HEATHER VILLALPANDO
Spokane,WA
Summary
Detail-oriented Compliance Analyst with 14 years of experience in medical coding and claims processing, adept at conducting comprehensive research and compliance investigations. Proven track record of ensuring accuracy and accountability while adhering to HIPAA regulations. Strong expertise in policy and contract interpretation, coupled with critical thinking skills to efficiently resolve complex issues.
Overview
14
14
years of professional experience
1
1
Certification
Work History
BILLING COMPLIANCE SPECIALIST
Community Health Association of Spokane
Spokane, WA
05.2024 - Current
- Conducted periodic internal audits to ensure compliance with applicable regulations.
- Performed risk assessments to identify areas of non-compliance and potential risks.
- Coordinated with various departments within the organization to ensure adherence to established standards.
- Assisted in developing strategies for improving overall compliance performance.
- Participated in meetings between senior leadership teams to discuss any potential violations or concerns about regulatory issues.
- Identified gaps in current control frameworks which may lead to non-compliance issues.
- Provided support to department by assisting with special assignments and projects.
- Checked records for required signatures by closely reviewing documents.
- Assisted in the development of compliance training materials and online resources.
CERTIFIED CODING SPECIALIST
Kaiser Permanente of WA
01.2012 - 01.2024
- Reviewed medical records to ensure accuracy and completeness of clinical documentation, coding and billing processes.
- Identified appropriate diagnosis codes based on ICD-10-CM guidelines.
- Verified insurance eligibility and coverage through payer websites.
- Analyzed denied claims to identify the root cause of denials and corrected errors accordingly.
- Resolved complex coding issues with providers in a timely manner.
- Assisted in developing training materials for new hires or existing staff members on best practices for medical coding.
- Participated in weekly meetings with department heads discussing coding trends and problem areas.
- Generated various reports using software applications such as Microsoft Excel or Access.
- Tracked daily productivity goals set by the department manager.
- Maintained high accuracy rate on daily production of completed reviews.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Resolved coding discrepancies and denials to maximize reimbursement.
- Participated in coding team meetings to discuss challenges and best practices.
Claims Adjuster
Group Health Cooperative
SPOKANE, WA, WA
10.2010 - 01.2012
- Analyzed medical claims for accuracy, completeness, and compliance with company policies and procedures.
- Investigated discrepancies in medical billing codes, patient information, and other data related to claims processing.
- Resolved complex claim issues through research, negotiation, and collaboration with other departments.
- Assessed claim denials to determine if appeals are appropriate.
- Documented all decisions made on claims in accordance with established guidelines.
- Developed strategies for reducing costs associated with claims processing.
- Provided customer service support to healthcare providers regarding denied or disputed claims.
- Identified trends in claim rejections or denials and provided feedback to management team.
- Performed quality assurance reviews of submitted insurance claims prior to payment approval.
- Verified that payments were made according to contracted terms between provider and insurer.
- Maintained accurate records of all activities related to claim adjustments.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Accurately processed large volume of medical claims every shift.
- Reviewed administrative guidelines whenever questions arose during processing of claims.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
Education
Associate of Applied Science - MEDICAL SECRETARY
Medical Secretary
Spokane, WA09-2003
Skills
- Compliance Auditing
- Codify expertise
- Time management abilities
- Reliability
- Strong problem solving
- Microsoft Excel expertise
- Data entry proficiency
- Proofreading
- Audit preparation
- Research abilities
- Multitasking Abilities
- Administrative Support
- Communication
- Professionalism
- Multitasking
- Problem-solving abilities
- Documentation skills
- Medical terminology expertise
- Data entry and management
- Insurance claims analysis
- Medical record security
- Patient data compilation
- Coding appeals
- Patient confidentiality
- Code validation
- Account resolution
- Professional ethics
- Medicare insurance regulations
- Continuing education
- Claim validity determination
- HIPAA
- Policy investigations
- Medical Records Review
- Claims adjustment
- Workload prioritization
- Claims
- Benefits review
- Denied claims identification
Certification
AAPC CPC Certification
References
References available upon request.
Timeline
BILLING COMPLIANCE SPECIALIST
Community Health Association of Spokane
05.2024 - Current
CERTIFIED CODING SPECIALIST
Kaiser Permanente of WA
01.2012 - 01.2024
Claims Adjuster
Group Health Cooperative
10.2010 - 01.2012
Associate of Applied Science - MEDICAL SECRETARY
Medical Secretary
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