Brenda Thomas
Baton Rouge,Louisiana
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Outpatient Medical Coder
Texas Digestive Disease Consultants
Baton Rouge, LA
06.2014 - 04.2024
- Researched and resolved discrepancies between coded data and source documents.
- Ensured all documentation was compliant with CMS regulations and guidelines.
- Evaluated documentation for specificity and clarity prior to assigning codes.
- Audited physician notes for accuracy prior to submitting claims for reimbursement.
- Assigned appropriate modifiers to accurately reflect services rendered.
- Actively participated in continuing education courses related to outpatient medical coding practices.
- Ensured accuracy of claim submissions by thoroughly analyzing patient charts for any deficiencies in information.
- Collaborated with physicians, nurses and other healthcare professionals regarding coding issues or questions.
- Performed chart abstraction activities including review of lab results, operative reports, discharge summaries.
- Reviewed medical records for accuracy and completeness to ensure compliance with coding standards.
Inpatient Coder
Baton Rouge General Hospital
Baton Rouge, LA
08.2017 - 12.2023
- Investigated denials from payers due to incorrect or incomplete billing information or coding errors.
- Assigned ICD-10-CM and CPT codes to diagnoses and procedures in accordance with accepted coding principles.
- Audited medical records for accuracy prior to submission for reimbursement purposes.
- Reviewed patient medical records to ensure accuracy of diagnosis and procedures codes.
- Maintained knowledge of reimbursement rules, regulations, policies, and procedures related to coding.
- Performed periodic quality assurance reviews on coded data to ensure accuracy of coding practices.
- Compiled statistical data from coded information for use in research studies and other healthcare initiatives.
- Participated in multidisciplinary team meetings regarding patient care plans and outcomes.
- Verified insurance coverage eligibility prior to assigning codes in order to maximize payment collections.
Precertification Specialist
Our Lady Of The Lake Hospital
Baton Rouge, LA
01.2014 - 12.2023
- Verified insurance eligibility, coverage levels, and benefit parameters prior to submission of precertification requests.
- Ensured compliance with all HIPAA regulations pertaining to protected health information.
- Resolved any discrepancies identified during the precertification process.
- Analyzed trends in denials or rejections of claims due to lack of proper authorization.
- Reviewed patient medical records to determine medical necessity for requested services and procedures.
- Generated reports summarizing key metrics related to the performance of the precertification team.
- Evaluated clinical criteria against existing health plan guidelines to determine authorization status.
- Provided follow-up on pending precertification requests to ensure timely processing.
- Developed and maintained relationships with payer contacts to resolve complex issues quickly.
- Utilized various software applications such as electronic medical record systems for data entry purposes.
- Processed appeals when necessary following denial or rejection of claims due to lack of proper authorization.
- Prepared detailed reports outlining the reasons why an individual was denied benefits.
- Monitored client accounts for any changes that could impact eligibility requirements.
Office Administrative Assistant
4ever caring
Baton Rouge, LA
08.2014 - 11.2021
- Assisted with scheduling meetings and appointments for the office staff.
- Ordered supplies and maintained an inventory of office equipment.
- Greeted visitors and answered incoming calls, providing information to callers or redirecting them to the appropriate personnel.
- Maintained confidentiality of sensitive data in accordance with company policies.
- Prepared documents such as correspondence, presentations, spreadsheets, reports and other materials using Microsoft Office applications.
- Compiled statistical reports related to sales activities.
- Managed employee records including payroll information, attendance tracking, vacation time requests.
- Set up new hire paperwork according to company standards.
- Collected data from various sources to create accurate financial statements on a monthly basis.
- Performed administrative duties such as photocopying, faxing documents and mailing packages.
- Processed incoming invoices for payment in a timely manner.
Education
Certification - Medical Coder & Biller
Delta College of Arts & Technology
Baton Rouge, LA02-2013
High School Diploma -
Cathedral City High School
Cathedral City, CA06-2011
Skills
- Clinical Documentation
- Revenue Cycle Management
- HIPAA Compliance
- Regulatory guidelines
- Coding Error Resolution
- Insurance Verification
- Qualified pain management coder
- Records Management
- Medical Billing
- ICD-10 coding
- Documentation oversight
- Patient data identification
- Medical record security
- Data Verification
- Proficiency in Epic Software
- Healthcare claim coding
- ASC Coding
- Claims Processing
- Ethical standards
Certification
- Certified Medical Coder (CMC)
- Nationally Certified Medical Assistant (NCMA)
Timeline
Inpatient Coder
Baton Rouge General Hospital
08.2017 - 12.2023
Office Administrative Assistant
4ever caring
08.2014 - 11.2021
Outpatient Medical Coder
Texas Digestive Disease Consultants
06.2014 - 04.2024
Precertification Specialist
Our Lady Of The Lake Hospital
01.2014 - 12.2023
Certification - Medical Coder & Biller
Delta College of Arts & Technology
High School Diploma -
Cathedral City High School
- Certified Medical Coder (CMC)
- Nationally Certified Medical Assistant (NCMA)
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