- Enjoy hobbies that combine physical activity with outdoor exploration
Crystal Smires
Barnet,VT
Summary
Adept at medical billing and coding, excellent team player, manages multiple tasks and provides excellent customer service with a positive attitude. Demonstrated success in accurately processing claims and maintaining patient records. Proven ability to navigate complex billing systems, intricate part of implementation of multiple EHR/Revenue Cycle software systems and ensure compliance with healthcare regulations. Track record of effectively troubleshooting issues and maintaining patient confidentiality.
Experienced leader with strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Known for collaborative approach and commitment to excellence.
Overview
26
26
years of professional experience
Work History
Medical Biller and Coder
Northern Counties Health Care, Inc.
05.2008 - 11.2024
- Correctly coded and billed medical claims for Federally Qualified Health Care (FQHC) primary care, behavioral health, various hospitalist services and nursing facilities.
- Reduced claim denials through meticulous verification of patient eligibility and coverage benefits prior to claim submission.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Worked closely with physicians to accurately assign ICD-10 diagnostic codes for optimal reimbursement rates from insurance companies.
- 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.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Played a pivotal role in maintaining positive cash flow within the organization by ensuring timely submission of clean claims and diligent follow-ups on outstanding payments.
Walk in Clinic/ED Registrar & Medicare Biller
Cottage Hospital
09.2004 - 03.2008
- Enhanced communication between medical teams for optimal patient outcomes through diligent documentation and regular updates.
- Accepted payment from patients, reconciled cash payments and offered feedback to supervisor regarding various payment and cash issues.
- Maintained current knowledge base regarding insurance information and managed care guidelines.
- Promoted a safe and welcoming environment for patients, families, and staff by adhering to infection control protocols and maintaining confidentiality of sensitive information.
Head Teller
Passumpsic Savings Bank
03.1999 - 11.2001
- Balanced cash drawers consistently at end-of-day without discrepancies, ensuring accuracy in all transactions processed throughout the day.
- Oversaw currency shipments and deposits while adhering to strict safety guidelines.
- Replenished ATM funds in empty canisters prior to validation process.
- Managed high-volume cash transactions daily, maintaining accuracy and efficiency under pressure.
- Assisted customers with account inquiries, resolving issues promptly to ensure satisfaction.
- Answered inquiries regarding checking and savings accounts and other related products.
- Developed strong rapport with customers by actively listening, addressing concerns promptly, and providing tailored solutions.
- Provided support during audits, gathering necessary documentation and demonstrating compliance with internal controls.
Education
Accounting And Finance
Central Maine Community College
Auburn, MEHigh School Diploma -
Mt. Blue High School
Farmington, ME01-1997
Skills
- Microsoft Word & Excel
- Outlook
- AthenaOne, Meditech & Cerner
- Payment posting
- Insurance verification
- ICD-10 proficiency
- Medicare, Medicaid, commercial & self-pay billing
- Medical coding expertise
- Claim submission
- Appeals processing
- HIPAA compliance
Interests
Timeline
Medical Biller and Coder
Northern Counties Health Care, Inc.
05.2008 - 11.2024
Walk in Clinic/ED Registrar & Medicare Biller
Cottage Hospital
09.2004 - 03.2008
Head Teller
Passumpsic Savings Bank
03.1999 - 11.2001
Accounting And Finance
Central Maine Community College
High School Diploma -
Mt. Blue High School
Similar Profiles
Joel StephensJoel Stephens
Executive Director at Advanced Home Health & Hospice NW of WenatcheeExecutive Director at Advanced Home Health & Hospice NW of Wenatchee
Peggy TowlesPeggy Towles
HBPC Nurse Practitioner at Northern Arizona VA Health Care SystemHBPC Nurse Practitioner at Northern Arizona VA Health Care System
Wendi PurcellWendi Purcell
Procurement Pharmacy Technician Supervisor (GS8) at VHA Northern California Health Care SystemProcurement Pharmacy Technician Supervisor (GS8) at VHA Northern California Health Care System
Jodi ComoJodi Como
Veterinary Office Manager at Ryegate Small Animal HospitalVeterinary Office Manager at Ryegate Small Animal Hospital
Brooke'lyn RobinsonBrooke'lyn Robinson
Licensed Nursing Assistant at Northeastern Regional HospitalLicensed Nursing Assistant at Northeastern Regional Hospital