Heather Wilson
Redding,CA
Summary
I am a highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
I have experience with quality assurance, denials, prior authorizations, coding, billing, payment collection and claim payouts. In addition to working in these roles, I’ve learned coding best practices and documentation integrity. I’m interested in transitioning into a coding role.
In addition to my work experience, I can leverage my education/credentials to support my career goals such as my Associates in Health Information Technology, Registered Health Information Technical credential, Billing and Coding Certification, and Certified Coding Associate credential.
I can leverage my background and expertise with quality assurance, denials, prior authorizations, coding, billing, payment collection and claim payouts and coding best practices for an inpatient coding position with a billing/coding provider/company in the inpatient coding department.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Office Manager
Dr. Stephanie Evans (Express Personnel)
10.2019 - 01.2020
- Developed and implemented a new filing system for medical records, resulting in improved patient care.
- Created and maintained office policies and procedures to ensure smooth operations and compliance with all state regulations.
- Coordinated with insurance companies to verify coverage of services rendered.
- Maintained accurate patient data, including medical history, laboratory results, billing information and other relevant documents.
- Scheduled appointments for patients in accordance with their individual needs and preferences.
- Managed accounts receivable for the practice, ensuring timely payments from insurance companies and patients.
- Provided support to physicians by organizing patient charts prior to scheduled appointments.
- Handled telephone inquiries from patients regarding appointment scheduling or general questions about the practice's services.
- Conducted regular audits of medical records to ensure accuracy and completeness of documentation.
- Prepared weekly reports summarizing financial performance metrics, such as revenue collections, accounts receivable balances.
- Oversaw day-to-day operations of the front desk area to ensure efficient flow of patients through check-in and checkout processes.
- Performed administrative tasks such as preparing correspondence or maintaining personnel files.
- Performed data entry and processing into system databases and troubleshot minor computer issues.
- Supervised patient billing, collection and financial counseling and assisted with cash posting.
Billing Specialist
ALN Medical Management DBA C.P.R. (California Physician Reimbursement)
07.2019 - 01.2020
- Reviewed medical records to ensure accuracy of billing information and patient data.
- Verified insurance coverage and identified third-party payers for billing purposes.
- Calculated billing charges, prepared and submitted claims to insurance companies.
- Monitored accounts receivable activity to ensure timely payment of invoices.
- Reviewed medical records and assigned appropriate codes to diagnoses, treatments, procedures, and services rendered by healthcare providers.
- Analyzed patient data for accuracy and completeness of information.
- Researched coding guidelines and regulations to ensure accurate coding practices.
- Assigned ICD-10-CM diagnosis codes as well as CPT procedure codes for billing purposes.
- Researched complex billing issues involving multiple providers or services rendered over a period of time.
- Assisted with the reconciliation of accounts receivable ledgers at month-end close process.
- Submitted appeals for denied claims when appropriate according to the insurance company's criteria.
- Monitored aging accounts receivable balances ensuring timely resolution of outstanding balances.
Designated Hitter
Walgreens Pharmacy
01.2022 - 08.2022
- Maintained patient profiles and medication records.
- Performed cashier duties such as accepting payments and issuing receipts.
- Verified insurance coverage for medications.
- Stocked shelves with pharmaceutical products.
- Ordered supplies from wholesalers or manufacturers when necessary.
- Organized drugs by expiration date to ensure freshness.
- Retrieved prescription requests from patients or healthcare providers via telephone or fax machine.
- Ensured compliance with state laws regarding controlled substances.
- Communicated effectively with other members of the health care team regarding medication orders and refills.
- Processed insurance claims for reimbursement purposes accurately and efficiently.
- Kept work areas clean, organized, and safe at all times.
Office Manager
Dr. Stephanie Evans (Express Personnel)
07.2021 - 01.2022
- Developed and implemented a new filing system for medical records, resulting in improved patient care.
- Created and maintained office policies and procedures to ensure smooth operations and compliance with all state regulations.
- Coordinated with insurance companies to verify coverage of services rendered.
- Maintained accurate patient data, including medical history, laboratory results, billing information and other relevant documents.
- Scheduled appointments for patients in accordance with their individual needs and preferences.
- Managed accounts receivable for the practice, ensuring timely payments from insurance companies and patients.
- Provided support to physicians by organizing patient charts prior to scheduled appointments.
- Handled telephone inquiries from patients regarding appointment scheduling or general questions about the practice's services.
