Rosalyn C. Reid
Raleigh,NC
Summary
Professional technical expert in Medicare, Managed Care, Private and Third-Party reimbursement policies and contracts. Broad and comprehensive understanding of US health care system. Proficient Coding and Billing expert on EPIC software. Experienced professional focused on meeting or exceeding objectives seeking Coding Denial Specialist position. Offers advanced training and knowledge of industry best practices. Recognized for leadership, planning abilities and clear, direct communication style. Results-driven professional seeking position as Coding Denial Specialist. Focused on performance and flexible with specific needs of different assignments. Collaborates professionally with individuals from broad array of backgrounds and cultures.
Overview
11
11
years of professional experience
Work History
Medical Insurance Instructor
Gwinnett College
Raleigh, NC
05.2022 - Current
- Supervised and monitored students' use of tools, resources and equipment.
- Engaged students in academic and practical coding, computer and English curriculum as to elicit critical thinking, creativity, collaboration and communication.
- Provided detailed instruction and role modeling for acceptable social and work-related behaviors.
- Established goals for courses with organized outlines and detailed lessons.
HCS Medical Coding Supervisor
UNC Health Care
Chapel Hill, NC
06.2017 - 03.2022
- Liaised with physicians, chairs, executives, coding staff and other healthcare staff regarding and ensuring proper coding for a high volume specialized coding team responsible for coding the divisions of: neurosurgery, ENT, OB, Gyn, Family medicine, pathology, dermpathology, nephropathology, 7 urgent care centers, pediatrics, and E/M coding across all divisions.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic and CPT as well as HCPCS codes.
- Responsible for three escalated denial workques. Provided high level research and demonstrated ability to comprehend and identify payer trends and remediate payer issues and successfully resolve billing issues.
- Resolved daily denials in a manner that ensured accurate and optimal reimbursement through a thorough and comprehensive understanding of CPT4 and ICD-10 coding protocols as well as a proficient knowledge base of multiple payers: UHC, BCBS, Humana, Cigna, Medicaid, Medicare and Medicare Advantage policies.
- Researched CCI conflicts on Optum EncoderPro and can expertly navigate EPIC.
- Monitored and planned the daily workflow for a specialized coding staff's daily production, maintained PTO time and attendance records via system software.
- Assigned overtime as needed, implemented corrective action and hired and terminated employees via corrective actions track.
HCS Coding Supervisor
Duke Health
Durham, NC
05.2011 - 05.2017
- Responsible for the leadership as well as daily operations of the revenue cycle. Oversaw all aspects of coding operations including coding denials and patient escalated denial workques.
- Ensured adherence to all AMA coding guidelines and protocols. Supervised a team of ED coders, neurosurgery, ENT, GI and OB coders.
- Responsible for two escalated denial workques, one patient complaints workque in addition to five coding and Edit workques.
- Reviewed, analyzed and resolved high level complex coding denials by reviewing the medical record documentation to ensure services were properly abstracted and billed with the correct ICD-10, CPT4, and HCPCS codes for optimal reimbursement.
- Extrapolated data to trend and identify denial patterns to resolve billing denials. Resolved patient disputes as they pertained to denied charges and provided coding direction to all applicable departments.
- Composedwritten appeals and provided realtime solutions to defend billable charges and provide relevant articulate recommendations to providers, management and coders.
- Ensured revenue integrity by providing timely and accurate denial turnaround to achieve entitled reimbursement.
- Mentored coding staff and reported compliant coding training in collaboration with the audit team.
- Responsible for time and attendance, corrective actions, hiring and terminations.
Education
Bachelor of Arts - Journalism, Broadcast And Political Science
Indiana University Bloomington
Bloomington, INSkills
Certifications: CPC, CBCS
Timeline
Medical Insurance Instructor
Gwinnett College
05.2022 - Current
HCS Medical Coding Supervisor
UNC Health Care
06.2017 - 03.2022
HCS Coding Supervisor
Duke Health
05.2011 - 05.2017
Bachelor of Arts - Journalism, Broadcast And Political Science
Indiana University Bloomington
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