Certified Medical Coder and Billing Specialist
Resume:
Tisha Carter
Rochester, NY ****3
Home: 1-585-***-****
***********@*****.***
Professional Summary
Certified Professional Coder (CPC) with 5+ years of dedicated physician/professional fee coding experience (including PB coding at University of Rochester Medical Center), complemented by 14+ years in medical billing, claims processing, and revenue cycle management. Expert in ICD-10-CM, CPT, HCPCS Level II, E&M coding, and modifier application for multi-specialty physician practices and outpatient services. Proven in achieving high coding accuracy (98%+), reducing denials, optimizing reimbursement, and resolving complex edits/denials. Proficient in Epic HB/PB and committed to compliant, accurate coding in fast-paced healthcare environments.
Skills
●ICD-10-CM/PCS and CPT/HCPCS coding
●Evaluation & Management (E&M) coding for professional/physician services
●Professional fee (PB) and outpatient coding
●Claims analysis, submission, denial management, appeals, and edit resolution
●Epic HB/PB proficiency
●Modifier application, diagnosis verification, and documentation querying
●Medical records abstraction, auditing, and charge capture
●Revenue cycle optimization and AR follow-up
●Team supervision (led team of 6) and training
●Problem-solving, attention to detail, and self-discipline
●HIPAA compliance and payer guidelines
Professional Experience
Business Office Associate HB- Senior
Business Office Associate HB- Supervisor
HIM PB Coder
Rochester Regional Health System, Rochester, NY 05/2012 – 02/2026
●Developed and implemented process improvements that maximized billing efficiency, reduced delinquency rates, and increased department accuracy in a high-volume healthcare environment.
●Assigned modifiers, coded narrative diagnoses, verified code accuracy, and ensured
●compliant charge submissions using Epic HB/PB and clearinghouse systems.
●Investigated and resolved claim denials through collaboration with providers, payers, and internal teams, recovering significant revenue and minimizing outstanding AR.
●Processed refunds, disbursements, payments, and monthly performance reports while reviewing accounts for accurate patient/insurance information.
●Maintained timely charge capture and rectified discrepancies to support optimal reimbursement.
●Supervised a team of 6 staff members, providing guidance on billing/coding best practices.
●Abstracted clinical documentation from physician notes and ancillary services to assign precise ICD-10-CM diagnoses, CPT procedures, and HCPCS codes for professional fee billing in outpatient settings.
●Specialized in E&M coding for office visits, preventive services, and consultations, maintaining 98%+ accuracy and reducing coding-related denials by 20%.
●Applied appropriate modifiers (e.g., -25, -59) and ensured adherence to payer-specific guidelines for improved claim acceptance.
●Conducted regular audits of coded encounters, identified documentation trends, and collaborated with providers on education to enhance coding specificity and compliance.
●Supported revenue optimization by identifying under-coded services and facilitating timely claim submissions through integrated workflows.
PB Coder (Professional Billing/Physician-Based)
University of Rochester Medical Center, Rochester, NY 10/2020 – 03/2023
●Assigned accurate CPT, ICD-10-CM, and HCPCS codes to physician professional fee services based on medical record documentation, including office visits, procedures, and consultations across multiple specialties.
●Reviewed and resolved system edits, coding denials, and claim errors in accordance with coding rules, payer policies, and University guidelines, achieving high first-pass acceptance rates.
●Queried providers for documentation clarification to ensure specificity, completeness, and compliance, reducing rework and supporting accurate reimbursement.
●Performed coding audits, abstracted data, and provided feedback to improve documentation and coding quality in Epic PB workflows.
●Handled complex denial follow-up and appeals, collaborating with billing teams and physicians to recover revenue and minimize aged AR.
Claims Processor
Rochester Laborers, Rochester, NY 11/2009 – 09/2010
●Processed high-volume medical claims daily, verified provider coding and service accuracy, and referenced administrative guidelines to ensure compliance.
Patient Account Representative
Unity Hospital, Rochester, NY 08/2002 – 07/2010
●Recovered over $70,000 in AR over 180 days through targeted special projects.
●Resolved patient, family, and payer inquiries; posted payments; adjusted charges; and corrected billing discrepancies.
●Assisted in training new employees and supported department-wide problem resolution.
Education and Certifications
Associate of Science in Liberal Arts and General Studies
Monroe Community College, Rochester, NY
Certifications
●Certified Professional Coder (CPC), AAPC – Current
●Notary Public
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