Remote EHR Medical Billing Specialist
Resume:
Michelle Coffey
*** *. ****** ****, ******* NY **228
*********@*****.***
Certificates:
Excel I, II, III, New Horizons Computer Center, Blasedell, NY
VA (ECHO) Expanding Your Career and Healthcare Opportunities/October 2014-April 2015 Catalyst Leadership Award; for being the “Catalyst” of the ECHO class by demonstrating leadership, engagement, and teamwork while participating as a student in ECHO/April 2015 Coursework ECHO, Catalyst Learning: Life Management Skills, Communication in the Workplace (physicians, clinical staff, hospital administrators, co-workers, patients), Principals of Patient Satisfaction and Safety, Medical Terminology, Effective Problem Solving, Plan and Asses Professional Development
Certified Medical Billing Specialist/January-June 2013
Certified Electronic Health Records/January-June 2012
Summary of Qualifications:
Course Work: Electronic Health Records/Electronic Health Record Procedures, Spanish for Healthcare Professionals, Medical Terminology, Introduction to Healthcare Professionals, Computer Fundamentals
Electronic Health Records customization and set up utilizing Spring Charts text, and online instruction application
Create and edit templates, pop-up text entries (accurate data entry skills), chart evaluation rules to create reports
Import/Export data and files to Electronic Health Records system to create reports, utilizing back up procedures
Health Information Portability and Accountability Act Regulations/Protected Health Information, Meaningful Use Attestation according to Center for Medicaid and Medicare Service standards and guidelines
Understanding functions such as Evaluation & Management Coding Manager, Routing Slips, Super Bill, International Classification of Diseases-9, and Current Procedural Terminology coding within the Electronic Health Records systems
Microsoft Office XP Applications, Lotus Notes 6.5, Facets 4.61, Internet, Outlook, HL7
Anatomy/Physiology
Medical Terminology
ICD-9CM (International Classification of Diseases)
CPT (Current Procedural Terminology)
HCSPCS (Health Care Common Procedural Coding System)
Insurance Processing utilizing industry-standard billing software
Employment History:
Senior Veterans Service Representative, Authorizer (03/23-Present) (GS11-4) Veterans Benefits Administration, 130 S. Elmwood Ave., Buffalo NY 14201
Promulgates and authorize Veterans claims reviewing all required work of other Veterans Service Representatives. Reviews and approve work for technical accuracy, clarity, thoroughness, and sensitivity to Veterans specific claims issues. Ensuring decision notices are prepared with an empathetic tone and completed and phrased in terms that claimant can understand. I have been trained as a Rating Veterans Service Representative. I am well versed in rating decision notices notice, elements, CFR’s, and M-21 references that pertain to correct rating decision notices that are sent to Veterans and their representatives.
Makes Administrative decisions and special determinations relating to qualifying military service, character of discharge, domestic relations contested claims, homicide, presumed death, line of duty, or willful misconduct, corpus of estate, and violations of U.S. Penal code, related attorney fees, administrative error, and fraud. Authorizes administrative decisions made by other Veterans Service Representatives including character of discharge, line of duty, or willful misconduct, corpus of estate, and apportionment decisions.
Explains a final decision if a Veteran expresses an indication of dissatisfaction with a determination (filed in person, by telephone, or by mail). I, as an (Authorizer) will explain the decision in question in an effort to gain acceptance of the determination, and also explain the post- decision review process.
Use of electronic data processing (EDP) systems for inputting data related to claims adjudication, processing, monitoring, and correspondence preparation.
Acts as an advocate for Veterans and their beneficiaries in their dealings with other VA elements and organizations that affects their claims.
Work closely with Coach and Assistant Coach in a Team environment. Provide mentoring to pre/post Veterans Service Representatives, and Senior Veterans Service Representatives to provide my knowledge and skill to help others while we work together to meet production and high quality of Veterans claims at promulgation and authorization.
Veterans Service Representative, Rating (5/22-03/2023) (GS-11/3) Veterans Benefits Administration, 130 South Elmwood Ave., Buffalo, NY 14201
Analyzes claims to determine if diseases and/or injuries were incurred or aggravated by military service in the line of duty for purposes of compensation, treatment, or hospitalization.
Determines service-connection, percentage of disability, permanent and total disability, and entitlement to compensation, pension, burial, dependency indemnity compensation, special monthly compensation and vocational training, medical and dental treatment, automobiles, or other conveyances, insurance, specially adapted housing, dependent education allowances, and other ancillary benefits.
Assures proper application of the Rating Schedule and other applicable instructions, and he or she is fully accountable for proper analysis, appropriate development, and final rating determinations.
May directly communicate and interact with Veterans and their representatives/advocates to facilitate timely, proper decisions. As dictated by the circumstances of each case, the RVSR may conduct interviews or hearings in person or by telephone with Veterans, eligible individuals, representatives, and advocates to obtain or clarify information.
Communicates with VSRs and other employees in the regional office, employees of VA medical centers, and other regional offices.
Actively participates in meetings, assists with training, and is expected to lend
his/her expertise in developing VSRs' skills as they relate to evidence gathering for rating decisions.
Performs other related duties as assigned.
Homeless Coordinator Specialist (1/21-5/22)
Veterans Benefits Administration, 130 South Elmwood Ave., Buffalo, NY 14201
Maintain and continuously update, expedite Homeless Veterans claims report for the Buffalo NY Regional Office.
Communicate and network with VA/Non-VA community outreach programs to assist in helping Homeless Veteran’s work towards or receive stable housing.
