Years in Medical Coding and Billing
Hi, I’m
Jacquelyn Gorman, BSHA, CPC, CRC
Healthcare
Butler,PA
Facts do not exist, only interpretations.
Friedrich Nietzsche
Summary
With over twenty years in the healthcare industry, I have developed expertise in Revenue Cycle Management (RCM), Hierarchical Condition Category (HCC) coding for the Medicare Advantage (MA) population, quality improvement, and documentation accuracy and improvement. Revenue Cycle Management (RCM) is where I began, and my attention to detail allowed me to submit clean claims, appeal and correct claims promptly, and closely monitor accounts receivable. As an HCC Coding Specialist, I use my expertise by reviewing electronic medical records (EMR) to ensure accurate and compliant coding for risk adjustment purposes. I contribute to quality improvement initiatives by applying my specialty diagnosis coding and provider documentation accuracy knowledge and experience.
My passion for delivering high-quality healthcare services and improving health outcomes drives me to seek new skills and take on more significant challenges. I recently completed my Bachelor of Science in Healthcare Adninistration and am currently studying for the Certified Professional Compliance Officer (CPCO) exam. I value collaboration, innovation, and excellence and look forward to joining a team that shares these values and goals.
Overview
26
2
AAPC Certifications
1
BS Healthcare Administration
13
Years Team Supervisor
3
Years in Assistant Management
Work History
Highmark, Inc.Pittsburgh , PA
Hierarchical Condition Category (HCC) Specialist
04.2017 - 07.2023
Job overview
- Conducting medical record reviews for Medicare Advantage members and capturing HCC codes that have been documented accurately.
- Formulating recommendations and alternative solutions to coding processes and workflow.
- Built partnerships with team members and other departments to provide comprehensive support for medical providers
- Providing strategic guidance by delivering data-driven, actionable category-level insights to assist with HCC gap closures.
- Conducted prospective and retrospective Risk Adjustment coding using natural language processing assistance to ensure all HCCs are captured in chart.
- Participated in planning and creating presentations for annual coding summit.
Dental Systems, Inc.Butler, PA
Billing and Coding Specialist
10.2015 - 04.2017
Job overview
- Responded to customer concerns and questions on daily basis.
- Executed billing and coding tasks for Dental and Orthodontic insurance claims and recorded information in company databases.
- Used data entry skills to accurately document and input statements.
- Monitored insurance claims aging reports and corrected errors to collect payment from insurance payers.
- Obtained prior authorizations for procedures required to treat patient conditions, and for outstanding claims denied for no prior authorization.
- Writing appeals for insurance claims denied incorrectly.
- Chiropractic medical coding
Buena Vista Enterprises, Inc,Butler, PA
Sergeant of Security Teams
12.2003 - 04.2016
Job overview
- Supervised team of security officers and managed scheduling and performance evaluations.
- Trained new security professionals to maximize performance and understanding of protocols.
- Analyzed and investigated incidents alongside law enforcement and emergency personnel.
- Recorded incident reports with detailed accounts of occurrences and outcomes.
- Provided backup to security officers to maintain coverage.
- Sole security officer in K-12 school for emotional support students.
- Extensive screening of students and public before granting entrance into building.
- Responded to situations when students created unsafe situations for themselves and others.
- Deescalated urgent situations and restored safe environment for students and staff.
- Secured building when school day ended.
Verizon WirelessCranberry Twp, PA
Customer Service Representative
04.2007 - 11.2008
Job overview
- Provided primary customer support to internal and external customers.
- Handled customer inquiries and suggestions courteously and professionally.
Automated Physician ServicesButler, PA
Medical Biller and Coder
10.2004 - 06.2007
Job overview
- Revenue Cycle Management
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Followed up with medical staff regarding missing information in patient records.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
- Communicated with insurance companies to research and resolved coding discrepancies.
Care Chiropractic CenterRenfrew, PA
Chiropractic Assistant/Medical Biller and Coder
10.2001 - 12.2003
Job overview
- Revenue Cycle Management
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Followed up with medical staff regarding missing information in patient records.
- Documentation accuracy
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Obtained prior authorizations
- Assisted in preparation of medical reports for external parties.
- Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
- Communicated with insurance companies to research and resolved coding discrepancies.
- Assisted with office computer network
Automated Physician ServicesButler, PA
Medical Biller and Coder
06.1999 - 06.2001
Job overview
- Revenue Cycle Management
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Followed up with medical staff regarding missing information in patient records.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
- Communicated with insurance companies to research and resolved coding discrepancies.
Education
Southern New Hampshire University, Manchester, NH
Bachelor of Science from Healthcare Administration
05.2020 - 10.2022
University Overview
- 3.840 GPA
- Honor Roll
- Graduated magna cum laude
Butler County Community College, Butler, PA
No Degree from Medical Coding
01.2015 - 08.2016
University Overview
- GPA – 3.6
Skills
- HCC Coding
- Revenue Cycle Management
- Team Supervisor
- Multitask
- Communication
- Exceptional work ethic
- Outpatient medical billing and coding
- Medical Terminology and HIPAA
- Electronic Medical Records (EMR)
- Revenue Cycle Management
- ICD-9-CM & ICD-10-CM
- CPT-4, CDT
- Microsoft Office
- Computer Literate
- ICD-10 Requirements
- Audit Reports
- EMR Systems
- Document Quality
- Code Requirements
- Electronic Health Records Systems
- Protected Health Information
- ICD-10 (International Classification of Disease Systems)
- Data Abstraction
- Records Accuracy
- Records Review
- Prepare Reports
- Doctor Communication
- Creating Treatment Plans
- Medical Billing and Collections
- Collections Procedures
- Organization and Prioritization
- HIPAA Compliance
- Quality Improvement
- Monthly Reconciliations
- Computational Abilities
- Denial Appeals Process
- Analytical and Critical Thinking
- Basic Medical Terminology
- Problem Identification
- Billing Data Verification
- Correct Errors
Affiliations
- Society of Human Resource Management (SHRM)
- Healthcare Finance Management Association (HFMA)
- American Academy of Professional Coders (AAPC)
Certification
- Cosmetology Teacher's License
- Certified Professional Coder (CPC)
- Certified Risk Adjustment Coder (CRC)
Availability
See my work availability
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Work Preference
Work Type
Full TimeWork Location
RemoteImportant To Me
Company CultureCareer advancementWork-life balanceHealthcare benefitsFlexible work hours401k matchWork from home optionPaid time offStock Options / Equity / Profit SharingPersonal development programsPaid sick leaveTimeline
Southern New Hampshire University
Bachelor of Science from Healthcare Administration
05.2020 - 10.2022
Hierarchical Condition Category (HCC) Specialist
Highmark, Inc.
04.2017 - 07.2023
Billing and Coding Specialist
Dental Systems, Inc.
10.2015 - 04.2017
Butler County Community College
No Degree from Medical Coding
01.2015 - 08.2016
Customer Service Representative
Verizon Wireless
04.2007 - 11.2008
Medical Biller and Coder
Automated Physician Services
10.2004 - 06.2007
Sergeant of Security Teams
Buena Vista Enterprises, Inc,
12.2003 - 04.2016
Chiropractic Assistant/Medical Biller and Coder
Care Chiropractic Center
10.2001 - 12.2003
Medical Biller and Coder
Automated Physician Services
06.1999 - 06.2001
- Cosmetology Teacher's License
- Certified Professional Coder (CPC)
- Certified Risk Adjustment Coder (CRC)
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