- Conducted regular audits of medical records to ensure accuracy and completeness of documentation.
- Prepared weekly reports summarizing financial performance metrics, such as revenue collections, accounts receivable balances.
- Oversaw day-to-day operations of the front desk area to ensure efficient flow of patients through check-in and checkout processes.
- Performed administrative tasks such as preparing correspondence or maintaining personnel files.
- Performed data entry and processing into system databases and troubleshot minor computer issues.
- Supervised patient billing, collection and financial counseling and assisted with cash posting.
Financial Counselor
Prime Healthcare Services Shasta DBA Shasta Regional Medical Center
01.2020 - 03.2021
- Reviewed medical records to ensure accuracy of required information needed for pre-authorization requests.
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Maintained accurate documentation on all pre-authorization requests, denials and appeals.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Analyzed complex health plan contracts to determine benefit coverage levels for services rendered.
- Researched third party payer guidelines related to prior authorizations, coding and billing processes.
- Interpreted Explanation of Benefits statements from various insurers and communicated relevant information with other departments as needed.
- Evaluated policies and procedures related to Insurance Verification activities.
- Collaborated with internal staff members such as Billing Specialists, Medical Coders., to resolve any discrepancies in patient's insurance information.
- Counseled patients on financial obligations associated with their medical care.
- Worked closely with insurance companies to ensure accurate reimbursement for services rendered.
- Maintained knowledge of current health care regulations related to billing practices.
- Processed credit card payments accurately and securely.
Billing Specialist
Express Personnel
06.2019 - 07.2019
- Reviewed medical records to ensure accuracy of billing information and patient data.
- Verified insurance coverage and identified third-party payers for billing purposes.
- Calculated billing charges, prepared and submitted claims to insurance companies.
- Monitored accounts receivable activity to ensure timely payment of invoices.
- Reviewed medical records and assigned appropriate codes to diagnoses, treatments, procedures, and services rendered by healthcare providers.
- Analyzed patient data for accuracy and completeness of information.
- Researched coding guidelines and regulations to ensure accurate coding practices.
- Assigned ICD-10-CM diagnosis codes as well as CPT procedure codes for billing purposes.
- Researched complex billing issues involving multiple providers or services rendered over a period of time.
- Assisted with the reconciliation of accounts receivable ledgers at month-end close process.
- Submitted appeals for denied claims when appropriate according to the insurance company's criteria.
- Monitored aging accounts receivable balances ensuring timely resolution of outstanding balances.
Child Support Specialist
Shasta County Child Support
02.2018 - 06.2019
- Conducted investigations to determine paternity and legal responsibility of parents for child support payments.
- Prepared, reviewed, and maintained accurate case files and records.
- Analyzed financial information related to income, assets, expenses, and liabilities of non-custodial parents.
- Negotiated payment arrangements with non-custodial parents in accordance with state laws.
- Assessed eligibility for public assistance programs such as Temporary Assistance for Needy Families.
- Reviewed court orders for accuracy and completeness of child support requirements.
- Researched and responded to inquiries from customers regarding their cases or the status of payments.
- Processed applications for services and verified customer identity through various means including driver's licenses or other forms of identification.
- Coordinated with other agencies to ensure timely receipt of funds from non-custodial parents.
- Enforced collection activities on delinquent accounts such as wage garnishment or property liens when necessary.
Senior Customer Care Processor
Blue Shield of California
06.2014 - 08.2017
- I handled complex cases for members of Blue Shield of California, weather it was an eligibility issue or a claim that needed to be processed
- I would process anywhere from 30 to 50 complex cases per week
- During my time at Blue Shield I held multiple positions and was promoted several times
- One of my many positions even included being a claims trainer teaching our employees how to properly process medical claims as they were received.
- Greeted customers and provided prompt, courteous service.
- Assisted with customer inquiries, complaints, and requests for information regarding insurance policies.
- Processed new policy applications and updated existing policy documents.
- Verified accuracy of customer data entered into the system.
- Maintained accurate records of customer interactions and transactions.
- Researched relevant policy information to answer customer questions.
- Facilitated payment processing for premium payments and renewals.
- Performed administrative duties such as filing, scanning, faxing, copying documents.
- Generated reports based on client data to analyze trends in customer service needs.
Temporary Producer Services Representative
Blue Shield of California
02.2014 - 06.2014
- I took phone calls from insurance brokers that sold health insurance and assisted them with inquiries regarding application statuses for new applicants.
- Greeted customers and provided prompt, courteous service.
