Rebecca Stephens
Daytona Beach,FL
Summary
Quality focused Certified Medical Coder and Billing Specialist offering 26 -year background in reviewing, analyzing and managing medical record information to identify appropriate ICD10, CPT4, and HCPCS codes for multiple specialties. Extensive knowledge of CMS and AMA CPT current coding guidelines and reporting requirements. Expertise in accurately inputting procedure and diagnosis codes into multiple Medical Billing Software Systems. Competent in handling a wide variety of medical coding and billing tasks, including, claim rejections, appeals, document oversight and resolving coding claim edits and errors.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Certified Medical Coder and Denials Specialist
Coding And Charge Master Specialists, LLC
Franklin , TN
11.2022 - 09.2023
- Assigned appropriate diagnosis, procedure, modifier and other codes, such as quality codes, based on clinical documentation, utilizing correct coding conventions and established policies and procedures for assigned specialty, in addition to multiple specialties for inpatient and outpatient hospitals and nursing facilities
- Conducted quality assurance review of codes assigned by Computer Assisted Coding, CAC
- Resolved coding edits, claims errors and denials
- Utilized Epic software and 3M encoder
- Verified medical charts for accuracy and completion
Medical Coder Contract
Elliott Health Information Pros., Inc.
Raleigh , NC
08.2022 - 10.2022
- Correctly coded and billed medical claims for Emergency Department
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in Pro-fee outpatient medical records
- Resourcefully used Epic software and 3M encoder
- Verified signatures and checked medical charts for accuracy and completion
Certified Professional Coder
Borland Groover-Clinic
Jacksonville , FL
10.2021 - 09.2022
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures
- Selected appropriate coding sequences by RVUs
- Applied charges and updated patient records in NextGen
- Reviewed Pathology reports ensuring most accurate diagnosis is coded appropriately
- Abstracted charts to assign appropriate codes for anesthesia services in endo, general surgery, and wide variety of ASC and hospital cases
- Ensured all cases are accurately coded and/or accounted for on each date of service
- Maintained files and properly followed processes for task completion
- Followed up on monthly reconciliation, as required
- Created daily physician schedules utilizing multiple hospital schedules
- Accessed multiple hospital software programs to retrieve medical records, outpatient and pathology reports
- Identified problems with documentation and effectively communicated all issues with multiple offices to resolve errors
Senior Resolution Recovery Analyst SIU Contract
United Health Group, Optum
Palm Coast , FL
03.2021 - 06.2021
- Performed pre-payment coding review of claims (employer and individual, Medicare and retirement, community & state) in all 50 states and made determination on case/payment disposition for possible fraud
- Investigated, recovered, and resolved all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
- Ensured adherence to federal and state compliance policies, reimbursement policies, and contract compliance; and used pertinent data and facts to identify and solve wide range of problems, including coding and claims discrepancies
- Guarded against fraud and abuse by verifying all coded data accurately reflected services provided
Certified Medical Coder
Independent Contractor
Palm Coast , FL
07.2015 - 02.2021
- E/M level coding, Urgent Care, Pro-fee, Outpatient Facility, Primary Care Family Practice, Behavioral Health, Gastroenterology, Anesthesia, Allergy and Immunology, General Surgery, OBGYN, Plastic Surgery, Ophthalmology, Pain Management, Pathology, Orthopedics, Podiatry, Reproductive Medicine, Endocrinology, DME
- Maintains coding and abstracting of records in 48 hour time period above 95% accuracy
- Investigates, reviews, and provides clinical and/or coding expertise in application of medical and reimbursement policies within claim adjudication process through file review. This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
- Reviews post-service claims, which requires interpretation of state and federal mandates, applicable benefit language, medical reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
- Performs coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
- Applies NCCI edits guidelines for bundling of codes applying reporting requirements of modifiers, CPT vs. HCPCS II, Evaluation and Management code assignment
- Communicates effectively with physicians office and clients to assure proper coding and reimbursement concerning medical record documentation for clarification of conflicting information
- Identifies opportunities for improvement in documentation and coding for levels of care or procedures billed
- Reviews and corrects coding errors, edits, rejections, and/or disputes
Assistant Account Manager
Quest National Services LLC
Orlando , FL
01.2020 - 03.2020
- Evaluated accuracy of provider charges, including dates of service, level of care, and locations
- Analyzed and interpreted medical records, verify and confirm diagnosis codes, procedure codes, HCPCS codes, and modifiers for multiple specialty medical practices and facilities nationwide
- Established new charges in accordance with hospital charging protocols
- Entered correct CPT, ICD-10, and HCPS charges utilizing Multiple Medical Billing Software Systems
- Anticipated clients' needs by staying in touch on regular basis
- Conducted regular audits and provides education to management on billing and charging processes
- Ensured consistent and accurate claims processing and data collection and documents all processes and procedures regarding revenue cycle
Lead Medical Coding and Billing Specialist
Southpoint Surgery Center LLC
Jacksonville , FL
04.2008 - 06.2015
- Developed and implemented billing policy and procedure manual to improve billing and coding practices
