DAWNEL WILLEFORD
Surprise,AZ
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethics and adaptability. Reliable medical coder with strong abilities in analytical research. Offering medical coding and auditing skills. Highly organized, proactive and punctual with team-oriented mentality.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Medical Coder/Audit Assistant
Adelante Healthcare
Phoenix, AZ
04.2023 - Current
- Collaborated with other departments such as billing, clinical documentation improvement, quality assurance to ensure accurate coding practices are being followed.
- Maintained up-to-date knowledge of coding changes, updates, and new rules.
- Validated accuracy of diagnosis codes as well as modifiers used on claims before final submission to payer and insurance companies.
- Reviewed patient medical records for accuracy, completeness and compliance with coding regulations.
- Coded diagnoses and procedures from patient medical records using ICD-10-CM and CPT-4 codes.
- Analyzed data from various sources including electronic health records databases, insurance websites, in order to identify potential errors in the coded data sets.
- Created detailed reports highlighting areas of improvement or potential risk associated with certain types of claims.
- Researched discrepancies between documentation and billing information in order to resolve any issues prior to submission.
- Identified opportunities for process improvements related to medical coding operations processes and procedures.
- Prepared reports summarizing coding trends or areas where additional training is needed.
- Verified accuracy of procedure codes to ensure proper reimbursement levels.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Maintained high accuracy rate on daily production of completed reviews.
- Verified proper coding, sequencing of diagnoses, and accuracy of procedures.
- Maintained updated knowledge of coding requirements, which included continuing education and certification renewal.
- Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
- Maintained positive working relationship with fellow staff and management.
Medical Biller/Coder
USPI/Tenet Healthcare
01.2019 - 10.2021
- Billing for California Ambulatory Surgical Centers (ASC) for all types of OP procedures
- Utilizing various EMR systems; Citrix Advantx, Waystar, Surgical Notes, Envi, Scan Chart, Medtek
- Coding support software; SuperCoder and Find-a-Code
- Reporting center progress through various Excel tracking systems
- Daily interfacing with each center Business Office Administrators and Managers
- Send OP notes, implants, supporting documents and schedules daily
- Uploading claims and statements to Waystar daily.
Medical Biller/Coder
TPC
Glendale, AZ
10.2016 - 01.2019
- Review & correct patient’s claims for accurate E/M, procedural & ICD coding per coding guidelines and make sure the appropriate documentation is there to support each encounter for a clean claim utilizing Centricity EMR system
- Run reports for laboratory services
- Review lab reports against patient’s charts & create claims
- Interface with providers daily via email for accurate processing of claims and reimbursement
- Create spreadsheets in Excel for revenue cycle and claim reimbursements
- Worked with & familiar with all types of insurance carriers
- Workflow 50% UDS/LCMS lab 50% OV billing average of 150-180 claims processed daily.
Medical Coder
Thunderbird Internal Medicine
Glendale, AZ
02.2014 - 10.2016
- Review & correct patient’s claims for accurate E/M, procedural & ICD coding per coding guidelines and make sure the appropriate documentation is there to support each encounter for a clean claim
- Run diagnostic reports for laboratory services against ECW (EHR system) for any discrepancies
- Reviewing lab reports against patient’s charts for clean billing making any needed corrections
- Pull charts from hospitals for specialist, code & bill procedures performed
- Run and audit exception reports for CXR, EKG, PFT and E/M looking for procedures that might have been missed during claim submission, then sending out corrected claims/appeals using manual and/or electronic transmission with 1500 form
- Interface with patients by phone resolving billing issues, taking payments and setting up appointments
- Interface with providers, medical administration and insurance companies daily via email, phone or face-to-face for accurate processing of claims and reimbursement
- Attend regular meetings and continual educational seminars to stay on top of the ever changing guidelines
- Assist the billing department with follow-up communications with insurance, write-up and send out appeals as needed
- Create spreadsheets in Excel for revenue cycle and claim reimbursements
- Prepares and verified patient accounts against various agencies including 70%-80% Medicare & Medicare Advantage Plans, 20%-30% Commercial/Other insurances such as UHC, Aetna, Humana, HealthNet, Cigna, Banner, BC/BS & private pay records for reimbursement projects assuring reimbursement is optimized
- Specialties included: Internal Medicine/Primary Care, Neurologist, Dermatologist, Podiatrist, Gastroenterologist, Audiologist, Sleep Lab & Laboratory Work Flow 60% Coding, 20% Billing/Collections, 20% Other tasks/skills
- Accessed & navigated through various EHR systems: Epic/Connect, ChartMaXx, eClinical Works, NetPractic, Citrix/Interactant/POC/Patron, GenX.
CMT, Physical Therapy
World of Wellness Chiropractic
Simi Valley, CA
05.2009 - 01.2014
- Vase knowledge of Anatomy & Physiology in order to identify abnormal findings related to administration of therapeutic massage and communications to the providers or team members for medical follow-up
- Administer massage & used other physical therapy as prescribed therapy applying knowledge of counteractive massage using deep tissue, other techniques and body physiology
- Assist in scheduling appointments, registering patients, collecting fees and assembling charts
- Perform treatments according to policy and provide sufficient documentation
- Works as a member of the team in the delivery of patient care
- Assist in developing and implementing patient and family teaching plans to promote good health and meet identified health education needs.
Medical Billing, Coding, Front Receptionist & CMT
Yin Yang Acupuncture
Simi Valley, CA
02.2009 - 12.2009
- Set-up a previously manual operating office onto EMR billing software system
- Reviewing and assigning accurate ICD-9-CM, E&M & CPT medical coding for diagnoses, procedures and services
- Scheduled appointments, registering patients, collecting fees and assembling charts
- Responsible for maintaining patient confidentiality by keeping both electronic and written records secure
- Generate case files based on treatment procedures, diagnostic codes, coding and billing guidelines and standardized procedures for medical claims reimbursement
- Interface with insurance eligibly administration for accurate processing of claims and reimbursement
- Follow-up with patient accounts in order to maximize reimbursement
- Follow procedures in registering, recording insurance and maintaining medical records to HIPAA compliance and privacy
- Generate patient records and process billing records based on the cost of treatment
- Verify billable provider services by reviewing applicable documentation
- Administer massage as prescribed therapy applying anatomy knowledge of counteractive massage using deep tissue, other techniques and body physiology.
Education
Associate of Applied Science - Anatomy And Physiology
Maricopa Community Colleges - Phoenix College
Phoenix, AZ03-2020
Skills
- Claims Processing
- Coding Error Resolution
- Medical Billing
- Knowledgeable in NextGen and EHR systems
- Proficiency in all Microsoft Office programs
- Healthcare claim coding
- Medical Terminology
Certification
- Licensed CPC
- Licensed LMT
- Currently pursuing CPMA
Accomplishments
- Consistently exceed expectations - awarded 3x the standard salary increase.
- Transitioning to an auditing position, as I pursue formal credentialing.
Timeline
Medical Coder/Audit Assistant
Adelante Healthcare
04.2023 - Current
Medical Biller/Coder
USPI/Tenet Healthcare
01.2019 - 10.2021
Medical Biller/Coder
TPC
10.2016 - 01.2019
Medical Coder
Thunderbird Internal Medicine
02.2014 - 10.2016
CMT, Physical Therapy
World of Wellness Chiropractic
05.2009 - 01.2014
Medical Billing, Coding, Front Receptionist & CMT
Yin Yang Acupuncture
02.2009 - 12.2009
Associate of Applied Science - Anatomy And Physiology
Maricopa Community Colleges - Phoenix College
- Licensed CPC
- Licensed LMT
- Currently pursuing CPMA
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