Summary
Overview
Work History
Education
Skills
Additional Information
Timeline
Marsharee Williams

Marsharee Williams

Tempe,AZ

Summary

Talented Team Leader experienced and dedicated to enhancing employee satisfaction and business success. Diplomatic and friendly with proven commitment to employee training. Hardworking team player bringing necessary experience and knowledge to tackle any operational demand. Adept at working effectively unsupervised, and quickly mastering new skills.

Overview

10
10
years of professional experience

Work History

AR Specialist II, Team Lead

Valley ENT, PC
06.2019 - 05.2023
  • Submitting Appeals
  • Submitting Claims Electronically
  • Payment Posting
  • Prior Authorizations
  • Reviewed medical records and identified diagnosis codes, procedures, services and supplies for coding.
  • Verified accuracy of patient information and insurance data in billing system.
  • Submitted claims to insurance companies electronically or by mail.
  • Resolved denied claims by researching payer requirements and preparing appeals.
  • Reconciled accounts receivable to ensure accuracy of payments received.
  • Maintained up-to-date knowledge of coding regulations and changes in reimbursement policies.
  • Performed daily audits on all bills submitted for accuracy and completeness.
  • Analyzed patient accounts for errors, inaccuracies or discrepancies in billing documentation.
  • Provided customer service support to patients regarding billing inquiries.
  • Processed corrections and adjustments as needed to ensure accurate payment from third party payers.
  • Interpreted physician orders, notes, lab results, radiology reports. for appropriate code assignment.
  • Developed an understanding of how various insurance plans process claims for reimbursement purposes.
  • Maintained current CPT, HCPCS codes library as well as ICD-9, 10 CM diagnostic codes.
  • Worked closely with physicians to obtain additional clinical information when needed for accurate coding assignments.
  • Ensured timely filing of all claims within established guidelines.
  • Responded promptly to requests from insurance companies regarding clarification on claim submissions.
  • Identified trends in denials and worked collaboratively with clinic staff to reduce denials.
  • Monitored aging accounts receivable report weekly to identify unpaid balances due.

Medical Biller and Coder

Phoenix Children's Hospital
08.2017 - 05.2019
  • Reviewed medical records and identified diagnosis codes, procedures, services and supplies for coding.
  • Verified accuracy of patient information and insurance data in billing system.
  • Submitted claims to insurance companies electronically or by mail.
  • Reviewed patient medical records for accuracy, completeness and compliance with coding regulations.
  • Coded diagnoses and procedures from patient medical records using ICD-10-CM and CPT-4 codes.
  • Verified accuracy of procedure codes to ensure proper reimbursement levels.
  • Collaborated with other departments such as billing, clinical documentation improvement, quality assurance to ensure accurate coding practices are being followed.
  • Ensured timely resolution of denials due to incorrect code assignments or missing information in the claim form.
  • Validated accuracy of diagnosis codes as well as modifiers used on claims before final submission to payer and insurance companies.
  • Participated in meetings with physicians, nurses, case managers and other healthcare professionals in order to discuss complex cases or clarify documentation requirements.
  • Created detailed reports highlighting areas of improvement or potential risk associated with certain types of claims.
  • Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.

Senior Medical Biller & Coder

Therapy Tree PLLC
10.2016 - 04.2019
  • Correctly coded and billed medical and behavioral health claims for facility
  • Generated reports to identify coding trends and discrepancies.
  • Communicated with insurance companies to research and resolved coding discrepancies.
  • Trained and mentored junior coders to support growth and development and apply high-quality coding practices.
  • Monitored changes in coding regulations to provide recommendations for compliance.
  • Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
  • Attained up-to-date knowledge of coding requirements through continuing education courses and certification renewal.
  • Interacted with physicians and other healthcare staff to ask questions regarding patient services.
  • Scanned and uploaded medical records into electronic medical records system.

Lead Reconciliation Specialist/ Medical Biller

MJHS
08.2013 - 09.2016
  • Process written requests for member dis-enrollment and/or reinstatement
  • Reviews member requests for re-enrollment or reinstatement
  • Follows up with member or his/her agent with regard to incomplete or unclear requests, and documents these conversations
  • Process Actions requested by Centers for Medicare and Medicaid Services and/or its agents
  • Works with supervisor, Centers for Medicare and Medicaid Services and its agents to investigate and resolve eligibility and health status data discrepancies, and communicate member requests
  • Special Needs Plans (SNP)
  • Verifies data accuracy prior to plan transmission of data to CMS
  • Runs monthly reports for members enrolled in special needs plans, D-SNP, QMB+, QMB only, SLMB +, SLMB only, QI, QDWI, FBDE
  • Corresponds with EMEDNY, ensuring that members are medicaid eligible each month
  • Medicare Second Payer/Coordination of Benefits
  • Able to apply MSP policies and guidelines
  • Evaluating and correcting online edits for services performed under Medicare Part B
  • Secondary Payer program
  • Premium Billing
  • Responsible for updating and billing client premium statements
  • Provide customer service with clients and carrier representatives
  • Ensures performance guarantees specific to client are met daily
  • Balances monthly billing statements for existing clients after changes are entered into billing system and make adjustments as necessary to statements.

Education

Bachelor's degree - Chemistry

City College, New York, NY
05.2012

High School Diploma -

Collegiate Institute For Math And Science, Bronx, NY
07.2008
  • Class of 2008 Valedictorian

Skills

  • Microsoft Office (10 years)
  • Medical Office
  • Accounting
  • Hospital Billing
  • Insurance Billing
  • Provider Billing
  • Microsoft Excel
  • EMR Systems
  • Charting and Clinical Documentation
  • EMR Systems
  • ICD-9 Coding
  • ICD-10 Coding
  • Microsoft Excel
  • Quality control
  • Team-building
  • Employee Evaluation

Additional Information

  • Proficient in Medical Billing and Coding
  • Expert in Medical Terminology
  • Expertise in Applications such as GC Centricity, Evicore, EClinical Works, Advanced MD, NextGen EHR, Citrix, Avaya, Outlook, Groupwise, Pharmscreen, Managed Care Organization, Market Prominence, My Ability, RSA token, Methasoft, MediSoft, LG CNS, Crescendo, Kronos, Perceptive Content, Softheon, Zirmed, Therpay Partner, iTherapy.

Timeline

AR Specialist II, Team Lead - Valley ENT, PC
06.2019 - 05.2023
Medical Biller and Coder - Phoenix Children's Hospital
08.2017 - 05.2019
Senior Medical Biller & Coder - Therapy Tree PLLC
10.2016 - 04.2019
Lead Reconciliation Specialist/ Medical Biller - MJHS
08.2013 - 09.2016
City College - Bachelor's degree, Chemistry
Collegiate Institute For Math And Science - High School Diploma,

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Marsharee Williams