Crystal Gaines
Ridgeland,MS
Summary
Organized Medical Biller with a 19-year career performing difficult multitasking and claims-processing tasks. Works quickly with insurance companies to resolve problematic disputes and handle patient inquiries. Brings a can-do attitude to collaborating with medical professionals, insurance providers, and clients to manage invoicing in a high-traffic office environment. Hands-on experience in account management, revenue generation, and medical billing and coding. Skilled in developing strategies to improve workflows and processes and implement procedures that enhance revenue generation. Demonstrated leadership skills to guide teams towards success, optimize performance, and sustain organizational success.
Overview
1
1
Certification
21
21
years of professional experience
Work History
Lead Billing Specialist
Thriveworks
07.2021 - Current
- Applied appropriate ICD-9, CPT-4, and HCPCS codes through detailed medical report interpretation.
- Interpreted physician orders, lab results, and radiology reports for accurate code assignment.
- Assigned additional diagnosis codes based on clinical findings from various reports and studies.
- Verified record copies for accuracy and relevance prior to final submission to enhance data integrity.
- Translated medical terminology and pharmacological information into the coding system effectively.
- Maintained an up-to-date CPT and HCPCS code library along with ICD-9 and ICD-10 CM diagnostic codes.
- Filed all claims promptly within established guidelines to ensure consistent revenue flow.
- Transmitted information or documents to customers via email, mail, or facsimile.
Medical Billing Coordinator
Medical Practice Solutions
Jackson, MS
11.2019 - 02.2022
- Ensured accuracy of medical claims verified correct ICD-9, CPT-10 codes, while being in compliance with the HIPAA regulations.
- Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
- Verified patient eligibility and coverage details to ensure accurate billing and reduce claim denials.
- Posted medical insurance payments for Aetna Better Health, Molina, traditional Medicaid, and private pay, ensuring timely revenue cycle management.
- Investigated and resolved denied or rejected claims from incorrect coding or lack of authorization, facilitating improved reimbursement.
- Interpreted medical terminology and pharmacological information to translate information into coding system.
Administrative Assistant
RevClaims
Jackson, MS
07.2014 - 11.2019
- Composed letters, memos, reports, emails, and presentations for management staff.
- Managed physical and digital files, monitored spreadsheets and updated reports to coordinate project materials.
- Answered incoming telephone calls and directed them to appropriate medical or administrative staff, ensuring efficient communication and support. and directed calls to appropriate medical or administrative staff.
- Conducted research and compiled statistical reports to synthesize information and effectively communicate insights throughout the organization.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
Customer Account Executive
Comcast Corporation
Jackson, MS
04.2014 - 07.2014
- Resolved customer inquiries, troubleshooting technical issues and providing solutions quickly and efficiently.
- Supported customers via phone and email, ensuring timely resolution of inquiries in a fast-paced environment.
- Assisted customers in setting up cable and internet connections, configuring routers, and connecting devices to enhance their service experience.
- Guided customers in utilizing online services effectively, improving their overall digital engagement.
- Received recognition from management for delivering outstanding customer service.
Billing Coordinator
PharMerica Pharmacy
Jackson, MS
06.2009 - 04.2012
- Developed effective invoicing procedures alongside accounting staff and contracts department to maximize effectiveness of billing operations.
- Processed and issued invoices, adjustments, and credit memos to ensure timely billing for customers.
- Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
- Verified insurance information and obtained billing authorization by contacting insurance providers.
- Responded promptly to customer inquiries concerning services, bills, payments.
- Prepared and posted weekly vendor and supplier payments to maintain accurate financial records.
Billing Coordinator
Medical Management Professional
Jackson, MS
01.2006 - 06.2009
- Coordinated with sales team to ensure timely and accurate billing for customer accounts.
- Eliminated inaccuracies in accounts payable payments by verifying information prior to generating checks and electronic payment transfers.
- Researched customer account information to effectively respond to inquiries and resolve billing disputes.
- Updated billing systems regularly by entering new customer information or modifying existing records.
- Trained new team members on company policies and accounting systems, enhancing team knowledge and operational efficiency.
Education
Diploma - Certified Billing and Coding Specialist
Virginia College
MS01-2007
Associates of Arts Science - General Studies
Hinds Community College
MS01-2005
Skills
- Medical Billing and Coding
- ICD-10
- HIPAA compliance
- Claims processing
- Payment posting
- Insurance Verification
- Medical Terminology
- Data Entry
- 10-Key Data Entry
- EPIC
- Nextgen
- AMD Advanced MD
- AS400 Billing software
- MyAvaility
- Navinet
- Therapy Notes
- HelpScout
- NICE
- Medical Transport Billing
Certification
Certified Medical Biller and Coder
Timeline
Lead Billing Specialist
Thriveworks
07.2021 - Current
Medical Billing Coordinator
Medical Practice Solutions
11.2019 - 02.2022
Administrative Assistant
RevClaims
07.2014 - 11.2019
Customer Account Executive
Comcast Corporation
04.2014 - 07.2014
Billing Coordinator
PharMerica Pharmacy
06.2009 - 04.2012
Billing Coordinator
Medical Management Professional
01.2006 - 06.2009
Associates of Arts Science - General Studies
Hinds Community College
Diploma - Certified Billing and Coding Specialist
Virginia College