- Accurately assigned and entered procedure codes, diagnosis codes, and patient information into billing software
- Consulted with physicians to obtain missing or unclear clinical information
- Maintained daily workflow of coding and billing productivity and quality standards in timely manner to facilitate effective and efficient data submission
- Resolved error codes and rejections associated with claims
- Maintained charge master file to aid in fewer claim denials, compliance, data reporting and accurate reimbursement
- Analyzed charge capture to resolve billing issues and capture lost revenue
- Monitored Medicare and other reimbursement bulletins and manuals, including reviews of various coding publications to stay current on requirements of government and third party payers
- Prepared routine management reports and quality reports
- Performed ongoing reviews of various coding publications to stay current on requirements of government and third party payers
- Communicated concerns regarding compliance, coding, or source documentation to compliance officer
- Provided administrative support for multiple physicians and providers and served as resource for proper usage of codes and modifiers, optimizing reimbursement for services rendered
Outpatient Coding Specialist Temporary Contractor
Brandon Ambulatory Surgery Center LLC
Brandon , FL
09.2011 - 02.2012
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy
- Performed coding audits, charge entry, charge approvals, and/or quality charge reviews; including but not limited to, appending modifiers, and checking clinical documentation
- Identified and resolved payment issues between patients, insurance companies and providers
Patient Access Specialist
St. Vincent's Medical Center
Jacksonville , FL
01.2006 - 01.2008
- Awarded "Star employee" recognition in Emergency Department
- Actively participated as member of Six Sigma Team to communicate with other internal resources in order to achieve desired results, resolve issues, and ensure optimal efficiency of service
- Reviewed outpatient records and interpreted documentation to identify all diagnoses and procedures
- Utilized clinical information and Medical Necessity Criteria to communicate plans of care to insurance case managers facility staff and healthcare partners
- Assigned appropriate outpatient hospital E/M level codes
Medical Office Manager
Dr. Kuthiala Allergy and Asthma
Jacksonville , Florida
06.2002 - 01.2006
- Managed daily billing and coding office operations
- Identified billing and coding errors and provided feedback to physician and staff improving billing practices
- Developed policies and procedures for effective practice management
- Optimized organizational systems for payment collections, AP/AR, deposits and recordkeeping
- Managed, developed and trained staff
Assistant Customer Service Manager
Praxair Inc
Jacksonville , FL
06.1998 - 06.2002
- Promoted from Managed Care Specialist to Assistant Customer Service Manager in 2000
- Awarded Employee of month in May 2000
- Reviewed outpatient records and interpreted documentation to identify all diagnoses and procedures
- Processed orders for Durable Medical Equipment from physicians, hospitals, and insurance companies
- Maintained all medical billing and accounts receivables for Managed care contracts, determined benefits and eligibility according to contract guidelines and fee schedules, and obtained authorizations and renewals
- Performed charge review to correct inaccuracies prior to billing
Skills
- Other Certifications include Medical Terminology, Anatomy and Physiology, ICD-9, ICD-10, CPT-4, Pharmacology, HCPS codes, and Rational Physician Coding for E/M Services certificate
- Expert knowledge and understanding of Coding guidelines, Medicare & Medicaid NCCI & MUE edits, CPT, HCPCS, ICD, LCD/NCD, UHDDS data sets, UB-04 Revenue Codes, NDC codes, device codes, coding related condition codes, HACs, HCCs, POAs, SOI/ROM, PSIs, PPS-RVU files, modifiers, billing regulations and guidelines for government and commercial payers
- Inpatient, including APR/DRGs
- Outpatient Diagnostic
- Physician office and clinic services
- Outpatient Hospital
- Same Day Surgery Facility Coding
- E&M and Pro-fee Coding
- Telehealth
- Radiology
- Interventional Radiology
- Emergency Department Coding
- Cardiac Catheterization
- Observation
- Clinic Services
- Gastroenterology
- Anesthesia
- Pathology
- Ophthalmology
- Hematology and Oncology
- Coding Error Resolution
- Screening and Assessment coding
- Claim Denial Reconciliations and Edits
- Strong background in multiple healthcare software's, including Epic
- Resourcefully uses various coding books, procedure manuals, and online encoders
- Physician education related to documentation improvement, and E&M coding guidance
- MS Office
Certification
Certified Professional Coder AAPC CPC
Certified Professional Medical Auditor AAPC In Progress CPMA
Timeline
Certified Medical Coder and Denials Specialist
Coding And Charge Master Specialists, LLC
11.2022 - 09.2023
Medical Coder Contract
Elliott Health Information Pros., Inc.
08.2022 - 10.2022
Certified Professional Coder
Borland Groover-Clinic
10.2021 - 09.2022
Senior Resolution Recovery Analyst SIU Contract
United Health Group, Optum
03.2021 - 06.2021
Assistant Account Manager
Quest National Services LLC
01.2020 - 03.2020
Certified Medical Coder
Independent Contractor
07.2015 - 02.2021
Outpatient Coding Specialist Temporary Contractor
Brandon Ambulatory Surgery Center LLC
09.2011 - 02.2012
Lead Medical Coding and Billing Specialist
Southpoint Surgery Center LLC
04.2008 - 06.2015
Patient Access Specialist
St. Vincent's Medical Center
01.2006 - 01.2008
Medical Office Manager
Dr. Kuthiala Allergy and Asthma
06.2002 - 01.2006
Assistant Customer Service Manager
Praxair Inc
06.1998 - 06.2002
Certified Professional Coder AAPC CPC
Certified Professional Medical Auditor AAPC In Progress CPMA
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