Melanie Carroll
Orlando,FL
Summary
Dynamic Coding and Reimbursement Specialist with extensive experience at Central Florida Pulmonary Group. Expert in ICD-10 and CPT coding, adept at resolving claim disputes through strong payer relationships. Recognized for enhancing billing accuracy and educating colleagues on coding best practices, fostering a collaborative team environment.
Overview
4
4
years of professional experience
Work History
Coding and Reimbursement Specialist
Central Florida Pulmonary Group
Orlando, FL
03.2024 - Current
- Collaborated with physicians to develop an understanding of their documentation habits and provide education on proper coding techniques to support more accurate billing processes.
- Served as a resource for colleagues regarding complex coding situations, offering guidance based on extensive knowledge of industry best practices.
- Developed strong relationships with payers, ensuring smooth resolution of any disputes or appeals related to claim denials.
- Utilized advanced computer applications to track claim status, maintain patient records, and ensure effective communication among team members.
Authorization Specialist
Central Florida Pulmonary Group
Orlando, FL
06.2021 - 03.2024
- Optimized workflow processes through effective communication between departments regarding authorization needs and statuses.
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Contributed to team goals by consistently meeting or exceeding individual productivity targets for processing authorization requests.
- Reduced processing times by effectively managing a high volume of authorizations, referrals, and appeals.
- Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
- Ensured prompt resolution of denied claims through comprehensive analysis of denial reasons and timely submission of necessary documentation for reconsideration or appeal.
Education
Associate Of Science - Nursing
Valencia College
Orlando, FLNortheast High School
Philadelphia, PA06.2007
Skills
- ICD-10 proficiency
- Appeals handling
- Medical billing experience
- HIPAA compliance
- Procedural coding
- Insurance verification
- CPT coding
- Charge entry
- Clinical documentation
- Data entry
- Medical claims coding
- Medical terminology
- Medical billing
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Coding and Reimbursement Specialist
Central Florida Pulmonary Group
03.2024 - Current
Authorization Specialist
Central Florida Pulmonary Group
06.2021 - 03.2024
Associate Of Science - Nursing
Valencia College
Northeast High School