Heather Villalpando
Medical Coding Specialist
Spokane,WA
Summary
CERTIFIED CODING SPECIALIST Dedicated insurance professional with more than 10 years of experience investigating and processing health insurance claims. Effectively manage multiple, high-priority projects and take pride in providing exemplary customer service. Hardworking professional applies official coding conventions and rules established by American Medical Association and Centers for Medicare and Medicaid Services. Confident Medical Coder adheres to data confidentiality and privacy rules in all workflows and promotes dynamic interpersonal skills.
Overview
15
15
years of professional experience
2
2
years of post-secondary education
1
1
Certification
Work History
Billing Compliance Specialist
CHAS
Spokane, wa
05.2024 - Current
- Supports Billing Compliance department with analytical support as par of compliance and monitoring activities, including drafting reports and presentations.
- Assists with documentation collection, review, and quality assurance for department as needed.
- Facilitates corrective action plan processes.
- Monitors department help ticket system and completes tasks as assigned.
Certified Coding Specialist
Kaiser Permanente
Spokane, WA
10.2012 - Current
- Review, analyze, and resolve claims coding denials
- Manage staff work assignment
- Receive and track all Safety Event claims and reconsiderations from providers
- Research coding concepts with vendors to create system flags to ensure accurate coding.
- Generated reports to identify coding trends and discrepancies.
- Utilized electronic medical record systems to store, retrieve and process patient data.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes
Claims Investigation & Reprocessing Specialist/Customer Service Specialist
Group Health Cooperative
Spokane, WA
06.2010 - 10.2012
- Review, analyze, and resolve claims through the utilization of procedures, reference materials and on-line tools, Knowledge of contract benefits and claims processing procedures, Translate data into information acceptable to the claims processing system including follow up on pended claims, Prepare claims for return to Provider or Customer when additional information is needed, Consistently meet cycle time/productivity goals that are aligned with corporate objectives, Maintain confidentiality of all documents/files, Provider education when needed, Provider/Customer support with claims status, issues, benefit quotes, Apply commitment to quality by doing things right the first time in order to avoid defects from reaching customers.
- Followed all company policies and procedures to deliver quality work.
- Listened and responded to customer requests and forwarded necessary information to superiors.
- Helped meet changing demands by recommending improvements to business systems or procedures.
- Conducted regular reviews of operations and identified areas for improvement.
- Fielded customer complaints, escalating complex issues to management for resolution
- Documented customer interactions and transactions for accurate, up-to-date records
- Maintained confidentiality of patient finances, records, and health statuses
- Modified, updated and processed existing policies
- Checked documentation for accuracy and validity on updated systems
- Maintained strong knowledge of basic medical terminology to better understand services and procedures
- Processed and recorded new policies and claims
Education
A.A.S - Medical Office Specialist
SPOKANE COMMUNITY COLLEGE
SPOKANE, WA 09.1999 - 05.2001
Skills
Claims Handling and InvestigationsHIPPA RegulationsPolicy and Contract InterpretationProvider Claims SupportClaims Reports and Documentation
Microsoft Excel, Word, Access, Outlook, PowerPoint, 10-key, Pegasystems, National pricing vendors, Optum, EPIC, EncodePro, Tapestry
CPC certification
Self-Motivated
Coding error resolution
Data Entry
Critical Thinking
Decision-Making
Insurance claims analysis
Data security procedures
Certification
CPC - Certified Professional Coder
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Resolved product issue through consumer testing.
- Collaborated with team of 3 in the development of system flags to capture incorrect coding.
Work Preference
Work Type
Full TimeLocation Preference
RemoteImportant To Me
Work-life balanceFlexible work hoursPaid time offHealthcare benefitsPaid sick leave401k matchStock Options / Equity / Profit Sharing4-day work weekPersonal development programsWork from home optionCareer advancementAffiliations
- AAPC
Quote
Be more concerned with your character than your reputation, because your character is what you really are, while your reputation is merely what others think you are.
John R. Wooden
Languages
English
Native or Bilingual
Interests
Music
Traveling
Long walks
Watching documentaries
Timeline
Billing Compliance Specialist
CHAS
05.2024 - Current
Certified Coding Specialist
Kaiser Permanente
10.2012 - Current
Claims Investigation & Reprocessing Specialist/Customer Service Specialist
Group Health Cooperative
06.2010 - 10.2012
A.A.S - Medical Office Specialist
SPOKANE COMMUNITY COLLEGE
09.1999 - 05.2001