CDC-led program.
1. National Diabetes Prevention Program (NDPP):
• Target Audience:
Individuals 18 years or older who have prediabetes or are at risk for type 2 diabetes.
• Program Structure:
The NDPP is a year-long program with 22 one-hour sessions, utilizing a group setting and a lifestyle coach to support participants.
• Goals:
To help participants lose weight, improve their physical activity levels, and adopt healthy eating habits, ultimately reducing the risk of developing type 2 diabetes.
• Impact:
The NDPP has been proven to cut the risk of type 2 diabetes in half. 1. Virginia Cooperative Extension (VCE) Diabetes Prevention Program:
• Focus:
Provides continuous support for a full year, focusing on lifestyle changes.
• Support Structure:
Group meetings are held weekly for the first 4 months, then bi-weekly for 2 months, and finally once a month for the second 6 months to maintain healthy lifestyle changes. 1. Other Programs:
• Diabetes Self-Management Education (DSME) Programs: Some centers also offer DSME programs, which focus on educating individuals with diabetes on how to manage their condition effectively, including topics like blood glucose monitoring, medication management, and understanding different types of diabetes.
Skilled Private Duty HCBS Licensed Practical Nurse Care Advantage-Colonial Heights, VA
October 2011 to December 2014
A skilled private duty LPN in an HCBS (Home and Community Based Services) setting provides direct patient care, including medication administration, wound care, and vital sign monitoring, within the patient's home or community. They also document care, educate patients and families, and coordinate with other healthcare professionals.
Key Responsibilities:
• Direct Patient Care:
• Assessing and addressing patient needs based on a plan of care.
• Administering medications, both oral and injectable.
• Providing wound care, including cleaning and dressing wounds.
• Monitoring vital signs and reporting changes to the patient's condition.
• Assisting with activities of daily living (ADLs) such as bathing, dressing, and eating.
• Documentation and Communication:
• Maintaining accurate records of patient care, treatments, and any changes in their condition.
• Communicating changes in patient status to other healthcare providers, family members, and caregivers.
• Patient and Family Education:
• Educating patients and families on managing chronic conditions, following prescribed treatments, and maintaining a safe home environment.
• Providing support and guidance to family caregivers.
• Collaboration:
• Coordinating care with physicians, therapists, social workers, and other medical professionals.
• Participating in patient care conferences and meetings.
• Other Duties:
• Collecting specimen samples when needed.
• Preparing patients for transfers or discharges.
• Assisting in medical procedures as needed.
• Managing emergency medical situations.
Education
Certificate Program in Life Style Coach
UVA Diabetes Prevention Program-Charlottesville, VA March 2015 to May 2025
Certificate in Pharmacy Technician
Bremo Pharmacy-Richmond, VA
May 2014 to May 2025
Certificate Program in Licensed Practical Nurse
Richmond School of Health and Technology/ Chester Career College-Chester, VA June 2008 to May 2025
Associate's Degree in Human Services
J Sargeant Reynolds Community College-Richmond, VA January 2011 to March 2013
Certifications and Licenses
CPR Certification
February 2025 to February 2027
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