Samantha Mbuuri
Lewisville,Texas
Summary
Highly skilled healthcare professional with strong expertise in medical billing and coding. Adept at accurately processing patient data and insurance claims while ensuring compliance with regulations. Strong focus on team collaboration and achieving results, adaptable to changing needs. Proficient in medical terminology, coding systems, and electronic health records, with reliable and efficient work ethic .Willing to relocate anywhere
Overview
13
13
years of professional experience
1
1
Certification
Work History
Medical Biller
Ut Southwestern Medical Center
04.2025 - Current
- Resolve billing and coding issues: Analyze, investigate, and correct coding errors for various medical services, including Current Procedural Terminology (CPT) codes, diagnoses, modifiers, and bundling.
- Process claims and charges: Use electronic systems like Epic to investigate and resolve claim edits.
- Review progress notes and procedure results to confirm or change CPT codes, diagnosis codes, and modifiers.
- Analyze and resolve complex coding issues, including CPT, diagnosis, modifier, bundling, and duplicate charge errors and custom edit resolution
- Ensure services are well-documented and meet all internal and carrier billing requirements.
- Review patient diagnosis codes to verify accuracy and completeness.
Medical A/R Specialist/Anesthesia coder
OrthoMed Anesthesia
11.2022 - 03.2025
- Telephone insurance carrier/patient to seek resolution on account
- Resolve inappropriate payments with insurance carriers that are not in compliance with payer contracts or governmental agency rates on individual accounts.
- Coordinate duplicate billings, coordination of benefits, medical records or clinical documents as needed to expedite payment of insurance claims
- Identify trends in payer non-compliance and inform management if not able to resolve with payer
- Ensure secondary carrier is appropriately billed or self-pay portion is pursued
- Follows up with appropriate staff to locate missing information
- Maintain necessary logs for error checking.
- Answer telephone calls as needed
- Assist with the planning and organization of departmental activities as needed and participate in said activities
- Participate in departmental meetings as necessary.
- Making sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations
- Complying with medical coding guidelines and policies
- Receiving and reviewing patients’ charts and documents for verification and accuracy
- Following up and clarifying any information that is not clear to other staff members.
- Assigning appropriate CPT and ICD-10 codes to inpatient and outpatient hospital services.
- Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
Charge Entry and Edi Specialist
USAP
02.2020 - 10.2022
- Create charge batches from paperwork received for provider cases.
- Enter patient demographics. Run eligibility and insurance verification checks and make necessary corrections.
- Review CPT, ICD-9, ASA and HCPCS coding on charge tickets
- Review anesthesia records for supporting documentation for charge tickets.
- Enter charge data on each patient into the patient accounting system with high level of accuracy.
- The expected performance is to enter 145+ charge tickets per day by 90 days of employment
- Batch Error reports for errors/rejections and make necessary corrections.
- Assist the Collections Department with corrections and billing issues as needed.
- Used a special coding system to process invoices like Athena idx and the edit portal services
- Trained new team members on various aspects of EDI, fostering a culture of continuous learning and development within the organization.
- Streamlined EDI operations for increased efficiency with the consolidation of multiple systems.
Remote Medical Coder
TTL
09.2018 - 01.2020
- Used a special coding system to choose diagnosis and procedure codes:(NueMD, Availity etcetera)
- Entered the correct codes into patients’ Electronic Health Records
- Reviewed claims to make sure coding is accurate
- Work with my boss to ensure accuracy
- Enter insurance claims into specialized billing programs: the data entry must be very accurate and efficient.
- Follow up with insurers about any late payments: I use the Availity program and call the insurance companies
- Track payments to make sure reimbursements are received on me
- Keep in tune with changes and advancements in the field
- Review accounts for possible assignments and makes recommendations to the Billing Supervisor.
- Perform daily backups on office computer system
- Perform various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers.
- Processes payments from insurance companies and post them
- Increased coding accuracy by diligently reviewing medical documentation and applying appropriate codes.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
Medical Biller and Coder
EBULLIENT MEDICAL SOLUTIONS
09.2015 - 08.2018
- Prepare and submit clean claims to various insurance companies either electronically or by paper.
- Answer questions from patients, clerical staff and insurance companies.
- Identify and resolve patient billing complaints, for example if the patient was overbilled for a specific service.
- Prepare, review and send patient statements
- Review accounts for possible assignments and makes recommendations to the Billing Supervisor.
- Perform daily backups on office computer system
- Perform various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers.
- Processes payments from insurance companies and post them.
- Prepare charge master for lab hospital billing.
- Perform quality control on the processed claims to ensure that they are sent out as clean claims
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Reduced claim denials through meticulous verification of patient eligibility and coverage benefits prior to claim submission.
Cashier/Customer Service
HEB
05.2014 - 09.2015
- Greeted customers entering store and responded promptly to customer needs.
- Receive payment by cash, check, credit cards, vouchers and automatic debits.
- Issue receipts, refunds, credits and change due to customers
- Assist customers by providing information and resolving their complaints
- Answer customer's questions and provide information on procedures or policies
- Sell tickets and other items to customers
- Process merchandise returns and exchanges.
- Handled multiple payment methods securely, minimizing discrepancies and potential losses.
Administrative Assistant
Mount Kenya University
03.2013 - 01.2014
- Answer phone calls and direct calls to appropriate pares and take messages
- Open, sort and distribute incoming correspondence including faxes and email
- Conduct research, compile data, prepare papers for consideration and presentation by executives, commissioners and boards of directors
- Attend meetings to record minutes
- Greet visitors and determine whether they should be given access to specific individual
- Maintained confidentiality of sensitive information by adhering to strict privacy policies and implementing secure filing systems.
Education
Master's degree - Health Administration
South University Savannah Online
Savannah, GA12.2017
diploma - Medical Billing & Coding
Fortis College
Houston, TX07.2015
Bachelor’s degree - Business Administration
Kenya Methodist University
Nairobi Kenya07.2013
Skills
- Client support
- Proficient in computer applications
- Effective communication
- Analytical thinker
- Multilingual proficiency: English, Swahili, Kikuyu
- Skilled in utilizing Athenahealth tools
- CPT coding expertise
- ICD-9 and ICD-10 proficiency
- EDI clearing house expertise
- Knowledge of clinical terminology
- Health information organization
- Electronic claims processing
Certification
- AAPC- CPC CODER
- July 2023- current
Languages
English
Native or Bilingual
Swahili
Native or Bilingual
kikuyu
Native or Bilingual
Timeline
Medical Biller
Ut Southwestern Medical Center
04.2025 - Current
Medical A/R Specialist/Anesthesia coder
OrthoMed Anesthesia
11.2022 - 03.2025
Charge Entry and Edi Specialist
USAP
02.2020 - 10.2022
Remote Medical Coder
TTL
09.2018 - 01.2020
Medical Biller and Coder
EBULLIENT MEDICAL SOLUTIONS
09.2015 - 08.2018
Cashier/Customer Service
HEB
05.2014 - 09.2015
Administrative Assistant
Mount Kenya University
03.2013 - 01.2014
Master's degree - Health Administration
South University Savannah Online
diploma - Medical Billing & Coding
Fortis College
Bachelor’s degree - Business Administration
Kenya Methodist University
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