Medical Billing & Coding Specialist with 7 Years Remote Experience
Resume:
***********@***.***
Brooklyn, NY **203
Experienced in medical coding,
billing, and claims resolution, with
expertise in reimbursement policies
and HIPAA compliance. Skilled in
team collaboration and
documentation review, offering a
thorough understanding of health
care terminology and benefits
administration. Eager to leverage
extensive customer service and
technical skills.
PROFESSIONAL SUMMARY
SKILLS
Decision-making
Team collaboration
Documentation review
Data analysis
Time management
Workers compensation
Jump Cloud
Community Outreach
Integrate Clinical User
Experiences
Program Evaluation
MS Office-Word PowerPoint
Explanation Of Benefits
Collaboration Of Benefits
Smart data Solutions Claims
Control Panel
Health Savings Accounts
Health Reimbursement
Accounts
DESIMARIE WRIGHT
Medical Coding Billing and Claims
Representative Sr.
Housing Specialist
EXPERIENCE
United Health Group
Jan 2024 – Apr 2025
• Ensure claims are accurate and in compliance with applicable laws
• Prepare and submit reports to management
• Provide advice on reimbursement policies and procedures Utilize appropriate knowledge resources to drive resolution of applicable questions/issues (e.g., websites, CRM tools, Onyx, Siebel, knowledge bases, product manuals, SharePoint)
•
Make outbound calls to resolve caller questions/issues (e.g., to callers, providers, brokers, pharmacies)
•
Ensure proper documentation of caller questions/issues (e.g., research conducted, steps required, final resolution)
•
Offer additional options to provide solutions/positive outcomes for callers
(e.g., online access to relevant information, additional plan benefits, workarounds for prescription delays)
•
• Develop and maintain productive relationships/interactions with callers Knowledge of applicable health care terminology (e.g., medical, dental, behavioral, vision)
•
Knowledge of applicable products/services (e.g., HIPPA, state/regional requirements)
•
Demonstrate knowledge of applicable products/services (e.g., benefit plans, disability, COBRA, FSA, HRA)
•
Brooklyn Center for Independence of the
Disabled (BCID)
May 2017 – May 2024
New York, NY
Assess barriers to the housing of individuals and families experiencing homelessness to determine housing and service needs and support them in obtaining and maintaining housing.
•
Develop a housing procurement, financial, and self-sufficiency case management plan with clients, including an intake interview to determine the client's needs, goals, and eligibility.
•
Provide mediation and advocacy with landlords, and property management companies, on the client's behalf to develop a workable plan to obtain and or maintain housing.
•
• Research Criminal and Sexual Offender background researcher. Maintain up-to-date knowledge about the different housing programs, NYCHA, Section 8, City Feps, LINC l, ll, lll, and others.
•
Meet with the clients, family members, and Social Workers to review if the client can be approved for the program. I collect all the paperwork and review the client's background by contacting the Department of Corrections and the United States Department of Justice Sex Offender Public Website, as well as the New York State Division of Criminal Justice Services, to verify the information. repairs or if there is a conflict between the client and the landlord.
•
• Participates as a mental health team member.
Flexible Spending Accounts
Cobra
Reimbursement policies
Health Insurance Portability and
Accountability Act
Medical coding Billing
Claims resolution
HIPAA compliance
Customer service
Technical skills
Teresa Diamond
Sharon Seignon
Yolanda Wright
REFERENCES
Management,
Whole Food - Co-worker
****************@*****.***
Customer Service Representative Sr.,
United Health Group - Co-worker
**********@*****.***
Processing Clerk,
Deustche Bank - Co-worker
****************@*****.***
Compliance Specialist/Housing (Criminal
Background Investigator)
Public Health Advisor Level II
In some cases, the client will need assistance to adjust to moving back into the community or dealing with serious mental illness. I will connect the participants to community resources and support groups. Check on them more than once a month to make sure they are okay.
•
Facilitated meetings between landlords and tenants to resolve disputes over rent payments or other matters.
•
Evaluated properties for suitability as affordable housing units and coordinated renovations when necessary.
•
Brooklyn Center for Independence of the
Disabled (BCID)
Jun 2022 – Jan 2024
Brooklyn, NY
Documents members' service benefits by contacting the appropriate health plans as needed
•
Processes appropriate authorizations for HMO/PPO clients as specified in the Optum procedures
•
Prints and mails authorizations to providers, patients, HMOs, and facilities as needed
•
Assists and monitors in the processing of referrals. Enters, updates, and closes referrals daily while assuring that appropriate internal/external referral providers are utilized, members are eligible and have benefits coverage, correct CPT/ICD-9 codes have been entered, accurate records of all dates and other required fields are entered, supporting clinical data for the referrals is entered, and all urgent referrals are processed within the designated time limit
•
Coordinates, identifies and routes referrals that require review to licensed Care Management staff who arranges outside physician medical review as appropriate
•
Assists with answering telephones and maintaining files, logs, or other reports
•
Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act
(HIPAA) standards
•
New York City Health and Hospital Central
(NYCHHC)
Jun 2022 – Jan 2024
New York, NY
• Provide advice on reimbursement policies and procedures Consistently exhibits behavior and communication skills that demonstrate our company's commitment to superior customer service, including quality, care, and concern with every internal and external customer
•
High School
EDUCATION
Erasmus Hall High School
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