Jennifer Toole
Plant City
Summary
Motivated Medical Billing and Coding Specialist. Certified Professional Coder and Certified Risk Adjustment Coder under AAPC. Efficient in multiple specialties, including but not limited to Pain Management, Pathology, Internal Medicine, Dermatology, Wound Care, Gastroenterology, Urgent Care, Primary Care, Podiatry, Pediatrics, Oncology, Dietitian, Behavioral Health and Nutritionist.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Certified Medical Coder
HCCS
2023.10 - Current
- Current systems includes EPIC, Cerner, Athena, TruBridge
- Current specialties includes RHC, Internal/Family Medicine, Pain Management, OBGYN, Urology, Rheumatology, Podiatry, Dietician, Surgical, Behavioral Heath, Pediatrics, Oncology, CCM, Cardiovascular
- Analyzed medical records to ensure accurate coding and compliance with industry regulations.
- Collaborated with healthcare providers to clarify documentation and resolve coding discrepancies.
- Reviewed and interpreted clinical data to assign appropriate codes for diagnoses and procedures.
- Maintained compliance with industry regulations by staying up-to-date on the latest changes in medical coding guidelines and conventions.
- Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
- Verified signatures and checked medical charts for accuracy and completion.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Followed up with medical staff regarding missing information in patient records.
- Verified accuracy of patient information in medical records.
Certified Risk Adjustment Coder/Coding Manager
Sanitas
2021.02 - 2023.08
- My current responsibilities include Medicare Risk Adjustment claims, including pre-visit record review and post visit review.
- Contacting providers through action notes to ensure ALL conditions are addressed yearly.
- Accurately assigns the proper CPT and diagnosis codes for providers to ensure proper reimbursement.
- Review all physician documentation to ensure compliance with regulatory guidelines.
- Ability to create web encounters for errors in documentation to ensure the documentation meets coding guidelines.
- Manage web encounters to ensure claims are submitted within a timely manner.
- Identifies and corrects denials to ensure correct coding guidelines were adhered to.
- Led code reviews to ensure adherence to quality benchmarks and facilitate knowledge sharing.
- Conducted thorough audits of coding practices, identifying opportunities for optimization and streamlining processes.
- Implemented ongoing training initiatives to keep staff up-to-date on industry trends and best practices in medical coding.
- Boosted team morale and fostered a positive work environment by organizing team-building activities and recognizing individual achievements regularly.
- Attended facility meetings and reported on performance.
- Performed coding quality reviews and tracked, trended and managed coding quality performance.
- Organized regular team meetings to foster collaboration, share updates on project status, and address any challenges or concerns as they arose.
- Generated reports to identify coding trends and discrepancies.
Certified Professional Coder, Insurance Claims Clerks
Medstat
2010.10 - 2021.01
- Accurately assigns the proper CPT and diagnosis codes for providers to ensure proper reimbursement.
- Review all physician documentation to ensure compliance with regulatory guidelines.
- Ability to contact physicians to seek additional records when needed to validate correct coding.
- Proficiency in multiple specialties including evaluation and management, pain management, pathology, internal medicine, wound care and dermatology.
- Identifies and corrects any discrepancies as needed to rectify an account.
- Answer incoming calls from patients, providers and attorneys, providing timely responses to their claim inquiries.
- Contact patients directly to ensure we have the appropriate information to accurately bill claims.
- Meticulously correct errors (exclusions), manage denials and appeals.
- Ability to train new employees to ensure they have success in the company.
- Banks Deposits/Credit Card Deposits.
Education
Medical Billing and Coding -
Sanford-Brown Institute
FLSkills
- Over 20 years of customer service experience, 16 years of that as a Medical Coder
- Proficient in Billing and Coding, 10-key, Microsoft Office, Excel, Clearinghouses-Relay Health, McKesson, Change Healthcare, Trizetto, Coding Softwares-AdvancedMD, EPIC, Nextech, MedStar, SuccessEHS, eClinicalWorks, TruBridge, Cerner, Athena and type 42 wpm
- Very organized and able to work in a stressful environment
- Extremely strong in all fields of customer service including verbal communications, multi-tasking and written requirements
- Capable of handling a high volume of calls
- Enjoy working with people and willing to assist others as needed
Certification
- CPC
- CRC
Honors and Activities
Academic Honors Award, National Technical Honor Society
Additional Information
Additional employment history available upon request.
Timeline
Certified Medical Coder
HCCS
2023.10 - Current
Certified Risk Adjustment Coder/Coding Manager
Sanitas
2021.02 - 2023.08
Certified Professional Coder, Insurance Claims Clerks
Medstat
2010.10 - 2021.01
Medical Billing and Coding -
Sanford-Brown Institute