DIKSHA PATEL
Moore,SC
Summary
Multi-dimensional professional with 15+ years of work experience as an Assistant Manager, Multilingual Interpreter (English, Hindi, Gujarati), Recruitment, and Department Supervisor. Resourceful Coding Supervisor known for high productivity and efficient task completion. Specialize in medical coding, compliance auditing, and team leadership. Excel in problem-solving, communication, and adaptability, ensuring successful project outcomes and effective team management. Hands-on professional offering a keen understanding of data confidentiality and HIPAA regulations. Highly trained Medical Coder knowledgeable in AMA and the CMS coding rules. Self-motivated Medical Records Specialist with expertise in scanning and indexing medical records to correct charts. A bilingual individual with a pleasant attitude and desire to help in any capacity. Skilled Coding Supervisor with substantial experience in managing coding teams and implementing effective coding standards. Possess strong knowledge of medical terminology, clinical procedures, and various coding systems. Demonstrated success in providing training to team members, improving workflow efficiency, and ensuring compliance with healthcare regulations. Strengths include leadership skills, a keen eye for detail, and the ability to support staff development while maintaining high levels of accuracy and productivity. Self-motivated Medical Records Specialist with expertise in scanning and indexing medical records to correct chart. Bilingual individual with pleasant attitude and desire to help in any capacity.
Overview
8
8
years of professional experience
Work History
Medical Billing & Coding Supervisor
Regional Health System
10.2022 - Current
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided
- Oversee daily Billing Department functions, including medical coding, charge entry, claims, payment posting, and reimbursement management
- Examine patients’ encounter forms to verify diagnosis codes and reconcile codes against services rendered
- Accurately input procedure and diagnosis codes into billing software to generate invoices
- Used electronic charge capture practices such as billing and account receivables (BAR) system and medical billing clearinghouse accounts to submit codes and invoices on time
- Follow up on past due invoices and delinquent accounts to reduce the number of unpaid and outstanding balances
- Document patient data and medical records and perform routine medical record audits to comply with insurance company requirements
- Uphold and reinforce compliance with hospital policies and federal regulations such as HIPAA
- Maintained a high level of confidentiality in compliance with HIPPA regulations
- Met productivity and accuracy standards established by CMS (Center for Medicare and Medicaid Services) and the customer
- Obtain and maintain credentials to abstract in number of modules, as determined by the Management
- Knowledge and Experience in AJCC staging
- Maintained the ability to read and process large amounts of information with extreme attention to detail, while interpreting pertinent information
- Consistently exceeded productivity and accuracy standards established by the customer, CMS, and CDAC with scores at or above 100% of the module average
- Validated and abstracted extremely large medical records received (5,000+ pages) without affecting my overall productivity rating in order to meet CMS deadlines
Revenue Cycle Specialist
TekSystems
08.2021 - 09.2022
- Good ability to interpret rules and regulations set by Medicaid Medicare and commercial insurance payors
- Strong medical bill collections practice
- Highly organized with strong attention to detail
- Ability to self-motivate and work with minimal supervision
- Excellent oral and written communication skills
- Thorough knowledge concerning patient confidentiality and HIPAA rules
- Analyzed account receivables and corrected all problems
- Met all productivity and collection goals including dollars collected and accounts handled
- Initiated appeals of denial of payment for services
- Reduced rates of delinquent accounts
- Set up payment plans for people with delinquent medical bills
- Made calls to insurance companies and individuals with outstanding accounts and arranged payments
- Documented all activities
- Report to the CFO, work seamlessly with the revenue cycle team as the primary resource for contracting, compliance and other issues that could prevent optimal revenue capture
- Handle contracting and registration with third-party payers including re-credentialing as well as all state registrations
- Administer electronic clearinghouse functions, conduct billing audits, coordinate outside vendors and audits, research and advise on CAQH and Medicare / Medicaid issues
- Respond to claim balance settlements and assist in staying current with system usage
- Maintain updated knowledge of health care billing procedures, documentation, regulations, and standards
- Maintain Medicaid contracts in 20+ states, Medicare contracts in 14+ states, Blue Cross / Blue Shield in 14+ states, and commercial contracts in 30+ states
- Spearhead a credentialing project to obtain more than 100 contracts with Medicare within a month
- Complete project obtaining contracts in less than a month
Assistant
Coding Quality Specialist II
12.2020 - 07.2021
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Oversee daily Billing Department functions, including medical coding, charge entry, claims, payment posting, and reimbursement management.
- Examine patients’ encounter forms to verify diagnosis codes and reconcile codes against services rendered.
- Accurately input procedure and diagnosis codes into billing software to generate invoices.
- Used electronic charges capture practices such as billing and account receivables (BAR) system and medical billing clearinghouse accounts to submit codes and invoices on time.
- Follow up on past due invoices and delinquent accounts to reduce the number of unpaid and outstanding balances.
- Document patient data and medical records and perform routine medical record audits to comply with insurance company requirements.
- Uphold and reinforce compliance with hospital policies and federal regulations such as HIPAA.
Insurance Follow up Specialist - part time
Robert Half Technologies
03.2018 - 11.2020
- Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies
- Communicate with third-party representatives as necessary to complete claims processing and/or resolve problem claims
- Follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, and rebilling, and denied claims for accounts that are greater than 30 days old
- Maintain accounts receivable detail by use of on-line system documentation
- Reports productivity results daily to the AR supervisor
- Maintains standards per payer for percentage accounts >90 days
- Works minimum standard number of accounts per payer per day
- Meets or exceeds collection goals by payer each month
- Works all assigned accounts at least once every 15 or 30 days, depending on balance
- Participates in educational activities and attends monthly department staff meetings
- Maintains confidentiality, adheres to all HIPAA guidelines/regulations
- Other duties as assigned from time to time
Research Assistant
CNS - Clinical Research Associate
12.2016 - 02.2018
- Help identify problems with clinical trial start-up and management.Assisted with organized improvement efforts and development of research study design improvements. Works with department supervisor/manager to assist and train new hires in the research department across all specialties. Works directly with faculty to design and improve data collection efforts. Manages all data
collection
Education
Nursing School - Medical Billing & Coding
Skills
- Check-in coordination
- Medical office administration
- Patient management
- First aid
- Appointment setting
- Patient scheduling
- Patient flow management
- Documentation expert
- Conversant in [English,Hindi, Gujarati]
- Medical transcription
- Patient relations
CERTIFICATIONS
- General Ultrasound Certification
Color Doppler Ultrasound
OHSA Certification
CPR Certification
BLS Certification
ACLS Certification
First Aid Certification
NRP Certification
Medical & Billing Certification (ongoing)
Timeline
Medical Billing & Coding Supervisor
Regional Health System
10.2022 - Current
Revenue Cycle Specialist
TekSystems
08.2021 - 09.2022
Assistant
Coding Quality Specialist II
12.2020 - 07.2021
Insurance Follow up Specialist - part time
Robert Half Technologies
03.2018 - 11.2020
Research Assistant
CNS - Clinical Research Associate
12.2016 - 02.2018
Nursing School - Medical Billing & Coding
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