- Assisted with customer inquiries, complaints, and requests for information regarding insurance policies.
- Processed new policy applications and updated existing policy documents.
- Verified accuracy of customer data entered into the system.
- Maintained accurate records of customer interactions and transactions.
- Researched relevant policy information to answer customer questions.
- Facilitated payment processing for premium payments and renewals.
- Performed administrative duties such as filing, scanning, faxing, copying documents.
- Generated reports based on client data to analyze trends in customer service needs.
Customer Service Representative
The Knot Wedding Company
03.2013 - 08.2013
- I took phone calls from brides regarding customized orders they placed for decorations for their wedding.
GMSN
The United States Navy
06.2011 - 03.2013
- I was a Gunner’s Mate in the Navy
- I was stationed in Great Lakes, Illinois and I worked at the James A Lovell Federal Hospital.
Hostess
Larosa’s Pizzaria
08.2010 - 12.2010
- I worked as a Hostess for a pizzeria, in Loveland, Ohio, seating customers, cleaning tables, taking drink orders, folding pizza boxes, working the cash register, and basically anything else that the rest of the restaurant employees needed assistance with.
Cashier
Meijer
04.2010 - 07.2010
- I worked as a Cashier for a grocery store in Loveland, Ohio.
Education
RHIT -
01.2019
CCA -
01.2018
Medical Billing and Coding Certificate -
Rasmussen University
Health Information Technician Associate of Science -
Rasmussen University
Skills
- Documentation Oversight
- Data Entry
- Data Verification
- Patient Data Identification
- Medical Terminology
- Records Management
- Medical Record Security
- Coding Error Resolution
- Document Management
- Attention to Detail
- Medical Billing Processing
- Medical History Recording
- Office Health Records Preparation
- Patient Medical Records Maintenance
- Word Processing Software
- Certified Medical Coder
- ICD-10 Coding
- Patient Information Verification
- Electronic Health Record Applications
- Protected Health Information
- EMR Systems
- ICD-9 Coding
- HIPAA Compliance
Certification
- RHIT obtained in 2019
- CCA obtained in 2018
References
References available upon request.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
I have not failed. I’ve just found 10,000 ways that won’t work.
Thomas Edison
Work History
Online Tutor
Tutor.com Inc.
01.2023 - Current
- Proven ability to learn quickly and adapt to new situations.
- Learned and adapted quickly to new technology and software applications.
- Passionate about learning and committed to continual improvement.
- Exercised leadership capabilities by successfully motivating and inspiring others.
- Collaborated with students to complete homework assignments, identify lagging skills, and correct weaknesses.
- Motivated students towards learning and studying to build self-confidence and reduce fear of failure.
- Provided homework assistance using specific curriculum and materials.
- Supported students with helpful study habits and exam strategies.
- Developed student confidence through positive reinforcement strategies.
- Tutored diverse groups of students to strengthen subject comprehension, boost confidence and build important learning skills.
Life Insurance Agent
New York Life Insurance Co
08.2023 - Current
- Sought out new clients and developed client relationships through networking, direct referrals, lead databases, and cold calling.
Timeline
Designated Hitter
Walgreens Pharmacy
01.2022 - 08.2022
Office Manager
Dr. Stephanie Evans (Express Personnel)
07.2021 - 01.2022
Financial Counselor
Prime Healthcare Services Shasta DBA Shasta Regional Medical Center
01.2020 - 03.2021
Office Manager
Dr. Stephanie Evans (Express Personnel)
10.2019 - 01.2020
Billing Specialist
ALN Medical Management DBA C.P.R. (California Physician Reimbursement)
07.2019 - 01.2020
Billing Specialist
Express Personnel
06.2019 - 07.2019
Child Support Specialist
Shasta County Child Support
02.2018 - 06.2019
Senior Customer Care Processor
Blue Shield of California
06.2014 - 08.2017
Temporary Producer Services Representative
Blue Shield of California
02.2014 - 06.2014
Customer Service Representative
The Knot Wedding Company
03.2013 - 08.2013
GMSN
The United States Navy
06.2011 - 03.2013
Hostess
Larosa’s Pizzaria
08.2010 - 12.2010
Cashier
Meijer
04.2010 - 07.2010
RHIT -
CCA -
Medical Billing and Coding Certificate -
Rasmussen University
Health Information Technician Associate of Science -
Rasmussen University
- RHIT obtained in 2019
- CCA obtained in 2018
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