FAMILY TIME
Amelia Rodriguez
Medical Coder/ Insurance Coordinator
Northampton,PA
Summary
Medical Coder with 10 years providing administrative and patient support in hospital and medical office settings. Advanced knowledge of private insurance processes and codes.
Overview
13
13
years of professional experience
3
3
years of post-secondary education
Work History
Provider Based Coding Analyst I/Prior Authorization Specialist
Lehigh Valley Hospital And Health Network
09.2019 - 02.2024
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Served as subject matter expert for all matters related to medical coding, providing guidance and insight to colleagues when needed.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Verified accuracy of patient information in medical records.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Analyzed medical records and other documents to determine approval of requests for authorization.
Prior Authorization Specialist
Twin Rivers Gastroenterology
Easton, PA
06.2018 - 09.2019
- Paid attention to detail while completing assignments.
- Applied effective time management techniques to meet tight deadlines.
- Excellent communication skills, both verbal and written.
- Proved successful working within tight deadlines and a fast-paced environment.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Verified eligibility and compliance with authorization requirements for service providers.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Analyzed medical records and other documents to determine approval of requests for authorization.
Medical Billing & Coding Specialist/Prior Authorization Specialist
Eastern Pennsylvania Gastroenterology & Liver Spec
Allentown , Pa
02.2011 - 06.2018
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Managed high volumes of medical records efficiently while maintaining strict attention to detail during the coding process.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Maintained up-to-date knowledge on industry changes, attending training sessions and workshops regularly.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Tracked referral submission during facilitation of prior authorization issuance.
- Proved successful working within tight deadlines and a fast-paced environment.
- Verified eligibility and compliance with authorization requirements for service providers.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
Education
GED - General Studies
Pennsylvania School of Business
Allentown, PA 09.2005 - 09.2005
Diploma - Medical Assistant And Office Technology
Allentown Career Institute
Allentown, PA 01.2009 - 11.2009
Certification of Completion - Certified Professional Coder Program
AAPC
04.2024 - 11.2024
Certification of Completion - Medical Terminology Course Program
AAPC
02.2022 - 07.2022
Certification of Completion - CPT And ICD-10-CM Course Program
AAPC
04.2021 - 04.2022
Skills
Medical coding and abstracting
Procedural coding
Diagnostic coding
HCPCS coding
Medical terminology
Insurance verification
Medical billing
Records management
Data entry and management
Attention to detail
EMR systems
Records review
Customer service
Doctor communication
Epic systems
Medical release of information ROI processes
Training and mentoring
Workflow management
HIPAA compliance
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Affiliations
- AAPC
- AHIMA
- AAP
Work Preference
Work Type
Full TimeLocation Preference
RemoteImportant To Me
Career advancementWork-life balanceCompany CultureFlexible work hoursWork from home optionHealthcare benefits401k matchPaid time offPaid sick leaveInterests
CURRENT NEWS
CONTINUING EDUCATION
READING
MUSIC
"ME TIME"
Languages
English
Native or Bilingual
Quote
Happiness is when what you think, what you say, and what you do are in harmony.
Mohandas Gandhi
Software
Microsoft Word
Microsoft Excel
Zoom
Microsoft Teams
Gmail
Windows OS
Microsoft Powerpoint
Timeline
Certification of Completion - Certified Professional Coder Program
AAPC
04.2024 - 11.2024
Certification of Completion - Medical Terminology Course Program
AAPC
02.2022 - 07.2022
Certification of Completion - CPT And ICD-10-CM Course Program
AAPC
04.2021 - 04.2022
Provider Based Coding Analyst I/Prior Authorization Specialist
Lehigh Valley Hospital And Health Network
09.2019 - 02.2024
Prior Authorization Specialist
Twin Rivers Gastroenterology
06.2018 - 09.2019
Medical Billing & Coding Specialist/Prior Authorization Specialist
Eastern Pennsylvania Gastroenterology & Liver Spec
02.2011 - 06.2018
Diploma - Medical Assistant And Office Technology
Allentown Career Institute
01.2009 - 11.2009
GED - General Studies
Pennsylvania School of Business
09.2005 - 09.2005