Office Manager Resume Profile

PR FILE

Billing and C ding Specialist. M tivated team player. G d rganizati n and multi-tasking
skills. Assertive and detailed riented. Fluent in Spanish b th ral and written.

PR FESSI NAL EXPERIENCE

Confidenital Medical Chart data c llecti n/abstracti n fr m medical rec rds received via fax/mail r c llecti n in the pr vider ffices and c ding the inf rmati n int the accredited HEDIS s ftware. Confidenital nduct chart review f r the purp se f identifying, c nfirming, and/ r d cumenting appr priate medical c ding. Upl ad c mpleted quality c ntr l ver-read reviews t Verisk's centralized server system via the Internet, intranet and ass ciated web p rtal Confidenital
Abstracti n f medical data fr m rec rd and assign ICD-9 and pr cedure c des.
Meeting quality requirements f r Heidis and Medicare Risk Adjustment
C mmunicati n with the Physician t clarify diagn sis, pr cedures and c ding d cumentati n.

Confidenital

C nduct chart review f r the purp se f identifying, c nfirming, and/ r d cumenting appr priate medical c ding.
Perf rm quality c ntr l ver-read reviews f previ usly c mpleted rec rd reviews t ensure accuracy, c mpleteness, and verall high quality f rec rd review pr cesses.
Upl ad c mpleted quality c ntr l ver-read reviews t In val n's centralized server system via the Internet, intranet and ass ciated web p rtal.
Confidenital Reimbursement Case W rker/Medicaid/Medicare Billing Specialist
Qualifies patients f r ICP Medicaid/C mmunity Medicaid H spice patients
Perf rms Financial Assessment f r charity cases
Bills and C des all claims f r Medicaid thru Web P rtal
n Call Verificati n f r Nursing H me Placement

Confidenital

ding Review C nsultant

C nduct chart review f r the purp se f identifying, c nfirming, and/ r d cumenting appr priate medical c ding.
Perf rm quality c ntr l ver-read reviews f previ usly c mpleted rec rd reviews t ensure accuracy, c mpleteness, and verall high quality f rec rd review pr cesses.
Upl ad c mpleted quality c ntr l ver-read reviews t MSR's centralized server system via the Internet, intranet and ass ciated web p rtal.
Site Review C nsultant Perf rm HEDIS chart reviews f care pr viders, sites, facilities, medical rec rds, and ther ass ciated medical field material, pers nnel and d cuments either nsite r at rem te l cati ns as designated by the c mpany.
Upl ad c mpleted reviews t MSR's centralized server system via the Internet, Internet and ass ciated web p rtal.

Confidenital

Field Reviewer

Retrieve rec rd d cumentati n f care pr viders, sites, facilities, medical rec rds, and ther ass ciated medical field material, pers nnel and d cuments either nsite r at rem te l cati ns as designated by the c mpany at pr vider acc rding t the health plan requirements.
Upl ad all scanned charts t utc mes, Inc. via the Internet and ass ciated web p rtal.

Confidenital

Medicare/FFS Billing Specialist

Kn wledge f HCPCS billing c ding f r medicati ns and Durable Medical Equipment.
Qualify Medicare patients f r their Enteral Nutriti n, T tal Parental Nutriti n, Chem therapy.
Gather criteria needed t meet the requirements f r submissi ns f Certificates f Medical Necessity.
Adjudicati n f claims t Medicare HM plans f r Part D drugs.
Internal Medicare chart auditing.
Handled all m nthly billing f Medicare, Preferred Care Partners, Le n Medical Center, Citrus D ct r Care plans.

Confidenital

Medicare Billing Specialist

Confidenital

Billing Reimbursement Specialist

HCPCS c ding f r billing f Infusi n therapy Durable Medical Equipment.
Billed c llected n HM c ntracts which included AV-Med United Health Care.
Managed m nthly billing f r nursing visits fr m ur h me health care pr viders f r RN, LPN, PT, LCSW n all HM c ntracts.
M nthly rep rting n all A/R acc unts f r review, resubmissi n r write ff.
Qualified all Medicare patients f r Enteral Nutriti n, T tal Parental Nutriti n and Pain Management Therapy.
Accurate tracking n all CMN's f r Medicare patients.
Office Manager Resume Profile
Supervis r-Billing C llecti ns
CPT c ding billing t all HM PP c ntracts.
Insurance verificati n f r all ur Infertility patients f r IVF, GIFT, IUI.
Pre-Auth rizati n letters t insurance f r c rdinati n f benefits f r ur Infertility patients surgical pr cedures.
C rdinated all ur in/ ut patient pr cedures at M unt Sinai f r surgery.
Managed all A/R f r rep rting t D ct r n a m nthly basis.
Translated all d cuments f r ur Spanish-speaking patients.

Confidenital

Office Manager