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Certified Professional Coder

Location:
Puyallup, Washington, 98375, United States
Salary:
Negotiable
Posted:
March 05, 2011

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Sally A Degenhart, CPC

Cell Phone (253) ***-****

E-mail- vzrzxu@r.postjobfree.com

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OBJECTIVE

To secure a temporary/permanent position with a well established organization (non-sales) with a stable environment which leads to a lasting relationship that will challenge me to use my vast knowledge of medical coding, insurance, data entry and revenue generation.

SPECIAL SKILLS

CPT4/ICD-9 coding Medical Insurance Follow-Up 10 key by Touch

Medical Terminology Internet Research Specialist Change Research

Multi Surgery Specialty Coding Flexibility Medical Claims Processing

Claims adjustments Call Center Customer Service Mental Health Claims Liaison

Data Entry Problem solving Software Conversion Cleanup

SUMMARY OF QUALIFICATIONS

Monitor and Implement quarterly CCI Edits

Challenge and Justify Insurance Rejected Billings

Surgery Schedule follow-up and Reconciliation

Review, Code, and certify specialty surgery procedure Reports

Develop Historical Data for New Procedures and Unlisted Codes

Authorize and Verify appropriate ICD-9 CPT-4 billing codes for self insured L&I claims.

Health Insurance Rebill/Research Specialist

Proficient with Windows 7, XP, Excel, Word 2003 and 2007, Outlook 2003, LastWord, and EPIC billing software

Accurate completion of documents, records and files, including government forms

Detected fault allowing overpayments in claims limit program software

Compiled training manual explaining the Mental Health /Chemical Dependency Insurance Benefit

Code, Chart, and Coordinate physicians work at affiliate hospitals

Tested at 11,350 kph for data entry (Numeric) 8500 kph (Alpha-numeric)

Managed financial area of the U.S. Air Force Entertainment Club Complex, including $100,000.00 Float

RELATED EXPERIENCE

Certified Coder-Southlake Clinic- Renton, WA (08/10-present) Using online electronic medical health records and online hospital charts; Verify Office E&M fee slips, for level of service, adding diagnosis codes per doctor’s handwritten words. Verify Gastroenterology surgeries and inpatient care. Verify Cardiology surgeries, inpatient, outpatient care and procedures. Using Next Gen software with Electronic Health Records, entering charges and payments to go automatically over to the clearing houses for processing.

Certified Coder-Pace Staffing/Group Health, Tukwila, WA (08/09-02/10) performed various duties pertaining to software operating system Last Word with conversion to EPIC software. Reviewing charts and operative notes in old system to make sure they have been paid correctly before system shutdown due to conversion to newer EPIC system.

Certified Coder- Accountemps/Southlake Clinic, Renton WA (05/09-07/09) Received daily office visit billing superbills along with inpatient, outpatient, hospital and critical care billing for cardiology and infectious disease specialties, verified diagnosis and procedure codes per online medical records and hospital charts.

Patient Account Specialist-Account Temps/Pacific Medical Center, Seattle WA (09/08-02/09) Contact payers to identify reason for payment discrepancies by telephone or written letter to pursue insurance payment. Promptly resolve and resubmit denied claims, Research and resolve rejected, incorrectly paid and denied claims in assigned work-files within an established time frame. Receive, document, research and respond to all account inquiries from patients, health plans, attorneys, and other Pacific Medical Centers departments and clinic personnel in verbal or written communication. Assemble and mail auto injury and medical insurance rebill and appeals claims packets.

Abstractor/Coder- NW Staffing/ Swedish Perinatal Studies- Seattle WA, (05/08-08/08) Extract detailed medical information from hospital medical records to insert specified data onto a 32 page research project packet.

Billing/Coding Specialist- Med Temps/Perot Systems- Renton WA (02/08-04/08) Scan superbills to be edited by system and myself for coding errors before electronic transmission. Balance copays and total AR batch. Edit Coding of the other billing specialist’s superbills containing errors rejected by system.

Unemployed-Disabled 10/2007-01/2008- unable to work due to injuries sustained in Motor Vehicle Accident.

Pro Fee Coordinator- Children’s University Medical Group- Seattle, WA (06/05-10/07) Certified coder, reconciling Surgery Schedule, Auditing/Coding billing sheets received from up to 23 specialty physicians for surgeries performed on a daily basis, charges then entered into EPIC billing system.

Coding/Billing Specialist - Rainier Surgical, Inc. (01/05-06/05) Durable Medical Equipment Company using the Lytec & InfoSys computer programs. Process average of $4000.00 accounts payable daily. Verified and updated the master fee schedule. Continuously updated and recommended coding changes to the managers and owners who then notified other workers.

Certified Coder-Insurance Overloads-Corvel Corp.-Seattle, WA (05/04-10/04) Analyzed and Interpreted claims data received from Private Workman's Compensation (third party) Insurance Companies. Applied Laws, Regulations, and Policies to review, code, and certify appropriate insurance claims documentation. Authorize and verify appropriate claims payment determinations.

Claims Processor-Pace Staffing-Group Health- Tukwila WA (10/03-05/04) processed all types of claims submitted on a CMS1500 and UB92, for payment or denial depending on the contract benefits of the subscriber.

Patient Registrar- St. Joseph Medical Center, Tacoma, WA (05/02-10/03) Collected demographic information from patients registering for appointments in the various outpatient clinics, surgery and inpatient admissions. Verify insurance coverage, necessary referrals and authorizations. Escorted patients to correct department location for their procedures.

Insurance Follo-Up Specialist-HealthServices NW, Renton, WA (10/01-02/02) ) Contacted various health insurance companies for update on claims over 30 days old. Verified receipt of claim, claim process status, and the outcome of that process and any necessary additional actions for payment of the particular claim

Medical Claims Processor/Adjudicator, Community Health Information Services, Seattle, WA (09/00-10/01) Data entry of claims, with processing for payment or denial of claim per contracted benefits of patient.

Medical Claims Processor/Adjudicator, Insurance Overload Systems, Renton WA (2000) Data entry of claims and processing for payment or denial of claim per contracted benefits of patient.

Multi-Function Specialist, Regence Blue Shield Insurance Company, Tacoma, WA (1997-2000) Telephone Customer Service, Data Entry of Referrals/Approval, and Rebill Specialist: verified submitted claims for system edits and payment status of claims. Processed for payment or denial per contracted benefit of the patient. Processed many types of medical claims for payment or denial. Liaison between Regence Blue Shield and Third Party Administrator for Mental Health Referrals, audit for referral issues and appeals.

EDUCATION

Certified Professional Coder National Certificate 04/2002

ICD-9 (10 Pending), 2005 Updates Continuing Education with AAPC, December 2004

Pierce College- Professional Medical Coding Classes Completed April 2002

Bridges Learning Center- Medical Office Reception, and ICD-9/CPT-4 Coding- November 2001

Health Insurance Association of America-Classes in Fundamentals of Health Insurance, Health Insurance Fraud, and Managed Care Delivery and Financing. 1998-1999

Associate Degree in Banking and Finance, Clark County Community College, N. Las Vegas, NV 1987



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