Paula Lightle
Tarpon Springs,FL
Summary
Consistently retrieve medical records on demand with top-notch quality and accuracy Accountable, detail oriented, and efficient Release of Information Specialist with 10+ years of experience in Health Information Management (HIM). Proficient in Electronic Health Records (EHR), patient files, medical billing, reporting, state and federal laws, and medical staff support. Committed to learning new computer processes, software, and systems with demonstrated attention to detail. Unwavering focus on customer support with excellent problem solving skills. Versatile professional serves as first point of contact for patients by verifying insurance, handling paperwork and preparing records. Patient-oriented and helpful candidate familiar with MS Office and EHR systems coupled with thorough knowledge of medical terminology. Committed to providing personalized service and quality patient care.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Referral Specialist
Children's Medical Center
08.2023 - Current
- Used Availity, UHC & Tricare websites to access insurance companies to get precertification and other benefits information on behalf of patients.
- Promoted clear communication between PCP and specialists through detailed documentation and f/u calls.
- Developed strong relationships with external healthcare facilities, fostering collaborative approach to patient care coordination.
- Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
- Ensured continuity of care by regularly updating patient records with recent or changes in medical history.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Entered data using Practicum to document referrals and results.
- Processed referral requests from patients, doctors and other health care professionals.
- Greeted visitors and initiated triage processes for clients to streamline patient flow.
Medical Billing/Apprentice Coder
Practice Forces
05.2019 - 02.2020
- Interacted with extremely high volume of patients
- Executed revenue cycle procedures, including charge auditing and daily use of A/R logs
- Accessed patient medical records and fulfilled requests through hospital portals
- Accepted and posted manual payments and apply refunds by conducting thorough investigation and research
- Resolved processing verification and medical claim issues
- Reviewed patient accounts using Advance MD and ECW10/11
- Accounted for 38% of team's collection revenue
- Completed billing audits 30% faster than anticipated and with 100% accuracy
- Gained recognition by management as company's top collector.
Registered Release of Information Specialist
Shriner's Hospital for Children
03.2018 - 05.2019
- Maintained database of patient records, organized and searched for patient files, provided reports to medical staff, and resolved file inconsistencies
- Served as daily contact for ROIs in both EHR and manual processes for reconsiderations, appeals, and denials
- Adhered to PHI and HIPAA state and federal regulations
- Reported turnaround time, calculated backlog figures, and executed timely filing requirements
- Retrieved medical records for 10+ hospital systems
- Completed record transaction requests with 100% accuracy
- Processed and fulfilled requests with 24% higher efficiency than other team members
- Requested by 4 nursing staff to pull database records due to proven track record of accuracy and speed
- Demonstrated expertise in HIM Access and PowerChart
- Managed daily procedures in Remote Record Distribution system.
Medical Records Compliance Coordinator
Alere Toxicology/Abbott Laboratories
03.2015 - 03.2018
- Audited medical records to identify ICD10 CM/PCS, CPT, and HCPCS coding inconsistencies
- Adhered to PHI and HIPAA regulatory policies
- Utilized medical terminology, computer applications, and laboratory database to submit daily reports and follow up on individual accounts
- Improved standard record request processing times 18%
- Prepared and presented reports to Compliance Officer detailing observations and results
- Collaborated with 6 customer service personnel
- Completed remote service requests within 1 business day without impact to daily performance expectations
- Hand selected by executive management for retention and promotion due to performance records.
Medical Records Clerk
Bayfront Medical Center
10.2013 - 12.2014
- Approved or denied procedures after determining if ICD9/10 coding supported medical necessity of tests
- Completed insurance verification using eCare NEXT systems.
- Ensured billing, patient record, and specimen transaction compliance with PHI and HIPAA regulations
- Achieved 100% accuracy with validation reviews of insurance coverage
- Executed outpatient registration and medical billing using Pulse.
- Confirmed patient coverage with Medicare/Medicaid and commercial insurance companies
- Conducted daily communication with 2 transcriptionists.
- Scanned medical records in digital format for easy retrieval and accessibility.
- Processed medical records requests from outside providers according to facility, state, and federal law.
Workers' Compensation Medical Bill Review Analyst
CorVel Corporation/Fortis
01.2010 - 01.2012
- Maintained highest accuracy and efficiency records out of 6 total analysts
- Ensured compliance with state mandates, company guidelines, and PPO rates
- Initiated action regarding authorizations, payments, denials, and eligibility to adhere with productivity standards.
Administrative Assistant
Wide Open West Cable Systems/Knology
01.2012 - 01.2013
- Tracked direct sales, payroll, and commission data using Excel
- Researched and analyzed direct sales to determine commission payouts in accordance with commission structure
- Provided superior customer service, including new account setup and follow up communication to address issues
- Served as subject matter expert on commissioning processes
- Completed sales payroll for company's largest division with 99.5% accuracy rating
- Conducted weekly A/P, expense report, and payroll activities for 100+ employees
- Assisted in companywide procedural changes to improve accuracy and efficiency.
Education
Associate of Science - Health Information Management
St. Petersburg College
St. Petersburg, FL06.2014
Skills
- PHI and HIPAA Compliance
- Written and Verbal Communication Skills
- Insurance Verification/Preauthorization
- Medical terminology knowledge
- EHR Software; Eclinical & Practicum
Certification
- Medical Terminology Certificate, American Academy of Professional Coders (AAPC), 2019
- Medical Coding Certificate, St. Petersburg College, 2014
- Certified Registered Health Information Technician (RHIT), American Health Information Management Association (AHIMA), 2014
State
FL
City
Tarpon Springs
Timeline
Referral Specialist
Children's Medical Center
08.2023 - Current
Medical Billing/Apprentice Coder
Practice Forces
05.2019 - 02.2020
Registered Release of Information Specialist
Shriner's Hospital for Children
03.2018 - 05.2019
Medical Records Compliance Coordinator
Alere Toxicology/Abbott Laboratories
03.2015 - 03.2018
Medical Records Clerk
Bayfront Medical Center
10.2013 - 12.2014
Administrative Assistant
Wide Open West Cable Systems/Knology
01.2012 - 01.2013
Workers' Compensation Medical Bill Review Analyst
CorVel Corporation/Fortis
01.2010 - 01.2012
Associate of Science - Health Information Management
St. Petersburg College
- Medical Terminology Certificate, American Academy of Professional Coders (AAPC), 2019
- Medical Coding Certificate, St. Petersburg College, 2014
- Certified Registered Health Information Technician (RHIT), American Health Information Management Association (AHIMA), 2014
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