Galiya Cabanes
Port St Lucie,USA
Summary
Results-driven Medical Coding and Billing Specialist specializing in revenue cycle optimization, with extensive expertise in ICD-10-CM and CPT coding. Achieved a 96% clean claims submission rate, enhancing compliance and client satisfaction through effective problem-solving and streamlined patient communications.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Contracted Coding Specialist
Palm Beach Neurosurgery LLC
Lake Worth, FL
01.2025 - Current
- Appeals Specialist.
- Worked closely with clients to answer questions related to billing, processing all forms needed for insurance billing purposes, and collecting the necessary documentation from clients.
- Assisted other medical billers with follow-up inquiries to clients, communicated with physicians' offices and hospitals to obtain records, and accurately recorded patient information.
- Assisted clients with processing insurance claims through both private insurance and Medicaid/Medicare.
- Noted and processed all necessary forms from the insurance.
- Assisted patients in navigating the billing and insurance landscape, including collecting all necessary forms and signatures.
- Worked with doctors' offices and hospitals to obtain charge information and billing details.
- Entered all billing and payment information into the system properly and without errors.
- Followed up with clients and payments, as needed.
- Answered phones, assisted clients with questions, took messages, and screened calls.
- Maintained the highest level of confidentiality.
- Reviewed and analyzed denied claims to determine the basis for denial, and assess the potential for a successful appeal.
- Prepared and submitted written appeals to insurance companies, including gathering the necessary documentation and evidence to support the appeal.
- Liaised with healthcare providers, patients, and insurance representatives to collect additional information or clarification needed for appeals.
- Monitored and tracked the status of submitted appeals, ensuring timely follow-up and resolution.
- Interpreted and applied current healthcare regulations, payer policies, and coding guidelines to ensure compliance in the appeals process.
- Analyzed appeal outcomes to identify trends, patterns, or issues in denials, recommending process improvements to minimize future denials.
- Facilitated peer-to-peer reviews between healthcare providers and insurance company medical reviewers when required.
Contracted Coding Specialist
Anley Cardiovascular
Fort Pierce, FL
01.2025 - Current
- Processed and submitted medical billing claims to insurance companies and government payers.
- Reviewed and verified patient information, insurance coverage, and medical records for accuracy.
- Utilized coding systems such as ICD-10 and DRG to assign appropriate codes for diagnoses and procedures.
- Followed up on unpaid claims, addressing any discrepancies or issues with insurance companies.
- Maintained organized medical records, and ensured compliance with privacy regulations.
- Collaborated with healthcare providers to resolve billing inquiries and disputes.
- Stayed updated on changes in medical billing regulations, coding practices, and insurance policies.
Medical Coder/Biller
IAN BOYKIN MD.PA
Ft. Pierce, FL
02.2024 - 12.2024
- Verified the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered
- Efficiently reported the quality care tied to HEDIS quality measures to Medicare
- Reviewed medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines
- Under the supervision of Billing Manager, responsibilities included to obtain payment from third party payers and self-pay accounts to enhance cash flow and gather reimbursement based on established contracts
- Performed a follow up activities on accounts to ensure prompt payment
- Identified coding or billing errors from EOBs and corrected them
- Monitor insurance claims and contacted insurance companies to resolve claims
- Updated the patient account record to identify actions taken
- Assigned bad debt accounts to the collection agency
- Negotiated payment plans with patients on self-pay accounts
- Maintained current working knowledge of ICD-10-CM, E/M, CPT-4, HEIDIS, HCPCS coding guidelines, government regulation and protocols
- Completed appropriate system entry regarding claim/encounter information
- Supported and participate in process and quality improvement initiatives
Clinical Denial Inpatient Coding Specialist/Appeal Denial Review Specialist
HCA Healthcare/Parallon
Remote
03.2023 - 03.2024
- Identified and troubleshot billing, guarantor, insurance plan, and payer issues, if necessary, and made calls directly to payers to resolve denial issues
- Informed management of trends identified through the review and validation process such as missing modifiers, ensured clean claim submissions
- Assured compliance with coding rules and regulations according to regulatory agencies such as the Center for Medicare Services (CMS), Office of the Inspector General (OIG), and AMA as well as company and applicable professional standards
- Performed accurate and timely charge entries into billing software
- Stayed up to date with coding changes
- As a Clinical Denials Coding Specialist handled correcting inpatient/outpatient coding guidelines and payor requirements for 22 clinical denials and 40 insurance claims per day per the company's requirement
- Post denials, post, or correct contractual adjustments, and post other non-cash related
- Resolved 30-40 claims daily impacted by payor recoupment, refunds, and posting errors
- Abstracted additional data elements during the chart review process when coding, as needed
- Adhered to the ethical standards of coding as established by AAPC and/or AHIMA
- Maintain required levels of performance in both coding quality and productivity as established by Optum360
- Provided documentation feedback to providers, as needed, and query physicians when appropriate
