Lisa Walsh, CPC

Effectively plan, coordinate and administer the complete spectrum of medical office operations, customer service, medical procedure processes, medical coding and billing and providing high efficient support to physician. Consistently meet or exceed expectations. Meet and greet patients, obtain proper referrals, enter patient demographics into EMR (Practice Fusion and Collaborate MD). Obtain and track Prior Authorizaions (PAs) for procedures and diagnostic studies. Kept up to date eligibility checks on patient's accounts. Continuous updating of physician websites and credentials such as CAQH and NPPES. Posted daily encounters efficiently and expeditiously. Ensured HIPAA compliancy whenever appropriate. Effectively organized physician documents and updated as necessary. Evaluated and ordered office/medical supplies as appropriate. Handled all incoming requests for patient medical records ad respond appropriately. Oversee day-to-day office operations including; receiving and organizing correspondence; answering phones and forwarding calls; create practice letters and records; maintain impeccable office organization to support efficiency; professionalism and performance objectives; handle scheduling and manage timely and effective allocation of resources and calendars.

Effectively planned, coordinated and administered all aspects of a medical office operations. Pre-Op'd patients for all orthopedic surgeries, emergent and elective, while ensuring proper OR scheduling and timing. Acted as a liaison between physician, hospital staff and patients to efficiently expedite the pre-surgical processes. Utilized computer expertise in Microsoft Office Suite and EMR software (EPIC). Supervised staff, conducted on-boarding of all new hires, arranged meetings and conferences, developed processes to maximize office resources and anticipate the needs of patients as they arose. Accurately coded surgical operative reports including case procedures and diagnoses for maximum reimbursement while staying within proper medical billing and coding practices and procedures. Cases to include Total Joint Arthroplasties, Arthroscopic procedures, ORIFs and MAKOplasty. Ensured consistent HIPAA compliance whenever applicable. Also exemplified the following:

• Excellent customer service skills
• Data management and organizational skills
• Experience delegating and supervising office tasks to staff
• Clerical training and experience
• Ability to communicate with people with various levels of medical knowledge in both written and verbal forms
• Diagnostic and problem-solving skills
• Computer software proficiency
• Emotional intelligence
• Medical Billing and Coding procedures and processes

Managed all coding/billing functions and customer service for a 9 surgeon Orthopedic practice. Acted as a liaison to the physicians and hospital departments, responded to inquires from providers on a broad scope of coverage issues pertaining to eligibility, coordination of benefits (COB), explanation of benefits (EOB) and payment schedules. Proficiently utilized skills in ICD-10, CPT and HCPCS coding to ensure accurate coding policies. Posted daily encounter charges and reconciled daily reports. Posted daily incoming payments by EOB, ERA and patient payments and copays into various medical software such as Aprima, Medical Manager, ADS, Practice Management Systems, Medcomp and AdvancedMD and reconciled receivable reports daily. Strong knowledge of out of network billing and collections as well as collections of patient payments. Carefully researched and reviewed individual/group claims and exercised a strong working knowledge of major medical plans and leading healthcare networks. Performed all levels of insurance verification, eligibility and prior authorization requests and follow up as needed.

Thorough ability to bill carriers such as Medicare (CMS), BCBS, Medicare Advantage, Commercial Insurances, Marketplace Insurances, Worker's Compensation and No-Fault claims. Ability to perform and review electronic billing and reconciling when appropriate. Performed coding of E&M visits, operative reports and diagnostic studies to ensure maximum reimbursement within proper billing and coding practices.

Analyzed denied claims and effectively and sent appeals in writing, online and through arbitrations. Thorough knowledge of all major health insurance websites and utilized daily for a variety of billing issues. Kept up to date on A/R reports for all insurances and managed the 30 to 120 day outstanding protocols.

Kept strict adherence to all HIPAA compliances and regulations. Attended various webinars pertaining to HIPAA and HIPAA compliance.

Performed high volume Orthopedic surgical scheduling and coding to schedule procedures, coordinated with facility/surgical reps, obtained authorizations and coordinated all clinical pre-operative tests, clearances and surgical orders with OR staff, physicians and patients.

Handled and organized all correspondence with medical malpractice. Coordinated information between attorneys, insurance carriers and physicians.

Performed all aspects of front desk duties such as signing patients in, discharging patients out, collecting copayments, posted daily charges and reconciled daily reports. Created charts for patients as well as filing and chart documentation.

Coded daily encounters as was necessary and reviewed for errors. Answered phones and routed calls to appropriate clinical staff as needed. Posted patient payments and reconciled daily.

Assisted clinical staff in rooming patients, running tests and getting vitals.