Miko D. Brown
Buda
Summary
Motivated, high-performing professional offering proficiency in data entry combined with over twenty years experience in accounting practices and medical claim billing/coding, serving in large private practice conglomerates, in fast-paced trauma based hospitals, and outpatient physician clinics.
Multi-talented in smoothly handling office administration support tasks with exceptional customer service abilities and analytical thinking skills.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Claims Assistant
Sedgwick Claims Management
09.2021 - 04.2024
- Provide assistance to the adjusting staff with by working closely with each adjuster for successful claims handling; work closely with our insureds to help remain in compliance submitting appropriate forms timely.
- Responsible for verifying indemnity benefit amounts with employers, calculating any difference in rate, and processing any underpayment with interest, or recouping any overpayments and sending appropriate correspondence to the injured worker.
- Gather and organize file material for sending to outside parties for medical examinations, hearings, vendors, etc. as needed.
- Manage attorney fee payments to injured worker’s attorneys, including monitoring weekly amounts payable to the injured workers on both automatic payments in the system and assign all EDI filings regarding weekly amount changes.
- Assist with subrogation by maintaining up to date tasks for submitting updates to the third party; maintain claims subrogation tracking documents.
- Work with medical bill review vendor to respond to fee disputes and process payments if needed.
- Obtain required forms from employers and state agencies, aiding in completion of forms when needed.
Accounting/Healthcare Billing Specialist
Women's Health Texas
09.2019 - 03.2020
- Responsible for coding of expenses to proper Great Plains account and correct site, department and physician class.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Evaluated and settled complex insurance claims in strict timeframes.
- Retrieve and verify invoices and requisitions, data entry invoices, process reports for data entry.
- Maintain online portal for electronic copies of invoices.
- Reconcile benefits invoices to their proper general ledger accounts and departments and assist in Month End Close.
- Orchestrated day-to-day operations of billing department, including medical coding, payment posting, accounts receivables and collections.
- Utilized EPIC and Athena software to manage and confirm patient data, such as insurance, demographic and medical history information.
- Provide administrative support including medical billing processing and insurance audits.
Business Office Specialist
HCA-CWT ASD CBO
10.2018 - 09.2019
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Orchestrated medical coding, payment posting, accounts receivables and collections.
- Filed and updated patient information and medical records.
- Reviewed patient records, identified medical codes and created invoices for billing purposes.
- Prepared billing statements for patients and verified correct diagnostic coding.
- Adhered to established standards to safeguard patients' health information.
- Delivered timely and accurate charge submissions.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Trained new employees on multiple medical billing programs and data entry software.
- Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
- Applied proper GL codes to invoices, files and receipts to keep records organized and easily searchable.
- Initiates new vendor set-ups and performs ongoing maintenance of vendor accounts in SMART and HOST.
- Managed over 150 purchase orders and 35 vendor contracts weekly, processing 2553 forms daily.
- Processed daily bills, checks and vendor payments , maintaining detailed records and receipts.
Claims Liasion I
Centene, Superior Health Services
10.2017 - 07.2018
- Audit check run and send claims to the claims department for corrections. Identify any system changes and work notify the Plan CIA Manager to ensure its implementation.
- Document, track and resolve all plan provider's clams projects.
- Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication.
- Run claims reports regularly through provider information systems Research verbal and written providers' claims inquiries as needed.
- Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes.
- Collaborate with the claims department to price pended claims accurately.
Charge Capture Analyst/ED Coder
Seton Family Of Hospitals-University Physician Women/ED Dept
01.2005 - 03.2016
- Participates in special projects and audits to improve process related to revenue cycle, efficiency of charging, billing and collection efforts.
- Abstracts pertinent information from OB/GYN and urology records. Assigns over 85-130 charts daily by applying International Classification of Diseases, Clinical Modification (ICD-9&10), Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes.
- Utilizes clinical and coding knowledge to ensure accurate and compliant charge items and to recognize and resolve billing inconsistencies.
- Queries physicians when code assignments are not straightforward or documentation in record is inadequate, ambiguous, or unclear for coding purposes.
- Reconcile clinical notes, patient encounters form, health information for compliance with HIPPA rules and JCAHO standards.
- Provide coding and documentation advice to providers, clinical and professional staff or by participating in coding team's regular meetings.
- Prepare statistical and narrative reports, or graphic presentations of information, such as ED trauma registry data, (LWBS/AMA) reports for use by hospital staff, researchers, or other users.
Education
General Studies - Accounting And Business Management
Texas State University
San Marcos, TXGeneral Studies -
Austin Community College
Austin, TXSkills
- Complex Problem-Solving, Strong Communication Skills
- Hospital Inpatient and Outpatient Records
- ICD-10 (International Classification of Disease Systems)
- Charting, Clinical Documentation, and Claims Investigations
- Electronic Health Record Applications
- Patient Admission Documents Processing
- Medical Release of Information ROI
- Workers' Compensation Forms
- Coding Error Resolution
- CPT Code Modifiers,Diagnostic Codes
- Advanced Excel Spreadsheet Functions
- Data Tracking and Trending Knowledge
- Accounts Payable and Accounts Receivable
- Healthcare and Medical Terminology
- Proficiency with Encoder Pro, EPIC and Compass, Athena, Meditech, Peoplesoft, eClinicalWorks, A2K
- Insurance Carrier Applications and Eligibility Determinations
Certification
- CNP - Certified Notary Public- State of Texas- Notary ID # 13312776-6
Accomplishments
"Excellent in Action" awards for outstanding performance and lasting contribution from Seton Medical Center in 2011 and 2009, in Emergency Coding.
Timeline
Claims Assistant
Sedgwick Claims Management
09.2021 - 04.2024
Accounting/Healthcare Billing Specialist
Women's Health Texas
09.2019 - 03.2020
Business Office Specialist
HCA-CWT ASD CBO
10.2018 - 09.2019
Claims Liasion I
Centene, Superior Health Services
10.2017 - 07.2018
Charge Capture Analyst/ED Coder
Seton Family Of Hospitals-University Physician Women/ED Dept
01.2005 - 03.2016
General Studies - Accounting And Business Management
Texas State University
General Studies -
Austin Community College