BAY MAR
San Diego,CA
Summary
Reliable Medical Biller with coding and medical terminology knowledge. Polished and hardworking performer with background overseeing accounts and handling records management tasks. Team-oriented person with great decision-making skills. I determined to solve problems to the best of my knowledge and I do not hesitate to ask for help when necessary. I am accountable for being essentially organized when dealing with patients files and documents. With over fifteen years of experience in the Medical career I proudly take ownership in my job duties.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Medical Billing Specialist
Scripps Healthcare
01.2006 - 09.2022
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Posted and adjusted payments from insurance companies.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Located errors and promptly refiled rejected claims.
- Identified and resolved patient billing and payment issues.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Ensured timely submission of claims to various insurance carriers, resulting in prompt payment for services rendered.
- Managed patient accounts effectively, resolving discrepancies and addressing outstanding balances in a timely manner.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Collected payments and applied to patient accounts.
Medical Coding Specialist
Scripps Healthcare
01.2009 - 10.2016
- Streamlined billing processes for improved efficiency by maintaining up-to-date knowledge of coding guidelines and procedures.
- Reduced claim denials by consistently ensuring accurate and compliant coding practices in line with regulatory standards.
- Stayed current on industry trends and advancements through regular participation in professional development courses and seminars, enhancing overall job performance.
- Maintained strict adherence to HIPAA regulations by protecting confidential patient information during the coding process.
- Increased staff proficiency with ICD-10-CM and CPT code sets through ongoing training sessions and individual coaching.
- Enhanced medical coding accuracy by meticulously reviewing patient records and diagnoses.
- Actively participated in interdisciplinary team meetings to discuss complex cases, promoting a holistic approach to patient care and documentation.
- Assisted in the development of new policies and procedures for the coding department, ensuring alignment with industry best practices and regulatory guidelines.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Created and maintained up-to-date patient medical records to enable tracking history and preserve consistent information.
- Promoted a collaborative work environment through effective communication and teamwork among fellow Medical Coding Specialists.
Patient Enrollment Associate
Scripps Healthcare
01.2008 - 01.2009
- Maintained comprehensive patient records, ensuring accuracy and compliance with regulatory requirements.
- Upheld strict confidentiality standards, protecting sensitive patient information and maintaining trust with healthcare providers.
- Enhanced patient satisfaction by providing timely and accurate information regarding their health plan benefits.
- Improved patient enrollment rates by efficiently processing and verifying insurance information.
- Verified patient insurance eligibility and entered patient information into system.
- Followed document protocols to safeguard confidentiality of patient records.
- Facilitated communication between patients and various departments and staff.
Education
Medical Billing/Coding Certification -
UC San Diego-Extension
San Diego, CA05.2014
Medical Billing Certification -
Valley Career College
El Cajon, CA09.2005
Skills
- HIPAA Compliance
- HIPAA Compliance Certification
- Medical terminology expert
- Payment posting
- Payment Transactions
- Accounts Payable
- Commercial and Private Insurance
- Claim submission
- Insurance Verification
- Medical coding knowledge
- CPT Knowledge
- ICD-9
- ICD-10 Coding
- Customer Service
Certification
AAPC Certificate of ICD-10-CM Profeficiency
Timeline
Medical Coding Specialist
Scripps Healthcare
01.2009 - 10.2016
Patient Enrollment Associate
Scripps Healthcare
01.2008 - 01.2009
Medical Billing Specialist
Scripps Healthcare
01.2006 - 09.2022
Medical Billing/Coding Certification -
UC San Diego-Extension
Medical Billing Certification -
Valley Career College
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