Roxana Silva
El Paso,TX
Summary
Dynamic Medical Billing and Coder Specialist with proven expertise at UMC Hospital, enhancing coding accuracy and compliance through meticulous documentation review and effective communication. Skilled in CPC registration and software debugging, I excel in training teams and optimizing processes, ensuring timely claim submissions and improved cash flow while maintaining high standards of patient confidentiality.
Overview
7
7
years of professional experience
Work History
Medical Billing and Coder Specialists
UMC Hospital
04.2024 - Current
- Maintained high coding standards by adhering to industry best practices and staying current with emerging technologies.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Facilitated knowledge sharing within the team by conducting regular code reviews, training sessions, and workshops on relevant topics.
- Delivered consistent results under pressure by prioritizing tasks effectively during periods of high workload or tight deadlines.
- Expedited project completion timelines with strong time management skills and adherence to deadlines.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Verified signatures and checked medical charts for accuracy and completion.
- Monitored changes in coding regulations to provide recommendations for compliance.
- Performed on-site coding audits to determine accuracy and compliance with coding guidelines.
- Communicated with insurance companies to research and resolved coding discrepancies.
- Followed up with medical staff regarding missing information in patient records.
- Maintained accuracy, completeness, and security for medical records and health information.
- Utilized electronic medical record systems to store, retrieve and process patient data.
- Identified new methods to optimize medical records management.
Medical Coder
West Texas Pain Institute
08.2022 - 04.2024
- Increased coding accuracy by diligently reviewing medical documentation and applying appropriate codes.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Maintained a high level of productivity while consistently meeting deadlines for claim submissions.
- Collaborated with physicians to obtain necessary documentation, improving claim approval rates.
- Trained and mentored junior coders to support growth and development amd apply high-quality coding practices.
- Reduced turnaround time for appeals by preparing comprehensive supporting documentation for denied claims.
- Expedited claim resolution with insurance companies through clear communication and prompt follow-up actions.
- Prevented costly fines by ensuring adherence to HIPAA regulations when handling sensitive patient information.
Insurance Biller
EspriDental
05.2018 - 08.2021
- Boosted office productivity by creating user-friendly templates for common forms and reports in the billing department.
- Minimized claim errors by staying updated on insurance regulations, medical terminology, and procedural codes.
- Tailored communication strategies when interacting with diverse clientele, adapting language choices based on individual needs.
- Maintained excellent professional relationships with insurance company representatives, facilitating efficient claim processing and reimbursement.
- Improved cash flow by reducing days in accounts receivable through timely follow-up on outstanding balances.
- Enhanced client satisfaction by efficiently processing insurance claims and addressing billing inquiries.
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the billing process.
- Resolved complex billing issues by collaborating with internal departments and external agencies as needed.
- Maintained detailed records of all transactions and correspondences to support accurate account management.
- Negotiated payment arrangements for clients experiencing financial hardship, ensuring continued access to care.
- Reduced claim denials by diligently reviewing and verifying patient insurance coverage prior to submission.
- Responded to inquiries from callers seeking information.
- Processed and recorded new policies and claims.
- Verified client information by analyzing existing evidence on file.
- Generated, posted and attached information to claim files.
- Posted payments to accounts and maintained records.
- Maintained confidentiality of patient finances, records, and health statuses.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Communicated effectively with staff members of operations, finance and clinical departments.
Education
GED -
College of Bachilleres
Ciudad Juarez CCS -
National Health Association
El Paso Texas Skills
- Software debugging
- Front-end development
- CPC registration
- Mobile app development
Languages
Spanish
Native or Bilingual
English
Professional Working
Timeline
Medical Billing and Coder Specialists
UMC Hospital
04.2024 - Current
Medical Coder
West Texas Pain Institute
08.2022 - 04.2024
Insurance Biller
EspriDental
05.2018 - 08.2021
GED -
College of Bachilleres
CCS -
National Health Association