April Miller
Miami,FL
Summary
Experienced and Compassionate Certified Professional Coder and Billing Specialist offering over 12 years of mastery in a physician and hospital setting. Expertise in managing all aspects of patient care with hands-on experience in coding, analyzing and prioritizing medical statistics. Adept at completing leadership duties efficiently and thoroughly. Proficient insurance professional with assessing properties, determining liabilities and negotiating settlements. Efficiently handle high case volumes with accuracy and care.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Senior Claims Examiner
MATRIX Resources
Miami, FL
05.2023 - Current
- Advised junior staff members on technical aspects of adjudicating difficult cases.
- Evaluated appeals from claimants who were dissatisfied with initial decisions made by examiners.
- Resolved escalated complaints from clients regarding denied or delayed payments.
- Provided training sessions for new employees on proper procedures for handling claims.
- Analyzed medical records to identify discrepancies between the claim and treatment history.
- Documented claim actions and decisions thoroughly for audit purposes.
- Managed caseload effectively, ensuring timely review and resolution of claims.
- Analyzed and audited open claims to calculate additional payments owed.
Remote Senior Collections Specialist
University of Miami Health System
Miami, FL
10.2021 - 05.2023
- Liaised with management to identify issues attributing to account delinquency and discuss solutions to bring in revenue.
- Developed collection methods to achieve or exceed company financial goals.
- Prepared documentation required for collection and repossession activities.
- Located and monitored overdue accounts using billing system to begin collections process.
- Recorded and updated customer personal accounts with accurate contact information.
- Received payment and posted to appropriate customer accounts.
- Processed payments over phone and set up recurring drafts.
- Answered customer invoice questions and resolved issues discovered during invoicing and collection process.
- Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
- Verified patient insurance coverage, created financial plan according to treatment schedules for collections and communicated between patient and billing company regarding health insurance.
Lead Bartender
Nomi Bar & Grill
North Miami, FL
07.2020 - 08.2022
- Operated cash register and Point of Sale (POS) system for transactions and made proper change for cash transactions.
- Stocked bar with beer, wine, liquor and related supplies.
- Managed bar area, cocktail design and menu and handled inventory, regulation compliance and customer relationships.
- Kept track of bar tabs and transferred open tabs to dining area for wait staff.
- Ordered and maintained inventory of bar products, alcohol, soft drinks and supplies to drive high volume of sales.
- Trained new bartenders on drink preparation and upselling techniques.
Medical Coding And Billing Specialist
Miami Children's Anesthesia Associates
Miami, FL
01.2012 - 07.2020
- Maintained current working knowledge of CPT and ICD -10 coding principles, government regulation, protocols and third-party billing requirements
- Performed accurate and fully compliant monthly closing processes, accruals and journal entries
- Reviewed and abstracted relevant clinical data from electronic medical records to select appropriate code for procedures
- Reconciled clinical notes, patient encounter forms and health information for compliance with HIPPA rules
- Prepared monthly and year-end closing statements, financial documents, and invoices
- Trained new team members on company policies and accounting systems to keep team operations productive and efficient
- Used coding rules established by the American Medical Association and the Centers of Medicare and Medicaid Services of procedural codes
Medical Biller And Coder
Aventura Hospital Orthopedicare Center
Aventura, FL
08.2006 - 01.2012
- Accurately inputted procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices
- Actively maintained current working knowledge of CPT and principles, government regulation, protocols and third party requirements regarding billing
- Assessed billing statements for the correct diagnostic codes and identified problems with coding
- Retrieved Electronic Remittance Advice (ERA's)
- Followed up on patient and insurance aging report to certify correct reimbursements in a timely event
- Scheduled surgeries, physical and occupational therapy services
- Processed legal claims such as automobile accidents, slip and falls and workers compensation
- Reviewed all claims for accurateness and appropriateness
- Participated in educational opportunities, including workshops, seminars and training classes to gain a stronger education in industry updates and federal regulation
- Maintained accurate and timely charge submissions utilizing electronic charge capture practices, including billing and account receivables (BAR) system and medical billing clearinghouse accounts
- Supervised and evaluated the activities of medical personnel when Department Manager was unavailable
Correctional Officer
Henry County Sheriff's Office
McDonough, GA
01.2000 - 02.2006
- Employed de-escalation techniques, verbal commands and physical and mechanical restraints to address unruly inmates
- Informed inmates and visitors of rules, safety and security procedures and responsibilities
- Observed and addressed incidents of anti-social behavior, alcohol and drug related offenses, weapon offenses and vandalism
- Maintained and demonstrated proficiency in the use and care of firearms restraint methods and emergency measures
- Monitored daily activities to identify and manage suspicious behavior, improper conduct and signs of conflict
- Processed inmates by completing paperwork, conducting searches and recording fingerprints
- Escorted prisoners to court appearances to protect everyone involved in proceedings and prevent escape
Education
High School Diploma -
North Miami Beach High School
North Miami Beach, FLCertified Medical Billing and Coding Specialist -
WOLI University
New York, USA, NYSkills
- Certified Professional Coder
- Extensive Medical terminology knowledge
- ICD 9/10 and CPT coding compliant
- Expertise in Medical billing and Coding
- Inpatient and outpatient care
- Time management and prioritizing
- Leadership and Analytical Abilities
- Tech Savvy
- Detail Oriented
- Data collection and analysis
- In-depth claims knowledge
- Critical thinking proficiency
- Claims Evaluation
Certification
AAPC Certified Professional Coder
Timeline
Senior Claims Examiner
MATRIX Resources
05.2023 - Current
Remote Senior Collections Specialist
University of Miami Health System
10.2021 - 05.2023
Lead Bartender
Nomi Bar & Grill
07.2020 - 08.2022
Medical Coding And Billing Specialist
Miami Children's Anesthesia Associates
01.2012 - 07.2020
Medical Biller And Coder
Aventura Hospital Orthopedicare Center
08.2006 - 01.2012
Correctional Officer
Henry County Sheriff's Office
01.2000 - 02.2006
High School Diploma -
North Miami Beach High School
Certified Medical Billing and Coding Specialist -
WOLI University
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