Medical Billing/Coding Supervisor (CPC)
Resume:
Alisa Hillock CPC
************@*****.*** C: 317-***-**** Morristown, IN 46161
Summary
Seeking a fulfilling position that offers both educational and growth opportunities, as well as the opportunity to utilize my knowledge and experience. Diligent, hardworking and knowledgeable Medical Billing/Coding Representative. Skilled in fielding inquiries and resolving problems using expertise in business practices and customer relations.
Skills
• Accounts Receivable
• Denial Management
• ICD-10 Coding
• CPT/HCPCS Coding
• Physician Office Billing
• Medical Terminology
• Charge Entry
• Payment Posting
• Leadership and Team Building
• Knowledgeable in Gastroenterology, Urology,
Ambulance & Ophthalmology Coding
• Denial Management
• Insurance Guidelines
• Microsoft Office Software
• Medical Billing Software
Experience
Priority Ambulance
Indianapolis, In
Medical Billing Supervisor -Prebill
07/24 to Current
• Oversee daily billing operations of 10 employees for 4 ambulance markets that originate in Tennessee, Mississippi, Arkansas and Alabama
• Organize workflows for all prebillers for proper invoicing of EMS charges based on contracts, payor and facility to ensure timely filing of all claims
• Responsible for hiring, discipline and performance reviews
• Identify professional development opportunities for current staff and provide hands-on training for new employees
• Ensure all current employees maintain proper certification and adhere to continuing education guidelines
• Prepare bi-weekly payroll for all team members
• Process and resolve aging and month end reports
• Research and rectify all account discrepancies
• Investigate denials/rejections and collaborate with our internal postbill team members to identify solutions
• Address and respond to all staff and client inquiries regarding CPT and diagnosis coding
• Ensure all billing staff maintain a high level of customer service when dealing with patients, patient families, co-workers, clients and other healthcare providers
• Maintain security and privacy of all company and patient information in accordance with HIPPA and all other local, state and federal regulations Eye Specialist of Indiana
Indianapolis, In
Billing Supervisor
11/2020 –June 2024
American Health Network
Greenfield, In
Patient Care Coordinator
09/2018 – 11/2020
• Monitors appropriate key indicators of effective billing and collections and take appropriate action when needed to ensure the company maximizes all legitimate revenue
• Oversee daily billing operations of 12 employees for a 2 surgeon/9 physician Ophthalmology practice with 2 Ambulatory Surgery Centers and 4 clinic locations
• Organize workflows of all positions including financial coordinators, payment posters, insurance verification specialist, coding/charge entry, AR/Denial management, precertification and collections
• Identify professional development opportunities for current staff and provide hands-on training for new employees
• Responsible for hiring, discipline and performance reviews
• Assisted in implementation of new HER/Practice Management System
• Prepare bi-weekly payroll for all team members
• Process and resolve aging and month end reports
• Research and rectify all account discrepancies
• Assess all billing statements for accuracy prior to sending
• Investigate denials and collaborate with internal team members and third- party representatives to identify solutions
• Address and respond to all staff, physician and client inquiries regarding CPT and diagnosis coding
• Obtain accurate insurance verification to provide patients with their estimated out of pocket cost for surgical procedures based of contracted insurance payors allowed rates
• Review all surgical encounters for proper CPT/Diagnosis coding prior to charge entry
• Prepare weekly deposit for all revenue collected from 4 clinic locations
• Process patient payments and manual/ ERA payments
• Participate in educational opportunities, including workshops, webinars and training classes to gain a stronger knowledge in industry updates and federal regulations
• Insurance Verification - Update demographic information, health insurance coverage, etc.
• Check In/Out Patients - Schedule follow appointments, collection of co- payments and prior balances.
• Coding & Charge Entry of Gastroenterology Charges and Inpatient Hospital Rounds.
• Corrects any billing errors identified by billing software to ensure proper claim submission.
• Processes billing in accordance with current ICD-10 and CPT coding guidelines.
