Melissa Anderson
Mechanicsville,MD
Summary
Healthcare professional with 11 years of experience in the medical field and 7 years as a business owner. Expertise in medical coding standards including ICD-10, CPT, and HCPCS, ensuring accurate code assignments for optimal reimbursement. Established an Insurance Authorization Department, enhancing patient care and increasing revenue. Proven ability to train team members on coding methodologies, significantly improving operational efficiency.
Overview
23
23
years of professional experience
Work History
CPC
Healing Partners
Sparks, MD
04.2024 - Current
- Review claims to ensure for accuracy and sequence of CPT, ICD-10, procedure codes, and modifiers when appropriate.
- Follow up with the provider on any documentation that is insufficient or unclear.
- Search for information in cases where coding is complex or unusual.
- Audit samples of patient charts for accuracy.
- Review coding-related rejected claims from the clearinghouse.
- Assists in identifying areas for improvement, recommending solutions to management, and developing policies and procedures.
- Follow up on denied claims and/or retractions related to coding.
- Maintained up-to-date knowledge of coding guidelines and regulations.
- Communicated with billing department to address coding-related inquiries effectively.
- Collaborated with other departments such as billing, clinical documentation improvement, quality assurance to ensure accurate coding practices are being followed.
- Conducted insurance verification of commerical and government policies.
Owner
Rustic Beginnings Boutique LLC
Mechanicsville, MD
06.2016 - 03.2024
- Manage budgeting, customer relations, order production, shipping and business relationships with local brick and mortar stores that carry my products.
- Drove sales growth by developing innovative marketing strategies tailored to our unique audience.
- Pioneered market research to identify and introduce cutting-edge designs, setting industry trends.
- Enhanced customer satisfaction by meticulously managing order production and timely shipping.
- Curated unique product selections for diverse customer preferences.
- Developed marketing strategies to enhance store visibility and attract customers.
- Managed inventory levels to ensure product availability and minimize waste.
- Fostered relationships with local artisans to source exclusive merchandise.
Insurance Authorization Coordinator
Greater Metropolitan Orthopedics
Clinton, MD
09.2009 - 02.2011
- Developed the Insurance Authorization Department, significantly enhancing patient services and care timeliness.
- Analyzed and extracted key data from medical records for successful authorization submissions.
- Pioneered Insurance Authorization Dept, boosting revenue by $60,000 through backdated claims.
- Enhanced patient service by expediting the Authorization process, ensuring timely care.
- Led meticulous review of medical records to secure necessary Insurance and Workers Comp Authorizations.
- Collaborated with Physicians to align medical documentation with insurance standards for Authorizations.
Central Sterile Coordinator
Calvert Memorial Hospital
Prince Frederick, MD
05.2008 - 09.2009
- Streamlined inventory process, maintaining fully stocked medical supplies, enhancing department readiness.
- Fostered strong vendor relationships for swift loaner equipment delivery, ensuring no delay in procedures.
- Mastered knowledge of surgical instruments and procedures through procedure observation, optimizing procedural efficiency.
- Optimized equipment turnover, ensuring all surgical cases proceeded without delays.
- Enhanced team coordination between Central Sterile and Operating Room staff, ensuring seamless surgical procedures.
Medical Assistant
Dunkirk Family Practice
Dunkirk, MD
02.2007 - 05.2008
- Advanced knowledge of medical terminology and office management.
- Efficiently documented patient histories, enhancing diagnosis accuracy at Dunkirk Family Practice.
- Streamlined exam processes by assisting physicians, improving patient throughput.
- Fostered clear communication between patients and physicians, ensuring comprehensive care.
- Maintained inventory, ensuring availability of vaccines and medical equipment.
- Collect and run needed cultures for efficient diagnosis.
- Optimized clinic workflow, reducing wait times and enhancing patient satisfaction.
Central Sterile Technician
Southern Maryland Hospital
Clinton, MD
01.2006 - 02.2007
- Ensured Operating Room readiness by meticulously sterilizing, assembling and distributing surgical tools, reducing infection risks.
- Streamlined equipment turnover for surgeries, significantly boosting Operating Room efficiency at Southern Maryland Hospital.
- Provided critical support in the Operating Room by managing surgical equipment, ensuring patient and staff safety by strategic cleaning.
- Analyzed and optimized sterilization processes, achieving higher standards of surgical equipment cleanliness.
Front/Back Desk
CHZ Urology
Clinton, MD
09.2004 - 01.2006
- Collect and post Co-payments.
- Obtain medical and radiological records/reports for physicians and insurance needs.
- Streamlined patient intake process, enhancing efficiency and patient satisfaction at CHZ Urology.
- Insured seamless surgery scheduling, ensuring timely care.
- Reviewed materials on post-op care with patients, reducing follow-up visits and complications.
- Actively participated in team meetings to share insights, improving overall service delivery.
- Managed insurance verifications and authorizations, ensuring accurate billing and patient information.
Medical Biller
All American Ambulance
Lothian, MD
08.2003 - 09.2004
- Verify Medical Insurance plans.
- Streamlined billing process, ensuring accurate ICD-9/CPT coding, improving claims accuracy.
- Expedited denial resolutions by collaborating with team leads, enhancing billing efficiency.
- Conducted thorough reviews of medical records and transport reports for precise billing.
EMT-B
All American Ambulance
Lothian, MD
07.2002 - 08.2003
- Obtain and review all medical records required for the transfer of patient care.
- Ensured timely patient transfers, improving response efficiency by streamlining communication.
- Managed meticulous documentation for patient care transfer, ensuring accuracy for billing.
- Provided critical support in high-stress situations, maintaining patient care standards.
- Passionately collaborated with medical staff to secure patient well-being during transfers.
Education
CPC - Medical
SMC Academy, LLC
07.2023
CPMA -
AAPC
Skills
- Electronic Medical Records
- E/M review
- ICD-10-CM
- CPT
- HCPCS II
- Modifier 25,59,51
- Billing procedures
- Claims auditing
- Insurance verification
- Medical Terminology
- Decision-making
- Team collaboration
- Effective communication
Personal Information
Title: CPC
Timeline
CPC
Healing Partners
04.2024 - Current
Owner
Rustic Beginnings Boutique LLC
06.2016 - 03.2024
Insurance Authorization Coordinator
Greater Metropolitan Orthopedics
09.2009 - 02.2011
Central Sterile Coordinator
Calvert Memorial Hospital
05.2008 - 09.2009
Medical Assistant
Dunkirk Family Practice
02.2007 - 05.2008
Central Sterile Technician
Southern Maryland Hospital
01.2006 - 02.2007
Front/Back Desk
CHZ Urology
09.2004 - 01.2006
Medical Biller
All American Ambulance
08.2003 - 09.2004
EMT-B
All American Ambulance
07.2002 - 08.2003
CPC - Medical
SMC Academy, LLC
CPMA -
AAPC