Beth Spires

· Analyze Medicare and Medicaid regulations and assist in education efforts for providers and staff towards compliance with these rules.

• Analyze third-party payer contracts towards proper reimbursements according to various contracts and fee schedules.
• Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
• Monitored changes in coding regulations to provide recommendations for compliance.
• Communicated with insurance providers to resolve denied claims and resubmitted.
• Adhered to established standards to safeguard patients' health information.
• Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
• Resourcefully used various coding books, procedure manuals, and on-line encoders.
• Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
• Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
• Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
• Generated reports to identify denial trends and discrepancies.
• Processed, tracked, monitor requests for medical records from external organizations to comply with Post- and/or Pre-Payment audits of documentation of billed medical services.

• Correctly coded and billed medical claims for physicians at various outpatient hospital and nursing facilities.
• Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
• Interacted with physicians and other healthcare staff to ask questions regarding patient services.
• Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
• Reviewed patient charts to better understand health histories, diagnoses, and treatments.
• Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
• Verified signatures and checked medical charts for accuracy and completion.
• Communicated with insurance companies to research and resolved coding discrepancies.
• Maintained accuracy, completeness, and security for medical records and health information.
• Assist in maintaining pre-submission claim editing systems.

• Captured and entered professional and facility charges for an ambulatory surgery center and cancer infusion unit.
• Delivered timely and accurate charge submissions.
• Filed and updated patient information and medical records.
• Verified insurance eligibility and information to update database.
• Compiled, verified accuracy, and sorted information to prepare source data for computer entry.
• Corrected data entry errors to prevent duplication or data degradation.
• Checked for accuracy by verifying data and records.
• Followed data entry protocols, rules and regulations.
• Used computer software to store and retrieve data.
• Verified signatures and checked medical charts for accuracy and completion.