• Resolves missing charge ticket reports.
• Provides continuous feedback to clinic manager regarding any charge entry related issues.
• Prepares daily deposits and ensures summary balances reconcile with charge tickets.
• Resource for patients to aid in resolving billing concerns - Coding issues, self-pay or time of service payments.
• Payment posting - Both insurance and private payments.
• Accounts Receivable
• Follow up with insurance companies on unpaid or rejected claims.
• Maintain strict confidentiality adheres to all HIPAA guidelines/regulations.
• Aid nursing staff, pre-cert department, and physicians in determining appropriate ICD-10 codes for procedures, surgeries, etc.
• Aid in resolving all requests that are received by department for denied treatment to medical necessity issues.
Indiana Eye Clinic & Ambulatory
Surgery Center
Greenwood, In
Account Services Representative
11/2016 - 02/2018
• Update demographic information, health insurance coverage, etc.
• Charge entry of all Optometry and Ophthalmologist Charges
• Gather, interpret and process charge encounter forms within 24 hours from date of service (E/M services, injections and ambulatory surgical procedures).
• Payment posting - Both insurance and private payments.
• Corrects any billing errors identified by billing software to ensure proper claim submission.
• Processes billing in accordance with current ICD-10 and CPT coding guidelines.
• Resolves missing charge ticket reports.
• Provides continuous feedback to clinic manager regarding any charge entry related issues.
• Prepares daily deposits and ensures summary balances reconcile with charge tickets.
• Reviews daily practice schedules for outstanding patient balances.
• Resource for patients to aid in resolving billing concerns - Coding issues, self-pay or time of service payments.
• Accounts Receivable.
• Follow up with insurance companies on unpaid or rejected claims.
• Answer patient inquiries by phone or in person regarding outstanding balances and insurance guidelines.
• Maintain strict confidentiality; adhere to all HIPAA guidelines/regulations.
• Medical Necessity/Precertification.
• Aid nursing staff, pre-cert department, and physicians in determining appropriate ICD-10 codes for procedures, surgeries, etc.
• Resolve all requests that are received by department for denied treatment and medical necessity issues.
• Contact insurance companies and obtain prior authorizations for surgical procedures.
Indianapolis Gastroenterology &
Hepatology
Indianapolis, IN
Coding Specialist
11/2015 - 11/2016
• Insurance verification - Update demographic information, health insurance coverage, etc.
• Responsible for the coding and abstracting of the following: ancillary/diagnostic services, ambulatory/inpatient surgeries, and all hospital rounding/consults.
• Charge entry.
• Processing of above-mentioned charge encounter forms (Surgeries and E/M hospital rounding services).
• Correct any billing errors identified by billing software to ensure proper claim submission.
• Processes billing in accordance with current ICD-10 and CPT coding guidelines and add appropriate modifiers as needed.
• Resolves missing charge ticket reports.
• Provides continuous feedback to department manager regarding any charge entry related issue.
• Accounts Receivable.
• Follow up with insurance companies on unpaid or rejected claims.
• Answer patient inquiries by phone or in person regarding outstanding balances and insurance guidelines.
• Maintain strict confidentiality; adhere to all HIPAA guidelines/regulations.
• Medical Necessity.
• Aid nursing staff, pre-cert department, and physicians in determining appropriate ICD-10 codes for procedures, surgeries, etc.
• Resolve all requests that are received by department for denied treatment to medical necessity issues.
Urology of Indiana
Greenwood, IN
Coding Specialist
12/2014 - 11/2015
• Insurance verification - Update demographic information, health insurance coverage, etc.
• Charge Entry.
• Gather, interpret and process charge encounter forms within 24 hours from date of service.
• Payment posting.
• Correct any billing errors identified by billing software to ensure proper claim submission.
• Processes billing in accordance with current ICD-9 and CPT coding guidelines and add appropriate modifiers as needed.
• Resolves missing charge ticket reports.
• Provides continuous feedback to department manager regarding any charge entry related issues.
