Summary
Overview
Work History
Education
Skills
Timeline
Generic

Desiree Swanson

Fieldsboro,NJ

Summary

Driven Billing Manager bringing 20 plus years of Medical Billing experience including Mental Health. OBGYN and Infertility, Orthopedics, and Durable Medical Equipment. Looking to apply expertise to a new role. Adept at managing team performance, improving operations and reducing delinquency.

Overview

14
14
years of professional experience

Work History

Medical Billing Lead

CFG Healthcare
Marlton , NJ
04.2019 - Current
  • Led team of 10 handling more than 500k in monthly charges.
  • Collaborated with physicians, nurses and other healthcare personnel to clarify diagnosis codes or treatments rendered when necessary.
  • Participated in meetings with internal stakeholders such as finance teams to discuss any challenges impacting successful billing operations.
  • Participated in workshops, seminars and training classes to gain stronger education in industry updates and federal regulations.
  • Researched complex billing issues using internal resources and external sources as needed.
  • Assisted auditors with required documentation related to accounts receivable audits.
  • Resolved billing issues by applying knowledge and completing in-depth research.
  • Set up and maintained Nextgen electronic billing system.
  • Identified and resolved discrepancies in patient accounts.
  • Supervised a team of medical billers to ensure accurate coding and timely submission of claims.
  • Reviewed patients' records for accuracy and completeness prior to submitting claims for payment.
  • Provided training on medical billing software applications.
  • Monitored productivity of staff members to maintain departmental efficiency.
  • Answered customer questions to maintain high satisfaction levels.
  • Submitted claims to insurance companies.
  • Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
  • Checked claims coding for accuracy with ICD-10 standards.
  • Reconciled codes against services rendered.
  • Performed research on insurance regulations related to medical billing practices.
  • Maintained updated knowledge of changes in healthcare regulations that impact the medical billing process.
  • Coordinated with providers, payers, and third-party vendors to ensure prompt resolution of claims disputes or rejections.
  • Gathered information to produce accounts payable reports for review.
  • Created strategies aimed at increasing cash flow from insurance companies by reducing denials rate through improved coding accuracy.

Medical Coding and Billing Specialist

Delaware Valley OBGYN & Infertility Group
Lawrenceville, NJ
11.2010 - 04.2019
  • Verified patient information, including medical history and insurance coverage, to ensure accuracy of coding and billing.
  • Conducted audits of medical records to identify missing or incorrect documentation that could affect accurate coding and billing.
  • Submitted claims electronically to insurance companies in accordance with regulations.
  • Researched denied claims to determine the cause of denial and corrected errors as needed.
  • Analyzed trends in denials in order to recommend process improvements which would reduce the number of denials received.
  • Reviewed physician orders, laboratory results, diagnostic images, clinical statements and other health care provider services for completeness and accuracy.
  • Assigned appropriate codes using ICD-10-CM for diagnosis, CPT for procedures, HCPCS for supplies and modifiers as required by payers.
  • Developed policies and procedures related to medical coding processes.
  • Monitored regulatory updates from Medicare and Medicaid programs as well as private insurers.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.
  • Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
  • Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
  • Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
  • Communicated with healthcare personnel, including practitioners to promote accuracy.
  • Verified proper coding, sequencing of diagnoses and accuracy of OBGYN and Infertility procedures.
  • Released information to persons or agencies according to regulations.
  • Answered questions and fulfilled requests with friendly and knowledgeable service.
  • Mentored junior team members and managed employee relationships.
  • Provided administrative support including filing documents, preparing correspondence .
  • Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes.

Education

Certificate - Medical/ Property And Casuality Insurance

South Jersey Professional School of Business
Marlton, NJ
11-2000

High School Diploma -

Bordentown Regional High School
Bordentown, NJ
06-1996

Skills

  • Project Management
  • Project Leadership
  • Training and mentoring
  • Audit Support
  • Staff Training
  • Process Improvements
  • HIPAA knowledge
  • Denial Management
  • Collections experience
  • Medical Billing Expertise
  • Proactive and Focused
  • Willing to Learn
  • Team Building Leadership
  • Customer Service
  • Insurance Negotiation
  • Problem-solving aptitude
  • Remote Video Conferencing
  • Attention to Detail
  • In-Depth Research
  • Reliability
  • Proficient in Multiple Billing System
  • Strategy Development
  • Discrepancy Reconciliation
  • Critical Thinking

Timeline

Medical Billing Lead

CFG Healthcare
04.2019 - Current

Medical Coding and Billing Specialist

Delaware Valley OBGYN & Infertility Group
11.2010 - 04.2019

Certificate - Medical/ Property And Casuality Insurance

South Jersey Professional School of Business

High School Diploma -

Bordentown Regional High School

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Desiree Swanson