PROFESSIONAL SUMMARY

• Highly motivated and resourceful CQI team player with one year experience as a Team Lead Denial Coder also two years as a Project Manager. Sixteen years of experience in abstract
• billing, coding, denials, contracts, charge caption-charge master, collections and analyst of high dollar claims/payment retractions, credentialed providers, and verified benefits.
• I completed special projects delegated by supervisors, managers, and directors in a timely manner. Sixteen years as an Administrative Medical Assistant/Health Unit Coordinator
• allowed me to facilitate as a Revenue Project Manager for Psychiatric and Substance Abuse Facility collecting 1.7 Million in six month without software.
• I am AAPC certified combined with thirteen years of Compliant Regulatory Billing and A/R experience with Commercial, Medicare MSP , Medicaid, and Military Insurances to secure reimbursement.
• I created policy and procedures, conducted in-services to train Clinicians, Physicians and staff on how to correctly document charts.
• I am diverse with 3 years of DME billing and collections, seeking a home that will utilize all pertinent skills. In addition allow me to flourish with EPIC Resolute, EPICARE
• and build on Health Information Technology Implementation Support Specialist knowledge base. Preparing for ICD-10 Certification Train the Trainer Beta Course .
• I have coded for Teaching Hospitals, University Hospitals, Residential Treatment Facilities and a Specialty Practice. During my tenure, I have assigned, corrected, reassigned
• ICD 9, CPT 4, HCPCS and Modifiers based on CCI Guidelines. I protected the revenue through analytics and due diligence. The largest hospital I have coded for has 750 beds.
• A morale booster and a career focused team builder. Who is trustworthy and committed to excellence, works well under pressure and thrive under challenging circumstances.
• Extremely comfortable interacting with individuals at all levels within an organization. I seek an environment that will make good use of my professional contributions as well as
• I help to enhance and expand my skill set and broaden my experience. Change is accepted because it is inevitable and it is a part of growth.

EXPERIENCE

Confidential

Medical Record Coder II, EPIC Resolute Project Consultant

• Executed Hospital and profession medical record reviewed DRG components for an insurance payment dispute, them forward to HIM for update
• Tracked trends regarding invalid Codes ICD 9, CPT 4, HCPCS, Revenue and assigned corrected codes, Charge Caption and Modifier correction
• Analyzed High and Low dollar work queues and provided solutions to internal and external customers
• Problem solved, research and complied data for resolution
• Corporate preparation for ICD-10 Compliance Training and 2014 Coding Updates
• Monitored Coding Denial Issues and protected revenue
• Working EPIC Resolute/HER and Legacy System Meditech

Confidential

Coding Denials Specialist

• Lead Coding Specialist for Commercial Denials Team and Insurance Reps
• Managed and resolved all commercial insurance coding denial issues
• Coded for EENT surgery and E/M services Cancer diagnosis codes
• Maintained a coding denial work queue
• Researched, executed appeals and upheld compliance
• Identified CPT and HCPC Codes that are not in the Charge Master
• Assisted staff with policy, procedure and problem solving
• Cultivated other Denial Specialist, Edit Specialist, Patient Account Representatives, Office Managers, Insurance Specialist and patients with email and telephone coding request. Answers were provided in a learning format support by policy/or CCI information and empathy
• Chart auditing

Confidential

Patient Account Representative III/Coding Specialist

• Worked on Special Coding Projects assisted manager with Coding issues
• Provided impeccable customer service internal and external
• Medicaid Specialist and total account resolution for all payers
• Managed/resolved outstanding claim edits and A/R issues for hospital and specialty clinics
• Applied a proactive approach with problem solving/trend tracking
• Worked collectively as a team, morale booster
• Executed technical appeals

Confidential

Travel Coding Consultant/Reimbursement Spec/Project Manager

• Coded inpatient and outpatient mental health and substance abuse claims UB04/HCFA
• Created methods to track work-flow in a manual environment and to code and collect over 1.7M in 6 months without a office system or billing system
• Negotiated Contact reimbursement Contracted analyst
• Executed technical appeals
• Insurance follow-up /collections
• Trained staff regarding charting and documentation
• Problem solved

Confidential

Seasonal Associate

• Worked on the 2008 Blizzard Project as a Benefit Verification Specialist
• Acquired detailed benefit information for REMICADE
• Verified coverage and access options for major medical AOB/SPP , retail PBM pharmacy options for Chemotherapy and IV infusion
• Received a certificate for quality work performance
• Detailed oriented
• Confidential Medical Billing Instructor per diem
• Taught material from approved curriculum
• Developed daily lesson plans that included a variety of teaching
• Exercised effective classroom management
• Provided assistance to students who required special attention

Confidential

Denials Management Rep/P.A.B.S Rep II / Medicare Billing Specialist

• Utilized CCI editing, Omega, 3M, Omnipro, Star Navigator, 3rd millennium, CareMedic and Meditech software. Capture a vast amount of lost revenue by identifying missing charges and procedures via knowledge of ICD9, HCPC/CPT4 codes and modifiers by abstract methods to maximize reimbursement Resolve MSP and Denied Time issues via analysis
• Created and implemented regulatory billing procedures, Compliance
• Assisted with training, educating staff, researching issues for departmental staff and worked closely with supervisor
• Volunteered personal time to code ED charts and entered charges
• Executed technical appeals to protect revenue
• Interpreted and comprehended commercial contracts regarding reimbursement and Regulatory policy and procedures
• Analytical, isolated and tracked trends to provide results regarding denial and billing issues
• Maintained an excellent rapport with co-workers
• Accepted and complete in a timely manner, special projects from supervisor, manager and director

Confidential

P.A.B.S Rep I / BC BS Specialist

• Decreased A/R by approximately 50 in the first 6 months
• Created and organized a BC BS Contact Sheet for various products
• PHS Smart Choice and Misc. commercial insurance Follow-up Rep
• Verification and pre-certification for outpatient procedures
• Identified erroneous BC BS 117K retraction to resolution and recouped 117K for The Stamford Hospital
• Back-up BC BS Biller

Confidential

Analyst Rep

• Answered a high volume of incoming calls from the VNA
• Processed an immense amount of supply and DME orders daily
• Obtained adequate information from Physicians and RN's for medical justification
• Billed Managed Care, Medicare and Medicaid
• Analyzed claims, identified trends and resolved issues with maximum results
• Won MVP in an accelerated cash collection contest, collected the most cash in a 30 day span
• Displayed external and internal customer service skills