Martha Spires
Columbia,TN
Summary
Medical Billing and Coding Specialist with 20 plus years experience coding in-patient, out-patient and E&M in medical office setting. Advanced knowledge of orthopedic surgical procedures. Experience in workers compensation claims and hospital admitting.
Overview
30
30
years of professional experience
Work History
AAPC Medical Coder and Auditor
MTBJ/TOA
Columbia, TN
05.2003 - Current
- Research and resolve medical record discrepancies.
- Utilize electronic medical record systems to store, retrieve and process patient data.
- Interact with physicians and other healthcare staff to ask questions regarding patient services.
- Promote teamwork within the department through effective communication and collaboration on complex cases.
- Collaborate with physicians to obtain necessary documentation, improving claim approval rates.
- Ensure compliance with industry regulations and guidelines by staying up-to-date on the latest coding changes.
- Minimize errors by providing ongoing feedback to clinical staff regarding proper documentation practices.
- Streamline the billing process for faster reimbursement by submitting accurate and timely insurance claims.
- Enhance team efficiency with training sessions on new coding updates and best practices.
- Follow up with medical staff regarding missing information in patient records.
- Verify signatures and check medical charts for accuracy and completion.
- Review patient charts to better understand health histories, diagnoses, and treatments as necessary for proper coding.
- Communicate effectively with staff by email and telephone.
- Review, analyze, and manage coding of diagnostic and treatment procedures contained in outpatient medical records.
- Apply official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Increase coding accuracy by diligently reviewing medical documentation and applying appropriate codes.
- Reduce claim denials by maintaining thorough knowledge of payer-specific requirements and guidelines.
- Monitor changes in coding regulations to provide recommendations for compliance.
- Maintain a high level of productivity while consistently meeting deadlines for claim submissions.
- Train and mentor junior coders to support growth and development and apply high-quality coding practices.
In-Patient Certified Coder
MRMC
Columbia, TN
09.2008 - 06.2011
- Improved accuracy in medical coding by conducting thorough reviews of patient records and ensuring compliance with coding guidelines.
- Streamlined coding processes by utilizing specialized software to increase efficiency and reduce errors.
- Participated in continuing education courses, staying up-to-date on the latest industry changes and coding guidelines.
- Maintained strict adherence to HIPAA regulations, safeguarding patient information during all aspects of the coding process.
- Consulted with physicians on documentation that was incomplete, inaccurate or required further diagnosis specification.
- Reviewed in-patient, observation, emergency room, radiology medical documents and surgical operative reports of diagnosis and procedures and assigned ICD-10, CPT, and HCPCS according to coding guidelines.
- Input data into computer programs and filing systems.
Hospital Admitting Representative (Part Time)
MRMC
Columbia, TN
04.2003 - 09.2008
- Streamlined patient admissions by accurately collecting and verifying insurance information.
- Enhanced patient satisfaction with thorough explanation of admission procedures and answering questions promptly.
- Maintained up-to-date knowledge on insurance policies, ensuring accurate billing for patients and the healthcare facility.
- Reduced wait times for patients by efficiently managing bed assignments in coordination with nursing staff.
- Ensured compliance with HIPAA regulations, safeguarding the privacy of sensitive patient information.
- Provided excellent customer service to patients and their families during the registration process.
- Contributed to a positive work environment by providing support to fellow admitting representatives as needed.
- Managed challenging situations involving upset or anxious patients with empathy and professionalism, ensuring their concerns were addressed appropriately.
- Effectively used hospital software systems to enter patient demographic information, verify insurance coverage, and schedule appointments when necessary.
- Participated in departmental meetings to stay informed on updates related to hospital procedures or policies affecting the admitting process.
- Registered patients for labs, surgeries and radiology.
- Reviewed hospital schedule and confirmed arrival times.
- Verified patient insurance eligibility and entered patient information into system.
Workers' Compensation Coordinator
MTBJ
Columbia, TN
09.1993 - 05.2003
- Scheduled workers' compensation appointments
- Verified workers' compensation authorizations
- Coordinated meetings with physicians, case managers and employers
- Scheduled plant tours for physicians and myself
- Mailed workers' compensation claims to insurance companies
- Prepared C-30A workers' compensation stating impairment rating and final report for each workers' compensation patient
- Responsible for workers compensation calls from patients, case managers, employers and insurance
Education
Certificate - Certified Medical Auditor
AAPC
01.2018
Certificate - Certified Medical Coder
AAPC
Nashville, TN02.2007
High School Diploma -
Loretto High School
Loretto, TN05.1981
Skills
- Medical Coding and medical Auditing
- Patient Data Compilation
- Proficiency in Nextgen and Cerner
- Ensure correct documentation of medical records
- Data Entry
- Medical Claims Coding
- Coding Error Resolution
- Inpatient Records Coding
- Data Verification
- Insurance Coding (ICD-10 CPT and HCPS)
- Certification maintenance
- Diagnostic coding
- Training and mentoring
Timeline
In-Patient Certified Coder
MRMC
09.2008 - 06.2011
AAPC Medical Coder and Auditor
MTBJ/TOA
05.2003 - Current
Hospital Admitting Representative (Part Time)
MRMC
04.2003 - 09.2008
Workers' Compensation Coordinator
MTBJ
09.1993 - 05.2003
Certificate - Certified Medical Auditor
AAPC
Certificate - Certified Medical Coder
AAPC
High School Diploma -
Loretto High School