Ernell Calhoun
Augusta,Georgia
Overview
22
22
years of professional experience
1
1
Certification
Work History
Medical Biller
Jefferson Hospital
10.2023 - Current
- Verified insurance of patients to determine eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Filed and updated patient information and medical records.
HCC Medical Coder
East Georgia Regional Primary Care Physicians
01.2023 - Current
- Review provider documentation to abstract and confirm all diagnosis codes mapping to Hierarchical Condition Category (HCC) conditions, according to Risk Adjustment policies, internal contract terms, and coding guidelines, for proper diagnostic code assignment
- Analyze IEHO claim and encounter data to identify incomplete and inaccurate ICD-10 coding patterns submitted at the physician level
- Develop measurement tools and track coding accuracy to identify trends in coding deficiencies, then educating providers to prevent errors from continuing.
Patient Account Representative II
Emory Healthcare
01.2020 - 01.2023
- Code medical records for the complete and correct assignment of CPT and ICD codes, following strict coding guidelines for various clinical specialties
- Query providers to obtain information, documentation, and patient data to ensure compliant and complete patient documentation and medical records
- Assess provider documentation to confirm that it supports selected codes.
A/R Billing Specialist
Providence Hospital/Lifepoint Health
01.2016 - 01.2020
- Managed billing processes, including ICD and CPT code selection and insurance claims submissions
- Followed up with government, commercial, and third-party payers to resolve unpaid claims
- Resolved payor denials, updating coding and submitting appeals, reducing improper and underpayment.
Coding Reimbursement Specialist
Broward Health Imperial Point
01.2006 - 01.2016
- Abstracted diagnosis and procedure codes from medical record documentation, selecting ICD-CM, ICD-PCS, and CPT codes for various clinical specialties
- Researched and appealed denied claims for satisfactory resolution and optimal reimbursement
- Reviewed claim errors and compiled error reports.
Patient Access Specialist
Broward Health Imperial Point
01.2002 - 01.2006
- Performed registration and pre-registration tasks for outpatient appointments, including insurance verification and financial screening
- Collected patient payments and kept patient charts updated.
Education
Precyse University
Skills
- CPT
- ICD-9/10-CM
- HCPCS
- Medical Terminology
- Anatomy
- Physiology
- Coding Guidelines
- HIPAA Policies
- Modifiers
- Coding Payment Policies
- NCD and LCD Edits
- NCCI Edits
- Accounts Payable
- Accounts Receivable
- Collections
- Compliance
- Microsoft Office Suite
- Athena
- Cerner
- Cirrius
- EPIC
- Meditech
- NextGen
- NThrive
- Insurance Claims
- Medical Billing
- HIPAA Compliance
- CPT Knowledge
Certification
Certified Coding Associate (CCA)
Affiliations
American Health Information Management Association (AHIMA)
Codingexpertise
- Risk Adjustment Coding
- HCC Coding Processes
- Provider Education
- Physician Coding
- Outpatient Coding
- Same Day Surgery
- Cardiac Catheterization
- Cardiology
- Colorectal Surgery
- Diagnostic Radiology
- Emergency Department
- Orthopedic
- Oncology
- Family Practice
- GI Endoscopy
- Infusion
- Internal Medicine
- Interventional Radiology
- Pain Management
- Wound Care
- Infusion
- Chemotherapy
- Oncology
- Orthopedic
Personal Information
Title: CCA
Timeline
Medical Biller
Jefferson Hospital
10.2023 - Current
HCC Medical Coder
East Georgia Regional Primary Care Physicians
01.2023 - Current
Patient Account Representative II
Emory Healthcare
01.2020 - 01.2023
A/R Billing Specialist
Providence Hospital/Lifepoint Health
01.2016 - 01.2020
Coding Reimbursement Specialist
Broward Health Imperial Point
01.2006 - 01.2016
Patient Access Specialist
Broward Health Imperial Point
01.2002 - 01.2006
Precyse University
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