Whether you think you can or whether you think you can’t, you’re right!
Henry Ford
Summary
Organized and motivated employee eager to apply time management and organizational skills in various environments. Seeking opportunities to share my many years of experience and knowledge in the Healthcare field and continue learning.
Overview
19
years of professional experience
Work History
Eastside Rheumatology
Bellevue, WA
Rheumatology Infusion Consultant
11.2023 - Current
Job overview
Providing advice on operational processes for a Rheumatology clinic focusing on Infusion Treatments
Training current manager on administrative duties (obtaining benefits, authorizations) to ensure clinic is coding correctly, following up with insurance on claim status, claim denials and applying techniques to analyze trends
Training on reports to run in their EMR system to show denials, reimbursement amounts
Advising on coding errors, working with team to correct and resubmit claims to insurance
Assisting in developing and implementing workflows and communication processing
Will participate in training and managing new hires to bring new team members up to speed
Preparing accurate and concise reports, conveying progress, issues and solutions
Tryon Medical Partners
Charlotte, NC
Medical Coder and Biller
09.2020 - 09.2023
Job overview
Assisted with the development of new processes for billing, coding, collections, and reimbursements
Trained clinic staff on the following tasks: obtain infusion benefits and prior authorization, calculate patient financial responsibility, obtain patient assistance from various programs, send in for the reimbursement from the co-pay programs after insurance pays their portion, track and document the payments and valid authorizations on a spreadsheet before patients' next infusion. Implemented several procedures to organize infusion administration processes
Ran reports to TRACK denials and claim rejections in Athena
Identified trends in denials and worked collaboratively with clinic staff to reduce denials
Communicated with insurance companies to research and RESOLVE coding discrepancies. Worked with team to correct and resubmit claims or appeals.
Analyzed patient accounts for errors, inaccuracies or discrepancies in billing documentation
Monitored aging accounts receivable reports to identify unpaid balances due
Correctly coded and billed medical claims for various outpatient physician offices including Rheumatology and Internal Medicine;specializing in Infusion Treatments. Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures
Submitted claims to insurance companies electronically or by mail
Communicated with healthcare personnel, including practitioners to promote and ensure accuracy
CaroMont Medical Group
Gastonia, NC
Practice Manager
01.2009 - 09.2020
Job overview
Managed daily practice operations to optimize appointment scheduling, patient records management and billing functions
Oversaw accounting, budgeting, and financial reporting
Implemented onboarding for new employees, which enabled each to effectively learn tasks and job duties
Performed all Coding and Billing For Rheumatology Providers, including Infusion Treatments, in office procedures and office visits
Track denials in both EPIC and Athena EMR systems, insurance follow up for denied claims;Analyzed claims data to identify trends in denials and rejections
Reconciled accounts receivable to ensure accuracy of payments received
Performed daily audits on all bills submitted for accuracy and completeness
Analyzed patient accounts for errors, inaccuracies or discrepancies in billing documentation
Assisted with the development of department policies related to charge capture processes and coding practices
Provided customer service support to patients regarding billing inquiries
Processed corrections and adjustments as needed to ensure accurate payment from third party payers;Acted as liaison between business department, billers and third party payers in resolving billing and reimbursement accuracy
Prepared financial statements that summarize account activity over a period of time
Oversaw staff to complete infusion benefit, authorization and patient assistance process. Implemented organized system to track all steps and results needed to get patients infused and practice reimbursed
Stepped in to help out when staff was overwhelmed (especially during beginning of the year benefits re-verification).
Successfully negotiated client contract renewals to create increased revenue
CaroMont Medical Group
Gastonia, NC
Infusion Coordinator
09.2004 - 12.2008
Job overview
Ensured all required documentation was completed accurately prior to administering an infusion therapy
Responsible for obtaining infusion benefits, authorizations, communicated with patients financial responsibility of insurance and self pay for Infusion Services
Set up patients on various Patient Assistance Programs to help with financial obligations
Successfully maintained Excel Spreadsheet for patient benefits, authorizations and patient assistance programs (expiration dates and financial amounts)
This is where I developed the organizational skills and refined my processes to ensure ALL steps are taken and tracked to confirm patient is eligible for the infusion and we were reimbursed correctly and from all resources (insurance and co-pay programs)