- Maintained a 98% compliance rating by performing HIPPA Auditor assessments on medical records and coding procedures
- Followed ICD-10-CM coding guidelines to assign appropriate diagnosis codes, which decreased coding errors by 16%
- Navigated eClinicalWorks to process medical claims efficiently, resulting in a 96% clean claims submission rate
Bilingual (French) Customer Service Representative - Remote
Alta Resources Neenah WI
Remote
08.2012 - 08.2023
- Reviewed, researched, solved, and processed assigned work; This would include navigating multiple computer systems and platforms (verify pricing, prior authorizations, applicable benefits)
- Independently completed daily documentation and communicated the status of claims as needed adhering to all reporting requirements
- Learned and leveraged new systems and training resources to help apply claims processes/procedures appropriately (online training classes, coaches/mentors)
- Managed approximately 30 incoming calls, emails per day from customers
- Consistent attendance with the ability to meet work schedule including the required training period
Benefits Verification Specialist
AmerisourceBergen
Remote
11.2022 - 02.2023
- Assigned to BMS Oncology Lash Premier Source client
- Completed 40 daily benefit verification processes including HCPCS/CPT codes
- Managed triage cases with missing information to the appropriate program associate
- Verified patient-specific benefits and precisely documented specifics for various payer plans for 40 accounts on a daily including patient coverage, cost share, and access/provider options
- Documented and initiated prior authorization process, claims appeal, etc
Coder Specialist
Patrick Synakowski Primary Care Provider
Charleville-Meziere, France
06.2017 - 08.2021
- Utilized Evaluation and Management guidelines
- Ensured accurate hospital billing by coding an average of 58 complex inpatient medical records per day
- Followed ICD-10-CM coding guidelines to assign appropriate diagnosis codes
End User Bilingual Support
Concur SAP Technologies
Remote
01.2015 - 06.2016
- Provided quality first-tier support for employee receipt, payment, and reconciliation of travel expenses to French Canadian and American clients
- Accepted employee calls to review discrepancies in expense reports or repayment concerns
- Documented appropriate details of inquiry, notify customers according to notification schedules, and take timely action including follow-up calls on cases as necessary, and escalating appropriately as determined by call flow processes
- Provided full guidance of Concur software; created cases in both French and English after each call, escalating, and following up with existing clients regularly
Education
Associate of Applied Science - Medical Billing And Coding
Cambridge College of Healthcare & Technology
Atlanta, GA08.2022
Associate of Arts - Graphic Design
Art International Institute of Minnesota
Minneapolis, MN06.2001
Skills
- Medical terminology
- HIPAA compliance
- ICD-10-CM
- CPT-4
- CPT II
- CPT III
- HCPCS
- HEDIS Measurements
- Knowledge of CMS/HCC Risk Adjustment
- Certified CPC
- Certified CPMA
- Coding guidelines
- EHR systems, billing software
- Medicare insurance regulations
- Revenue Cycle Management
- Accounts receivable
- Inpatient/outpatient medical claims
- Clinical claims denials
- Benefit insurance verification
- Translate medical procedures and medical diagnosis codes
- CPT and ICD-10 coding
- Medical documentation
- Strong communication
- Strong problem-solving
- Ability to work independently
- Ability to work within a team
- Ability to multitask
- HIPAA-compliant
- LCD
- NCD
- Client-specific guidelines
Certification
- AAPC CPC Certified, 11/01/22
- CRC AAPC Trained
- AAPC CPMA Certified
Hobbies and Interests
- I enjoy helping others and giving back to the community.
- Participating in local clean-up initiatives.
- Sharing travel tips, recommendations, and insights with fellow enthusiasts.
- Exploring famous landmarks, historical sites, and cultural attractions in a new destination.
- I like working with my hands and fixing things.
Volunteer Experience
- Assisted with special events and programs within MarineBio Conservation Society
- Red Cross Volunteer, Madison WI. Skills used some medical terminology, filing, and bookkeeping.
Languages
- French, Full Professional
- Russian, Native or Bilingual
Related Experience
- Medical Coding
- Revenue Cycle Management
- Accounts receivable
- Inpatient/outpatient medical claims
- Clinical Claims Denials
- Benefit insurance verification
- Translate medical procedures and medical diagnosis codes
- CPT and ICD-10 coding
- Medical documentation
- Medical Terminology
- Strong communication (both oral and written), documentation, and critical thinking skills essential
- Strong problem solving and decision making
- Ability to work independently and within a team
- Ability to multi-task and provide quality work
- HIPAA compliant
- Locate and apply CCI, LCD, NCD and other applicable coding rules and client specific guidelines
Languages
French
Full Professional
Russian
Native/ Bilingual
Timeline
Contracted Coding Specialist
Palm Beach Neurosurgery LLC
01.2025 - Current
Contracted Coding Specialist
Anley Cardiovascular
01.2025 - Current
Medical Coder/Biller
IAN BOYKIN MD.PA
02.2024 - 12.2024
Clinical Denial Inpatient Coding Specialist/Appeal Denial Review Specialist
HCA Healthcare/Parallon
03.2023 - 03.2024
Benefits Verification Specialist
AmerisourceBergen
11.2022 - 02.2023
Coder Specialist
Patrick Synakowski Primary Care Provider
06.2017 - 08.2021
End User Bilingual Support
Concur SAP Technologies
01.2015 - 06.2016
Bilingual (French) Customer Service Representative - Remote
Alta Resources Neenah WI
08.2012 - 08.2023
Associate of Applied Science - Medical Billing And Coding
Cambridge College of Healthcare & Technology
Associate of Arts - Graphic Design
Art International Institute of Minnesota
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