Danielle Robinson
Bolingbrook,IL
Summary
With over 15 years of healthcare experience, I am a Certified Professional Medical Coder (CPC) who is skilled and knowledgeable in the revenue cycle process. I have a high level of proficiency in accurately assigning Evaluation and Management (E&M) codes, ICD diagnoses, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) for outpatient encounters.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Medical Coding Coordinator 3
Humana
05.2023 - Current
- Reviews outpatient records and interpreted documentation to identify diagnoses and procedures
- Analyzes submitted medical documentation and corrected claims to verify accuracy of code edit denials
- Utilizes administrative processes and organizational knowledge to manage assigned case volume
- Educates providers on disputes related to adjudicated claims that contain code edit related denials or recovery
- Confirms appropriate diagnosis related group (DRG) assignments
- Makes coding recommendations to internal teams of accuracy on denials to assist in claims adjudication process
- Responds to and/or clarifies internal requests for coding information
- Exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques
- Maintains productivity standards
Member Account Specialist
HealthJoy
06.2021 - 05.2023
- Conducted in depth insurance plan and billing documentation reviews for member advocacy assistance
- Audited medical, dental, and vision claims and coding to verify the accuracy of claim outcomes
- Facilitated meetings with members, and their providers, and insurance carriers to resolve balance discrepancies
- Notified clients of appeal processes for individual healthcare plans
- Documented internal systems with client account outcomes
- Communicated account status to clients via written reports
- Enhanced client satisfaction by promptly resolving account issues and providing exceptional customer service
Medical Coding and Billing Specialist
Loyola University Health System
06.2019 - 09.2020
- Maintained knowledge of and complied with coding guidelines and reimbursement reporting requirements
- Analyzed outpatient records and interpreted documentation to identify all diagnoses, procedures, and modifiers
- Assigned appropriate ICD-10-CM, CPT, HCPCS, and modifiers for outpatient claims
- Audited reports to resolve discrepancies, improve accuracy, and increase compliance with regulatory requirements
- Worked within healthcare system to update authorizations for inpatient and outpatient claims processing
- Utilized Epic to manage and confirm internal patient data, insurance, demographic and medical history information
- Successfully submitted inpatient and outpatient claims electronically and manually
- Processed insurance company denials and submitted written appeals
- Verified and updated patient insurance eligibility via phone calls and payor portals
- Processed and tracked requests for medical records from external organizations
- Sorted and distributed incoming and outgoing medical records
- Identified new methods to optimize medical records management
- Developed and implemented new filing system for medical records to improve efficiency
Medical Billing Specialist
ADVENTIST HINSDALE HOSPITAL
09.2008 - 03.2019
- Consistently passed departmental bonus structured audits with 98 % accuracy
- Provided key input to management in identifying and correcting root cause issues preventing clean claim submissions with the goal of reducing billing and coding errors and improving clean claim rates
- Performed audits to identify billing and coding errors
- Successfully completed assigned work ques adding coding based on documentation
- Accurately submitted inpatient and outpatient claims electronically and manually
- Evaluated patients' financial status and established appropriate payment plans
- Researched and added missing patient insurance information, and demographics preventing claim submissions
- Communicated with cross-functional teams to achieve appropriate and timely results for ongoing functional responsibilities
Education
High school diploma -
Proviso East High School
Maywood, ILCertification in Health Information Management -
Harold Washington College
Chicago, ILSkills
- Strong attention to detail
- HIPAA Compliance Understanding
- Medical Coding Certification
- Time Management Capabilities
- Medical terminology proficiency
- Medical claims coding
Certification
Certified Professional Coder (CPC), Present
Timeline
Medical Coding Coordinator 3
Humana
05.2023 - Current
Member Account Specialist
HealthJoy
06.2021 - 05.2023
Medical Coding and Billing Specialist
Loyola University Health System
06.2019 - 09.2020
Medical Billing Specialist
ADVENTIST HINSDALE HOSPITAL
09.2008 - 03.2019
High school diploma -
Proviso East High School
Certification in Health Information Management -
Harold Washington College
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