Kayla Carlson
Billings,MT
Summary
I am a responsible and motivated professional ready to apply my expertise to the purposes of a reputable organization which may offer growth opportunities. I possess an appetite to gain and apply new skills and knowledge in addition to extensive experience in the area of medical business. I demonstrate a positive attitude and exemplary problem-solving skills and would love the opportunity to contribute to the growth of your organization.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Business Lead
The Eye Clinic Surgicenter
Billings, MT
09.2019 - Current
- Provided training and guidance for employees on how best to use available resources in order to maximize productivity.
- Collaborated with healthcare providers to verify necessary documentation for coding accuracy.
- Educated healthcare staff on coding standards and changes in coding guidelines.
- Reviewed physician orders, laboratory results, diagnostic images, clinical statements and other health care provider services for completeness and accuracy.
- Oversaw the hiring process, including recruiting, interviewing, and onboarding new employees.
- Participated in weekly meetings with senior leadership teams to discuss progress.
- Developed and implemented departmental policies and procedures.
- Evaluated current systems and identified opportunities for streamlining processes.
- Evaluated performance of individual team members and provided feedback.
- Conducted daily meetings with department staff to review progress on projects.
- Ensured accuracy and completeness of billing data in the system.
- Analyzed customer account information for accuracy prior to issuing invoices.
- Provided training, support, and guidance to new employees on correct coding billing procedures.
- Conducted performance reviews for staff members.
- Established goals for each team member and monitored progress towards those objectives.
- Emphasized compliance with CMS requirements/regulations in all billings and coding functions.
- Cooperated with senior leadership to troubleshoot issues or potential roadblocks in order to keep revenue consistent.
- Identified, screened and interviewed potential employees.
Medical Coder/Medical Biller
The Eye Clinic Surgicenter
Billings, MT
10.2014 - 09.2019
- Coded diagnoses and procedures from patient medical records using ICD-10-CM and CPT-4 codes.
- Reviewed patient medical records for accuracy, completeness and compliance with coding regulations.
- Provided support for coding queries raised by coders or staff members regarding specific cases or coding issues.
- Maintained up-to-date knowledge of coding changes, updates, and new rules.
- Maintained confidentiality of patient information according to HIPAA regulations.
- Validated accuracy of diagnosis codes as well as modifiers used on claims before final submission to payer and insurance companies.
- Researched discrepancies between documentation and billing information in order to resolve any issues prior to submission.
- Performed audits on coded claims to ensure that all required data elements are included for accurate payment processing.
- Verified accuracy of procedure codes to ensure proper reimbursement levels.
- Maintained updated knowledge of coding requirements, which included continuing education and certification renewal.
- Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
- Communicated with healthcare personnel, including practitioners to promote accuracy.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Quickly responded to staff and client inquiries regarding CPT codes.
- Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
- Collaborated with healthcare providers to verify necessary documentation for coding accuracy.
- Utilized coding software and tools efficiently to expedite the coding process.
- Resolved coding discrepancies and denials to maximize reimbursement.
- Analyzed patient charts and records to extract relevant coding information.
Medical Biller
SCL Health (now Intermountain Health)
Billings, MT
06.2012 - 10.2014
- Ensured compliance with HIPAA guidelines when handling confidential patient information.
- Submitted electronic claims to various insurance carriers.
- Maintained up-to-date knowledge of government regulations related to healthcare reimbursement policies and procedures.
- Reviewed patient insurance information to ensure accuracy and completeness of claims submission.
- Verified medical codes for diagnosis, treatments, procedures and supplies using ICD-10 coding system.
- Compiled and processed data for billing purposes utilizing billing software programs.
- Performed follow up activities on unpaid claims with insurance companies or other third party payers by phone or written correspondence.
Medical Biller/Medical Coder
Northern Rockies Neurosurgeons, PLLC
Billings, MT
07.2007 - 06.2012
- Maintained accurate records of all billing activity in accordance with departmental standards.
- Provided training and support to new staff members regarding billing processes.
- Maintained up-to-date knowledge of government regulations related to healthcare reimbursement policies and procedures.
- Compiled and processed data for billing purposes utilizing billing software programs.
- Processed refunds requests timely and accurately according to established protocols.
- Generated reports in order to track payments due from insurance companies or other third party payers.
- Prepared detailed financial reports as requested by management team.
- Researched discrepancies between billed charges and payments received from insurance companies or other third party payers.
- Collaborated with managers to develop strategies for improving revenue cycle processes.
- Assisted in auditing process by verifying accuracy of submitted claim forms against documentation provided by physicians' offices.
- Reviewed patient insurance information to ensure accuracy and completeness of claims submission.
- Performed daily reconciliation of accounts receivable with payment postings on the computer system.
- Verified medical codes for diagnosis, treatments, procedures and supplies using ICD-10 coding system.
- Performed follow up activities on unpaid claims with insurance companies or other third party payers by phone or written correspondence.
- Assisted with collection efforts as needed including contacting patients via phone, mail or email for collection of past due balances due to insurance denials or patient responsibility amounts owed.
- Ensured compliance with HIPAA guidelines when handling confidential patient information.
- Submitted electronic claims to various insurance carriers.
- Organized information for past-due accounts and transferred to collection agency.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Reviewed claims for coding accuracy.
- Contacted insurance providers to verify insurance information and obtain billing authorization.
- Completed and submitted appeals for denied claims.
- Monitored reimbursement from managed care networks and insurance carriers to verify consistency with contract rates.
- Submitted appeals using provider portals and phone communication.
- Maintained billing software by updating rate change, cash spreadsheets and current collection reports.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Distributed or posted financial data to appropriate accounts and prepare simple reconciliations.
Education
Some College (No Degree) - General Studies
Montana State University - Billings
Billings, MTSkills
- Analytical Thinking
- Experience in leadership
- Team Collaboration
- Operations Management
- Interpersonal Skills
- Attention to Detail
- Problem-Solving
- Process Improvement
- Professionalism
- Adaptability and Flexibility
- Excellent Verbal/Written Communication
Certification
- Obtained OCS (Ophthalmic Coding Specialist) certification in 2022 from AAO (American Academy of Ophthalmology)
References
References available upon request.
Timeline
Business Lead
The Eye Clinic Surgicenter
09.2019 - Current
Medical Coder/Medical Biller
The Eye Clinic Surgicenter
10.2014 - 09.2019
Medical Biller
SCL Health (now Intermountain Health)
06.2012 - 10.2014
Medical Biller/Medical Coder
Northern Rockies Neurosurgeons, PLLC
07.2007 - 06.2012
Some College (No Degree) - General Studies
Montana State University - Billings
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