• Responsible for the coding and abstracting of the following: ancillary/diagnostic services, ambulatory/inpatient surgeries and observations, hospital and interventional radiology procedures, and hospital rounding/consults.
Collaborating For Kids, LLC
Greenwood, IN
Billing Specialist
06/2014 - 12/2014
• Insurance Verification/Authorizations.
• Call insurance companies to obtain benefit/coverage information for all potential clients for ABA, Mental Health and OT/PT/ST Services.
• Collaborate with clinic coordinator and outpatient therapist to ensure insurance benefits are conveyed to the families correctly and all visit limitations/exclusions are upheld.
• Review structured clinical data matching it against specific clinical/medical terms and diagnosis/procedure codes to ensure the proper established procedures of the appropriate insurance carrier for the authorizing request are completed.
• Responsible for providing complete and accurate documentation to the insurance companies for precertification request for all required services.
• Maintain a cooperative working relationship with the program managers, clinic coordinator and BCBA-D to ensure all documentation submitted for precertification is accurately completed in a timely manner.
• Adhere to each insurance payors’ guidelines when submitting authorizations, stay updated with current procedures/protocols and receive appropriate training as needed.
• Accounts Receivable.
• Work closely with billing manager to aid in resolving denials in a timely manner.
• Process all outpatient therapy and mental health charges in accordance with current ICD-9 and CPT coding guidelines & add appropriate modifiers as needed.
Solutions Healthcare Management
Indianapolis, IN
Charge Entry Specialist
10/2012 - 05/2014
• Demographic Workfile.
• Review and correct all errors on the New and Updated Patient Registration Reports received from St Elizabeth Hospital.
• Run Plato Code and generate charge batch.
• Review and updated Medicaid eligibility for all patients covered under a Medicaid plan prior to charges being keyed.
• Charge Batch.
• Review all charges dropped into Ideal for completeness and accuracy.
• Process all charges in accordance with current ICD-9 and CPT coding guidelines & add appropriate modifiers as needed.
• Accounts Receivable.
• Work all front-end AR reports: Exclusion Claims Report, ANSI Data Report and Insurance Edit Report.
• Medicaid Secondary Payer AR Adjustments.
• Review all accounts in work queue to ensure primary payor has paid Medicaid allowable; complete adjustment as needed.
• Demographic & Insurance Verification.
• Enter new patient demographic and insurance information into Ideal system for clients.
• Invalid Insurance Reports: Review Epic system to ensure proper insurance information is updated in Ideal for all charges keyed without a proper insurance carrier attached.
• Workers Compensation & Auto Accident Claims: Actively follow patients medical record in the EPIC hospital system to ensure proper payer information is obtained, claim is submitted and payment is received on all accounts.
• Pre-Collect.
• Review all accounts in work queue prior to sending to collections to ensure claim was filled to the proper insurance carrier by reviewing patient’s medical records in the Affinity, Epic and Ideal software systems.
• Run Medicaid eligibility on all patients in work queue to verify if they have effective coverage for the dates of service in question.
• Collections - Work with IMC collection agency to provide them with accurate and current account status for all patients needed. Education and Training
American Academy of Professional Coders
Certified Professional Coder Certification - AAPC
Member #01441903 Greenwood Indiana Chapter
2016
MedTech College Greenwood, In
Associates of Applied Science in Medical Billing & Coding 2012
Center Grove High School Greenwood, In
High School Diploma in General Studies
1996
Billing Software
Cerner (IU Health System) Centricity IDX Web Framework - RISC (Wishard System) - Meditech (JMH System) - Mysis Tiger (Greenwood Pediatrics System) - Ideal (Solutions Healthcare System) - Epic
(Franciscan Alliance System) - MedEvolve (Indiana Eye Clinic System) - NextGen (Urology of Indiana
& AHN), Nextech/Pratice Plus (Eye Specialist)
References
References available upon request
Certifications
American Academy of Professional Coders – CPC Certified Professional Coder
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