Summary
Overview
Work History
Education
Skills
Timeline
Generic
Barbara Boudreaux

Barbara Boudreaux

Lafayette,LA

Summary

Revenue Cycle Specialist with a proven track record in enhancing efficiency and managing medical billing processes. Spearheaded significant process improvements at Medexcel Urgent Care, resulting in reduced denial rates and a 30% boost in accounts receivable management. Expertise in medical coding and team collaboration ensures compliance while maximizing reimbursement outcomes.

Overview

11
11
years of professional experience

Work History

Care Manager

IQVIA
Northborough, MA
11.2021 - Current
  • Maintained records management system to process personnel information and produce reports.
  • Communicated authorization decisions, including approvals and denials
  • Maintained accurate and up-to-date records of authorization requests and outcomes
  • Identified areas where improvements can be made within the department by analyzing trends in denials and approvals.
  • Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
  • Provided guidance to providers regarding the prior authorization process.
  • Ensured compliance with state and federal regulations pertaining to prior authorizations.

Revenue Cycle Specialist

Medexcel Urgent Care
Abbeville, LA
06.2020 - 10.2021
  • Reviewed patient accounts to ensure accuracy and completeness of information.
  • Identified and corrected payment problems involving patients or third-party payers.
  • Performed account reconciliations between insurance companies and internal systems.
  • Audited payments from third-party payers to ensure accuracy of reimbursement amounts.
  • Contacted insurance providers to check patient coverage.
  • Maintained current knowledge of insurance policies, procedures, regulations, and guidelines.
  • Developed reports detailing billing activities, including payment trends and denial rates.
  • Assisted with the development of new processes for billing, coding, collections, and reimbursements.
  • Researched discrepancies on unpaid invoices and reconciled them.
  • Monitored accounts receivables daily to determine appropriate follow-up action needed.
  • Reached out to responsible companies and individuals to collect on outstanding debts.
  • Completed weekly account reconciliations to identify discrepancies.
  • Analyzed claims data to identify trends in denials and rejections.
  • Evaluated existing workflows for efficiency and effectiveness in order to recommend changes as needed.
  • Reviewed patient charts for accuracy prior to submitting claims for reimbursement.
  • Conducted audits of medical records to ensure compliance with payer requirements.
  • Processed appeals related to denied or rejected claims in a timely manner.
  • Advised healthcare providers on best practices for submitting accurate claims for reimbursement.
  • Ensured all regulatory requirements were met when submitting claims for payment.
  • Maintained updated knowledge through continuing education and advanced training.
  • Assisted with customer requests and answered questions to improve satisfaction.
  • Provided excellent service and attention to customers when face-to-face or through phone conversations.
  • Exceeded customer satisfaction by finding creative solutions to problems.
  • Recognized by management for providing exceptional customer service.
  • Utilized various software and tools to streamline processes and optimize performance.
  • Identified needs of customers promptly and efficiently.
  • Completed day-to-day duties accurately and efficiently.

Medical Coding and Billing Specialist

Louisiana Orthopedic Specialists
Lafayette, LA
03.2014 - 04.2020
  • Assisted with the development of coding policies and procedures.
  • Reviewed patient records and assigned accurate codes for diagnoses and procedures.
  • Performed quality assurance checks on coded data.
  • Collaborated with healthcare providers to verify necessary documentation for coding accuracy.
  • Maintained high accuracy rate on daily production of completed reviews.
  • Educated healthcare staff on coding standards and changes in coding guidelines.
  • Facilitated payment arrangements with patients and guarantors who were unable to make full payment at time of service.
  • Coordinated with billing department to clarify billing issues related to coding.
  • Monitored regulatory updates from Medicare and Medicaid programs as well as private insurers.
  • Provided administrative support including filing documents, preparing correspondence .
  • Managed coding for multiple specialties, ensuring specific codes are accurately applied.
  • Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
  • Advised on the impact of coding decisions on reimbursement and compliance.
  • Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
  • Maintained updated knowledge of coding requirements, which included continuing education and certification renewal.
  • Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes.
  • Verified proper coding, sequencing of diagnoses, and accuracy of procedures.
  • Utilized coding software and tools efficiently to expedite the coding process.
  • Submitted claims electronically to insurance companies in accordance with regulations.
  • Assigned appropriate codes using ICD-10-CM for diagnosis, CPT for procedures, HCPCS for supplies and modifiers as required by payers.
  • Analyzed trends in denials in order to recommend process improvements which would reduce the number of denials received.
  • Interpreted medical terminology and pharmacological information to translate information into coding system.
  • Performed data entry into electronic health record system for all relevant patient information including diagnoses, procedures performed, medications prescribed .
  • Utilized ICD-10, CPT, and HCPCS coding systems to process claims and billing.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.
  • Entered coded data into electronic health record (EHR) systems.
  • Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
  • Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
  • Researched denied claims to determine the cause of denial and corrected errors as needed.
  • Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
  • Communicated with healthcare personnel, including practitioners to promote accuracy.
  • Resolved coding discrepancies and denials to maximize reimbursement.
  • Trained new employees on medical coding practices.
  • Maintained updated knowledge through continuing education and advanced training.
  • Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
  • Completed day-to-day duties accurately and efficiently.
  • Worked effectively in team environments to make the workplace more productive.

Education

Medical Coding And Billing - Healthcare

Remington College
Lafayette, LA
01-2010

Some College (No Degree) - Nursing Practice

LSUE
Eunice

Skills

  • Case assessments
  • Medical chart documentation
  • Healthcare
  • Clinical documentation
  • Referral management
  • Workflow coordination
  • Payment posting
  • Billing cycle management
  • Problem-solving
  • Accounts receivable expertise
  • Medical coding
  • Analytical thinking
  • Team collaboration
  • Claims processing
  • Coding proficiency
  • Insurance confirmation
  • Billing software proficiency
  • Data entry proficiency
  • Cash posting
  • Claim submission
  • Conflict resolution
  • Relationship building
  • Billing dispute resolution
  • Customer service
  • Billing best practices
  • Medical billing and collections
  • Report generation
  • HIPAA compliance
  • Revenue cycle management
  • Monthly billing management
  • Medical billing expertise
  • Insurance verification
  • Accounts receivable management
  • Collection practices
  • Regulatory compliance
  • Attention to detail
  • Insurance claim processing
  • Collections management
  • Dispute resolution
  • Verbal and written communication
  • Month-end closing procedures
  • Ttime management
  • Invoice processing
  • Collections
  • Denial management

Timeline

Care Manager

IQVIA
11.2021 - Current

Revenue Cycle Specialist

Medexcel Urgent Care
06.2020 - 10.2021

Medical Coding and Billing Specialist

Louisiana Orthopedic Specialists
03.2014 - 04.2020

Medical Coding And Billing - Healthcare

Remington College

Some College (No Degree) - Nursing Practice

LSUE

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Barbara Boudreaux