GALIYA CABANES
Port St Lucie
Summary
Detail-oriented Certified Coding Specialist/Auditor with extensive experience in accurately coding patient records and ensuring compliance with healthcare regulations. Proficient in utilizing advanced coding software to maintain meticulous documentation, significantly enhancing operational efficiency. Possesses a robust understanding of healthcare billing processes and regulatory requirements, facilitating effective collaboration with multidisciplinary teams to improve patient care and streamline administrative workflows. Committed to upholding the highest standards of accuracy and integrity in all aspects of healthcare documentation, recognized for strong analytical and communication skills in fast-paced environments.
Overview
13
13
years of professional experience
3
3
Certifications
2
2
Languages
Work History
CONTRACTED CODING SPECIALIST
Palm Beach Neurosurgery LLC
01.2025
- 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
01.2025
- 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 and Biller
Symmetry Vascular Center Inc
03.2025 - Current
- Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
- Submitted claims to insurance companies electronically or by mail.
- Interpreted physician orders, notes, lab results, radiology reports for appropriate code assignment.
- Reviewed medical records to meet insurance company requirements.
- Documented and filed patient data and medical records.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Maintained positive working relationship with fellow staff and management.
- Developed an understanding of how various insurance plans process claims for reimbursement purposes.
- Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
- Reconciled accounts receivable to ensure accuracy of payments received.
- Performed routine quality assurance audits to promote data integrity.
- Worked closely with physicians to obtain additional clinical information when needed for accurate coding assignments.
CONTRACTED CREDENTIAL SPECIALIST
Psychiaric Specialty Center
02.2025 - Current
- Credentialed and Maintaining 25 physicians within a group practice with private payers, Medicare, Medicaid.
- Recredential with designated hospitals for current providers.
- Maintaining and posting accurate records for services provided and tracking aging on accounts.
- Verifying insurance coverage.
- Following up on unpaid claims and resubmitting claims as needed.
- Collecting on past due accounts.
- Solid information medical background with experience in Mental Health.
- Thorough knowledge of medical office billing practices including ICD and CPT coding systems.
- Thorough knowledge of all HIPPA regulations pertaining to the medical office environment.
- Interacting with physicians, therapists, mid-levels and assistants to ensure accuracy.
- Managing detailed, specifically-coded information.
- Maintaining patient confidentiality and information security.
- Excellent organization, interpersonal, communication and time management skills.
- EMR used for Psychiatric Specialty Center: Tebra (previously known as Kareo), eTenet Physician Portal, CredentialStream for Groups.
Medical Coding Appeals Analyst I
Elevance Health (Contracted by Wipro)
11.2025 - 01.2026
- Demonstrated expertise in appeals and denials, including NCD/LCD, Duplicate, and MUE.
- Accumulated two to three years of experience in E&M/GMC coding.
- Conducted investigations into customer grievances and appeals regarding service and benefit coverage issues.
- Contacted customers to gather case information and communicate resolutions while documenting interactions.
- Generated written correspondence for customers, providers, and regulatory agencies.
- Performed research to respond to inquiries and interpreted policy provisions to assess company liability.
- Resolved appeals from CS Units, Provider Inquiry Units, members, and providers regarding processed claims.
- Ensured timely resolution of inquiries, grievances, and appeals per regulatory standards or customer needs.
- Identified barriers to customer satisfaction and recommended actions to overcome operational challenges.
- Obtained active certifications as Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA).
- Demonstrated expertise in appeals and denials, including NCD/LCD, Duplicate, and MUE.
- Accumulated two to three years of experience in E&M/GMC coding.
- Possessed strong knowledge of CPT, HCPCS, ICD-10 codes, and CMS reimbursement guidelines.
MEDICAL CODER/BILLER
IAN BOYKIN MD.PA
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 follow up activities on accounts to ensure prompt payment.
- Identified coding or billing errors from EOBs and corrected them.
- Monitored 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 participated in process and quality improvement initiatives.
CLINICAL DENIAL INPATIENT CODING SPECIALIST/APPEAL DENIAL REVIEW SPECIALIST
HCA Healthcare/Parallon
03.2023 - 01.2024
- 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
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
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
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
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 language proficiency
- Compliance with HIPAA standards
- Application of regulatory guidelines
- Claims management
- ClaimsXten proficiency
- Pega
- Ethical standards
- Microsoft Excel
Certification
AAPC CPC Certified
Timeline
Medical Coding Appeals Analyst I
Elevance Health (Contracted by Wipro)
11.2025 - 01.2026
Medical Coder and Biller
Symmetry Vascular Center Inc
03.2025 - Current
CONTRACTED CREDENTIAL SPECIALIST
Psychiaric Specialty Center
02.2025 - Current
CONTRACTED CODING SPECIALIST
Palm Beach Neurosurgery LLC
01.2025
CONTRACTED CODING SPECIALIST
Anley Cardiovascular
01.2025
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 - 01.2024
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
08.2012 - 08.2023
Associate of Arts - Graphic Design
Art International Institute of Minnesota
Associate of Applied Science - Medical Billing And Coding
Cambridge College of Healthcare & Technology