Jessica Young
Mechanicsville,VA
Summary
Detail-oriented and methodical Medical Coder accomplished in optimizing billing processes and enhancing fiscal health, my background in both clinical and financial settings showcases a proven expertise in multiple billing systems, claims processing, documentation requirements, denials management and problem solving abilities. Offering 13 years of experience in related roles, I have significantly contributed to streamlining operations and ensuring HIPAA compliance, demonstrating a commitment to excellence and continuous improvement in healthcare administration ranging from clinical documentation improvement to accurately coding and billing insurance claims.
Overview
13
13
years of professional experience
3
3
Certifications
Work History
Billing Specialist
Upstream Care LLC
01.2023 - Current
- Identify, research, and resolve billing variances to maintain system accuracy and currency.
- Prepare itemized statements, bills, or invoices and recorded amounts due for services rendered.
- Research and resolve billing discrepancies to enable accurate billing.
- Work with multiple departments to check proper billing information.
- Utilize various EMR systems for claims processing.
- Perform Clinical Chart Reviews to maintain accurate clinical documentation.
- Created a process for denials management to ensure timely response to discrepancies or billing errors.
Senior Medical Coding Specialist
Dominion Women's Health
11.2019 - Current
- Review, analyze, and manage coding of diagnostic and treatment procedures contained in outpatient medical records.
- Interact with physicians and other healthcare staff to ask questions regarding patient services.
- Correctly code and bill medical claims for office and hospital services.
- Train and mentor junior coders to support growth and development and apply high-quality coding practices.
- Communicate with insurance companies to research and resolved coding discrepancies.
- Monitor changes in coding regulations to provide recommendations for compliance.
Medical Office Specialist
Advanced Surgical Partners Of Virginia
03.2019 - 11.2019
- Received, recorded and filed medical payments by check, cash, and credit card.
- Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
- Utilized ECW to schedule appointments for doctor visits and procedures.
- Scheduled and organized monthly Bariatric Surgery Seminars for new patients.
- Reconciled daily payments received and prepared deposits for smooth office finances.
- Prepared patient charts by gathering and organizing medical records ahead of appointments.
- Provided prompt, polite and professional in-person and telephone customer service.
Inventory Specialist
Alpha Automation LLC
02.2018 - 03.2019
- Completed physical inventory counts each month.
- Performed data entry and completed proper paperwork.
- Inspected products received for customer orders to ensure accuracy.
- Sorted and delivered materials to different work areas and staff.
- Requisitioned new supplies and maintained storage areas for smooth department operations.
- Inspected incoming and outgoing shipments to identify discrepancies with records.
Clinical Pharmacy Technician
Magellan Health
03.2017 - 02.2018
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Researched, resolved and documented prior authorization outcomes.
- Communicated prior authorization criteria, benefit coverage and formulary alternatives to physicians, physician office staff, medical management staff and/or pharmacists.
- Escalated requests to Pharmacist when request required extensive clinical review or denial.
- Researched, resolved and documented physician or client inquiries and grievances and provided verbal or written results to client, prescriber, provider and/or management.
RX Shift Supervisor
CVS Pharmacy
07.2016 - 02.2018
- Trained new employees and delegated daily tasks and responsibilities.
- Maintained clean and well-organized production areas to avoid violations or unnecessary work delays due to hazards or inefficient layouts.
- Resolved customer complaints and issues and offered thoughtful solutions to maintain customer satisfaction.
- Processed product returns/credits.
- Streamlined operational efficiencies by supervising inventory cycle counting processes, including accounting and reporting of surplus, product returns and damages.
- Responsible for scheduling, auditing, and determining inventory needs for the entire store.
- Responsible for maintaining drug inventory.
Lead Pharmacy Technician
CVS Pharmacy
12.2011 - 07.2016
- Set up and modified patient profiles in ScriptPath to include current information such as medications and insurance details.
- Resolved non-routine issues like third-party billing, computer system, and customer service issues.
- Collaborated with team members and delegated tasks as needed.
- Responsible for creating Pharmacy Schedule.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
- Maintained proper drug storage procedures, registries, and records for controlled drugs.
- Supervised pharmacy technicians and coordinated day-to-day assignments.
- Monitored ordering of pharmacy medication stock to maintain streamlined inventory and low overhead.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
Education
GED -
Franklin County High School
Rocky Mount, VA07.2018
Skills
- Billing systems and software
- Denials Management
- Claim submission & processing
- Clinical Coding Knowledge
- Insurance Verification
- HIPAA Compliance
- Data entry proficiency
- Research and due diligence
- Medical terminology proficiency
- Clinical Documentation Improvement
- Proficiency in multiple EMR systems including Greenway Intergy, Athena, ECW, Allscripts, Medpointe, Epic, PracticeFusion, & Kareo
- Quality Assurance
- Invoice Processing
Accomplishments
- Paragon Award Recipient 2016 - Recognizes the best of the best among CVS Health colleagues and are among the highest honors awarded by the company.
- Developed a pathway to assist Upstream team members with insurance denials – implemented a follow up process and manual on how to submit corrected claims and reconsiderations depending on the requirements for individual payers.
- Assisted in creating a database to house outstanding claims and provide updates and outcomes of follow up that resulted in an overall recoupment amount of $46,097.75 across all practices we submitted CCM claims for from January 2023 through May 2024.
- Increased billing accuracy rates by an average of 7% based on chart audit reviews.
Certification
- CPht - Certified Pharmacy Technician 2011-2024
- CPC - Certified Professional Coder 2018
- CDEO - Certified Documentation Expert Outpatient 2024
Timeline
Billing Specialist
Upstream Care LLC
01.2023 - Current
Senior Medical Coding Specialist
Dominion Women's Health
11.2019 - Current
Medical Office Specialist
Advanced Surgical Partners Of Virginia
03.2019 - 11.2019
Inventory Specialist
Alpha Automation LLC
02.2018 - 03.2019
Clinical Pharmacy Technician
Magellan Health
03.2017 - 02.2018
RX Shift Supervisor
CVS Pharmacy
07.2016 - 02.2018
Lead Pharmacy Technician
CVS Pharmacy
12.2011 - 07.2016
GED -
Franklin County High School
- CPht - Certified Pharmacy Technician 2011-2024
- CPC - Certified Professional Coder 2018
- CDEO - Certified Documentation Expert Outpatient 2024
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