LAVERNE LUMPKIN

• Proficiency with Current Procedure Terminology (CPT-4), usage of evaluation and management, surgical procedure codes, and use of modifiers when appropriate
• Proficiency with ICD-10-CM, and HCPC II, effective use of coding to the highest level of specificity
• Adept in the use of ICD-10-CM, CMS, and local coverage determination guidelines usage
• Review medical records: office encounter notes, and post-operative notes to accurately code and capture all charges and soft audit for clean claim billing submission
• Electronic claim submission and manual claim processing to primary, secondary, and tertiary payers
• Processing claims for outpatient, inpatient, and ambulatory (POS:2,11,12,21,22, and 24)
• Ensuring current insurance information is active through verifying insurance benefits and eligibility and resolving incorrect information by correctly updating insurance profiles
• Investigate denied claims, rejected claims, and accounts receivable (A/R)
• Claim correction for resubmission and reconsideration of payments
• Responding to correspondence from insurance companies to resolve any concerns or discrepancies
• Research, and process all edits associated with claims and appeal process
• Communicate with providers when there are coding issues to ensure submission of clean claims to insurance company.

· Followed up on self-paid accounts by applying hospital charity discounted rates and submitting a statement to patients for payments.

· Updated accounts with accurate insurance information and verified eligibility for claims to be processed and submitted to insurance payer’s primary, secondary, and tertiary.

· Researched, and processed all edits, such as billing errors, denials, corrected claims, rejected claims, timely filing, and reprocessing claims for reconsideration for payments, and appeals.

· Resolved issues for accounts with discrepancies in underpayments.

· Managed inbound patients and insurance calls, posted credit card payments, and made payment arrangements for outstanding account balances, transfer payment adjustments, and balance write off.

• Responsible for the day-to-day operations of billing needs for the Medical and Clinical Department
• Prepared and processed claims for billing and reimbursement for Medicaid and Managed Care Medicaid
• Abstracted and assigned accurate diagnosis codes using current procedure terminology (CPT-4), ICD-10 CM, and HCPC II, and applied corrected modifiers when appropriate
• Prepared and processed invoices and claims for billing payment and reimbursement for Managed Care Medicaid
• Handled all adjudication according to Medicaid fee schedule for all incoming claims, using a soft audit to make sure coordination of care was coded correctly for physician’s office visits and behavioral health services
• Liaison for the agency’s participating providers, Medicaid, Medical, Clinical, and the Fiscal Department
• Set up account profiles, and payment arrangements for providers and collected W9’s for newly participating providers
• Created and implemented a system to streamline all claims to be processed for payments and tracked outgoing bills using Excel on a shared drive so that multiple people can track, edit, and ensure proper services were rendered
• Communication happened simultaneously
• Proficiency with Guidelines for Child Foster Care Agency, Mental Health Article 31 Clinic and Providers manuals-eMedNY
• Data entry of all clinical evaluations, treatments plan reviews, and psychiatric medications into EMR Evolve CS/Net Smart
• Processed electronic treatment authorization requests for a Government funded program- (eTAR) process claims entered in Point of Comfort Underwriter’s portal for approved services and to be processed and paid by Medicare
• Responsible for payroll for the Medical Department, performing time and attendance edits to ensure proper bi-weekly payments using Paycom
• Order and maintain office supplies and inventory.

• Review medical records to capture diagnoses and procedure codes related to Emergency Interest and Affiliation
• Department encounters
• Accurately assigned evaluation and management levels for emergency room encounters coding levels 99281-99285, critical care 99291-99292, and observation codes 99218-99220, 99224-99226, and or 99217 (POS: 23 and 22)
• Assigned diagnoses primary, secondary, and to the highest levels of specificity
• Coded procedure codes associated with charges for trigger point injections, iv hydration, moderate sedation, and services not bundled in critical care and proper usage of associated modifiers when appropriate.