Melissa Guzman, RHIA, CCS, CPC, CPMA, CRC
Fort Lauderdale,US
Summary
Medical coding professional with extensive experience in accurately coding patient records and ensuring compliance with healthcare regulations. Known for strong focus on team collaboration and achieving results, adaptable to changing needs. Skilled in utilizing coding software and maintaining detailed documentation, with reputation for reliability and precision.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Medical Coder
Guidewell Sanitas, LLC
12.2022 - Current
- Analyzed medical records for accurate code assignment and compliance with regulations. Ensures progress notes are coded accurately and to the highest level of specificity following established coding guidelines. Collaborated with healthcare providers to ensure documentation supports coding accuracy. Query providers for clarification and to obtain accurate and complete documentation as needed. Participated in regular audits of coding practices to maintain high standards of quality and accuracy.
Medical Biller and Coder
Amicus Medical Center
04.2021 - 12.2022
- Charge entry and diagnosis validation. HEDIS reporting. Query providers for clarification and specificity of documentation in accordance with company policies. Process and apply patient payments, resolve patient billing inquires. Visit tracking and reconciliation reporting to ensure all visits are accounted for. A/R follow up on unpaid claims.
Coordinator, Revenue Billing and Coding
Broward Health Medical Center, PBO
04.2020 - 02.2021
- Ensures the accuracy of high-volume system generated claims and electronic submission for payment. Develop monthly clearinghouse claim related indicator reports for management and operations to review in effort to identify submission errors. Raise accounts receivable related issues with appropriate staff and work to resolve recurring concerns. Monitors managed care physician contracts to ensure claims pass the clearinghouse.
Medical Biller and Coder (Internal Medicine & Pediatrics)
Care Management Resources
07.2018 - 01.2020
- Review documentation ensuring proper vaccine, evaluation and management, EPSDT, and medical services are reported. Insurance and patient payment posting, mailing patient statements. Onboard new practice acquisitions onto company billing software, charge master maintenance. A/R follow up on unpaid claims.
Medical Biller and Coder
Sports Medicine Associates of S. Florida
06.2016 - 06.2018
- Office, surgical and physical therapy charge entry accurately prior to submission with special attention to detail (e.g., modifiers, ensure inpatient hospital dates in place, place of service identified) in accordance with NCCI edits and payer guidelines. Assisted A/R Department in relation to service bundling and denials utilizing documentation and coding resources in effort to compile appeals. Conducted monthly reconciliation of patient encounters to ensure all charges are accounted for.
Medical Biller and Coder
International Orthopaedic Specialists
09.2009 - 06.2016
- Charge entry, payer and patient payment posting. Appeal denied or bundled claims in accordance with NCCI edits and Musculoskeletal Coding Procedural Guidelines. Relayed information to utilization management and workman comp adjusters in effort to obtain authorizations for diagnostic testing (MRI's and CT). Liaison between adjusters, attorneys and physicians in scheduling IME's, depositions and court appearances. Trained new front office staff. Interfaced with front desk to collect patient balances.
Medical Front Office
Cardiovascular Specialists of South Florida
02.2005 - 09.2009
- Check in & check out criteria, insurance verification, chart preparation. Obtained authorizations from health plan utilization management for diagnostic procedures (nuclear thallium stress tests, cardiac catheterizations, echocardiograms). Answer multiple phones lines and acted as liaison between doctors, patients, hospital and staff. Assume advocate role on the patient's behalf with insurance carriers to ensure approval of necessary supplies/services.
Education
Bachelor of Science - Health Information Management
Western Governors University
Salt Lake City, UT11-2025
Associate of Arts - General Education Curriculum
Broward College-South Campus
Pembroke Pines, FL01.2018
Certified Medical Auditor -
AAPC Auditing Training Course
Salt Lake City, UT01.2022
Certified Risk Coding - undefined
Florida Healthcare Institute
Fort Lauderdale, FL01.2019
Certified Professional Coder - undefined
Unique Career Academy
Miami Lakes, FL01.2017
Skills
- Experienced in NCCI edits, knowledgeable in HCC & HEDIS coding
- Highly proficient in billing, collection, and denial resolution
- Various EMR software, applications and payer portals (AdvancedMD, Allscripts, Medisoft, NueMD, Kareo, NextGen, Waystar, Availity)
- Proficient in MicroSoft products Keyboard 50wmp
Certification
Registered Health Information Administrator & Certified Coding Specialist (AHIMA) Certified Professional Coder & Certified Risk Coder (AAPC)
ADDITIONAL INFORMATION
References Available Upon Request
Timeline
Medical Coder
Guidewell Sanitas, LLC
12.2022 - Current
Medical Biller and Coder
Amicus Medical Center
04.2021 - 12.2022
Coordinator, Revenue Billing and Coding
Broward Health Medical Center, PBO
04.2020 - 02.2021
Medical Biller and Coder (Internal Medicine & Pediatrics)
Care Management Resources
07.2018 - 01.2020
Medical Biller and Coder
Sports Medicine Associates of S. Florida
06.2016 - 06.2018
Medical Biller and Coder
International Orthopaedic Specialists
09.2009 - 06.2016
Medical Front Office
Cardiovascular Specialists of South Florida
02.2005 - 09.2009
Associate of Arts - General Education Curriculum
Broward College-South Campus
Certified Risk Coding - undefined
Florida Healthcare Institute
Certified Professional Coder - undefined
Unique Career Academy
Bachelor of Science - Health Information Management
Western Governors University
Certified Medical Auditor -
AAPC Auditing Training Course