Create and send correspondence to VA/Non-VA Community Agencies to assist those agencies providing compensation benefits verification for homeless Veterans.
Working with the Veterans and, representatives including to assist homeless Veterans facing barriers such as cognitive disorders, depression, military sexual trauma, PTSD, and substance use.
Directing homeless Veterans to resources at VHA, and community resources coping with the psychosocial stress related to illness and related stressors and homelessness.
Veterans Service Representative (12/17-Present) (GS-10/2)
Veterans Benefits Administration, 130 South Elmwood Ave., Buffalo, NY 14201
#VIPCHALLENGE Training and mentoring. Providing claim review to new VSR’s
(via QMS, and MQRL’s), feedback, mentoring and training to get them ready for successful quality and production of Veterans claims
Serve as a primary contact for the veteran and his/her representative or advocate and the decision-maker for compensation or pension claims.
Explain the full range of veteran benefits and all related programs.
Make determinations as to eligibility for the type of benefit sought and fully analyzes, develops, and requests required evidence for certain claims requiring a rating decision.
Decide the necessity for and type of examinations, reexamination, or medical opinions to determine the existence of or to evaluate disabilities resulting from diseases or injuries.
Develop comprehensive requests for these examinations/opinions to ensure appropriate evidence is received from which to adjudicate the claim.
Prepare correspondence to members of Congress and special interest groups on case assignments and other "controlled" correspondence.
Rotate through the Cross-Functional, Intake Processing Center, Direct Contact, Appeals, and Quality Review teams to gain experience in all aspects of the Transformation Initiative.
Utilize various electronic data processing (EDP) systems for inputting data related to claims adjudication, processing, monitoring, and correspondence preparation.
Act as an advocate for Veterans and their beneficiaries in their dealings with other VA elements and organizations that affect their claims.
Trained and work claims through claims processes from initial development to promulgation, utilizing VBMS, and VBMS A
Worked very complex cases assigned by Senior Authorizers, Coached, and Supervisors
Program Support Assistant/Laboratory Pathology Department (02/14-12/17)
Veterans Administration Medical Center 3495 Bailey Ave. Buffalo NY 14215
Efficiently and accurately enters gross description of pathology entry/edit, transcription
Consistent utilization of Medical Terminology, Anatomy, and Physiology
Utilize SNOWMED CT/CPT/ICD coding to code pathology, diagnoses, and procedures of current reports
Scanning lab reports, and consultation reports into CPRS, VISTA/VISTA IMAGING (Electronic Health Records System)
Provide excellent customer service for providers, staff, and patients.
Account Executive (08/13-01/14)
Clinical Support Services 701 Seneca Street, Suite 205, Buffalo, NY 14203
Data Account Manager for health insurance providers, submitting Medication Therapy Management outcomes to the Center for Medicare and Medicaid Services
Responsible for initiation and completion of contracts, statements of work, business associate agreements, feasibility, invoicing, creating design documents for their data loads
Set up through implementation, and managing software for the client, and educating end users
Medical Records Administrator (03/12-01/13)
Gastroenterology Associates LLC. 60 Maple Road, Amherst, NY 14228
Responsible for utilizing an optical scanner to transition paper medical records into practice’s the electronic health records to reduce volume
Forwarding provider mail from hard copy lab results, radiology reports, pathology/biopsy results of diagnostic procedures into their practice management inbox
Comparing data entered with source documents for accuracy. This task requires I apply critical attention to detail, a high degree of accuracy, proficient use of medical terminology, and strong computer skills
Project manager to implement reduction of paper records in records room to add additional office space for providers and nurse practitioners as the practice expands
Results Delivery Specialist/Project Administrator (10/11-03/12) Temporary/Contract
Health-e-link 2568 Walden Avenue, Cheektowaga, NY 14225
Met with local physician groups to implement Results Delivery Interface (lab results, radiology reports, transcription reports) and Coordination of Care Documents, electronically
Successfully accomplished several practices to sign quotes with their Electronic Medical Records Vendors to receive Results Delivery Interface and Coordination of Care Document Applications
Utilized HL7 to encrypt, de-identify patient information in electronic medical records format to test and stream interoperability between practice EHR Vendors and their Healthline Interface for a successful Go-Live date
Extract, analyze, and construct reports to reduce medical records transfer error to maintain efficiency for practices
Provider Relations Call Center Associate (12/05-10/11) Health Insurance
Fidelis Care of New York 480 Crosspoint Parkway, Getzville, NY 14228
Responsible for answering and directing provider calls for resolution while maintaining a high level of professionalism and confidentiality
Complete appropriate tracking documentation to identify trends for quality improvement within Provider Relations, Claims, Provider Reimbursement, Credentialing, Contracting, Enrollment, Eligibility, Member Services, and EDI departments.
Assist with aging report follow up and special projects as assigned, including follow up with providers to determine the status of their issues, especially claims review and reimbursement
resolution
Identify system problems/issues and escalate them to the Claims Review Department
Train and mentor junior level associates to be more efficient in various applications
Area of Specialty; claims issue/resolution according to managed care (Medicaid-Medicare Guidelines), provider reimbursement
Research of billing ICD-9CM, CPT, HCPCS, and Inpatient Coding, according to CMS Guidelines
Assisting providers/members with portal questions/issues and providing resolution in a timely manner
Education:
UB Educational Opportunity Center Buffalo, NY - Electronic Health Records Certificate June 2012 Medical Billing/Coding Certificate, June 2013
Medaille College Buffalo NY- 60 credit hours completed Buffalo State College Buffalo NY-60 credit hours completed
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