Laura Santos
Long Beach,CA
Summary
Medical Billing and Coding Specialist with 7 years providing administrative and patient support in hospital and medical office settings. Advanced knowledge of private insurance processes and codes. Offers background in reviewing, analyzing and managing medical record information to obtain prior authorizations from insurance companies and ensure payment. Willingness to take on added responsibilities to meet team goals.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Medical Biller and Coder
Senior Doc
10.2022 - Current
- Train providers one on one for proper coding and documentation
- Created reference documents as tools for providers to use ensuring information is up to date
- Podiatry, Laboratory, Hospital Care, and E/M Coding
- Analyze, process, research and adjust claims
- Review and analyze medical records and patient information to accurately assign codes for billing purposes
- Utilize knowledge of medical billing procedures, DRG coding, and ICD-10 coding systems
- Ensure compliance with coding guidelines and regulations
- Communicate with healthcare providers to obtain necessary documentation or clarification for accurate coding
- Verify accuracy of billing information and resolve any discrepancies or errors
- Prepare and submit claims to insurance companies or government agencies for reimbursement
- Follow up on unpaid or denied claims and appeal as necessary
Billing and Coding Supervisor
Citrus Valley Gastroenterology
11.2017 - 10.2022
- Oversaw daily Billing Department functions, including medical coding, charge entry, claims, payment posting, and reimbursement management
- Extensive knowledge of coding EGDs, Colonoscopies, Sigmoidoscopies, ERCPs, G-tubes, Laparoscopies, Colostomies, Capsule Endoscopies, Hemorrhoid removals as well as E/M visits
- Coded and input charges for over 50 procedures and 40 office visits a day.
- Trained and mentored peers to support growth and development to apply high-quality coding practices.
- Collected, posted, managed patient account payments, prepared and submitted claims forms to insurance companies and other third-party payers
- Performed insurance verification, pre-certification, and pre-authorization
- Entered procedure and diagnosis codes and requisite patient information into billing software to streamline invoicing and account management; added modifiers, verified diagnoses, and coded narrative diagnoses
- Responded to staff and client inquiries regarding CPT and diagnosis codes
- Project Manager for implementing new software system to practice.
- Developed and implemented new filing system for medical records to improve efficiency.
Education
Certificate -
Downey Adult School
Downey, CA06.2017
Diploma -
South Gate Senior High
South Gate, CA06.2008
Skills
- NextGen, EPIC, Kareo/Tebra, ModMed, Medisoft
- Microsoft Office Suite
- ICD-10, CPT, HCPCS
- Medical Terminology
- Eligibility Determination
- Medicare, Medicaid, PPO, HMO, EPO, and POS insurances
- Data Entry
- Coding error resolution
- Insurance claims analysis
- Medical billing code accuracy
- Good Telephone Etiquette
- Attention to Detail
- Written Communication
Certification
- CPC - Certified Professional Coder
Timeline
Medical Biller and Coder
Senior Doc
10.2022 - Current
Billing and Coding Supervisor
Citrus Valley Gastroenterology
11.2017 - 10.2022
Certificate -
Downey Adult School
Diploma -
South Gate Senior High
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