SANDRA CASEY
Monroeville,PA
Summary
Dedicated medical biller, coder and revenue management specialist with more than 25+ years of experience is seeking a full-time remote/hybrid position that offers professional challenges utilizing excellent time management, problem solving and interpersonal skills. Strong leader and problem-solver dedicated to streamlining operations to decrease costs while increasing revenue and promoting organizational efficiency. Uses independent decision-making skills and sound judgement to positively impact company success. Skilled in working under pressure with no problem adapting to new situations and challenges to best enhance the organizational demands. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet individual & team goals. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Offering strong attention to detail and keen ability to learn and adapt quickly in a professional environment. Brings an understanding of basic accounting principles and skills in data entry. Works well with a team as well as independently. Looks at work and life in a positive and happy manner. Willing to lend a hand or share knowledge with co-workers to enable and encourage others to develop stronger skill sets trading and receiving knowledge willingly. Strives to learn something new every day.
Overview
22
22
years of professional experience
Work History
Medicare Billing Coordinator
Apidel Technologies/CVS Caremark - Contingent Workforce
Monroeville, PA
08.2025 - Current
- Collaborate with cross-functional teams to enhance & ensure accurate and timely billing for all products and services provided.
- Identify, research, and resolve billing variances to maintain system accuracy and currency.
- Enter details into accounts accurately and efficiently.
- Maintain strict confidentiality when handling sensitive client information, adhering to HIPAA or other privacy guidelines as required in specific industries.
- Reduce billing errors through consistent review and reconciliation of account discrepancies.
- Research and resolve billing discrepancies to enable accurate billing.
- Work with multiple departments to check proper billing information.
- Utilize various software programs to process accurate Medicare B claims.
- Maintain detail records of transactions, ensuring compliance with company policies and procedures.
- Strives to meet CVS' 5-day RWQ billing goal.
- Personally aligns with CVS' Core Values in Action of "We Care. We innovate with purpose. We are accountable. & We prioritize safety and quality" as well as CVS' stated purpose "to simplify health care one person, one family and one community at a time."
- Stand behind CVS' ambition "to be America's most trusted health care company".
Co-Pay Card Coordinator
Apidel Technologies, Inc. - CVS Caremark, Monroeville, PA - Contingent Work Force
Chicago, IL
12.2023 - 09.2024
- Facilitated payments by the co-pay card companies by calling and speaking with representatives requesting status of the payment, requesting a reverse & rebill of a claim when warranted, or submitting the claim while the representative was on the phone getting updated payment information once the claim paid.
- Contacted foundation to request the amount available on the copay card and requesting that the copay card be refilled when available.
- Requested updated BIN & PCN numbers when needed to ensure claims were going to the most accurate area for payment.
- Updated the CBG status of a claim and rebilled claims for payments.
- Worked with PAP cards and Prudent the payer of last resort following the rule that with a Prudent claim the copay should be 30%.
- Followed CVS" rule that AIDS, CA & Hemophilia patient's claims are adjusted because they are utilizing "life sustaining" drugs.
- Submitted paper claims after calling and verifying the correct phone number that the claim and primary eob would be going to.
Medical Biller, Coder & Practice Management Spc.
M&B Medical Billing, Inc.
Indiana, PA
08.2004 - 07.2023
- Established positive and effective communication among staff and clients.
- Set, enforced, and optimized internal policies to maintain responsiveness to client demands.
- Developed and implemented strategies to maximize insurance reimbursements.
- Introduced new methods, practices and systems to reduce aged accounts including new billing software and EMR systems both in office and in client's office including staff training both on site and remotely.
- Notified clients of patient insurance verification and obtained prior authorizations when necessary.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Applied official coding conventions and rules from American Medical Association and CMS to assign diagnostic codes to procedures and illnesses.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Reviewed patient charts to better understand health histories.
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Communicated with insurance companies to research and resolved coding discrepancies.
- Utilized active listening, interpersonal and telephone etiquette skills when communicating with others
- Followed up with medical staff regarding missing information in patient records.
- Verified provider signatures and checked medical charts for accuracy and completion.
- Created and maintained up-to-date patient medical records to enable tracking history and preserve consistent information.
- Performed on-site coding audits to determine accuracy and compliance with coding guidelines.
- Monitored changes in coding regulations to provide recommendations for compliance.
- Generated specialized reports to identify coding trends and discrepancies.
- Communicated effectively with staff, patients and insurance companies by email and telephone.
- Utilized electronic medical recorded systems to store, retrieve and process patient data.
- Processed insurance company denials by auditing patient files, researching CMS LCD's, coding trends and discrepancies.
- Communicated effectively with staff, patients, and insurance companies by mail and telephone.
- Processed insurance denials developing documentation and communication for appeals for providers.
- Analyzed and reported on key performance metrics to clients.
- Negotiated contracts with vendors and suppliers to obtain best pricing and terms for clients.
- Responded consistently within 10 minutes of receiving client emails either by return mail or phone calls.
- Handled problematic insurance companies with slow pay or no pay claims.
- Educated clients of Correct Coding Initiative Edits.
- Successfully credentialed new physicians, nurse practitioners and physician extenders and was responsible for all updates or changes to files.
- Obtained and maintained physician UPINS and NPI's as well as new provider Medicare PTANs.
Education
Associate of Applied Science - Medical Assisting, Medical Billing & Coding
Rhetts Technical College
Centerville, OH05-1997
Skills
- Medical Billing & Coding
- Claims Follow-up
- Revenue Management
- Practice Management
- Records Organization and Management
- Corrective Actions
- Performance Metrics
- Process Development & Streamlining
- Customer Service Best Practices
- Financial Reporting
- Database Maintenance
- Audit support
- Deadline oriented
Timeline
Medicare Billing Coordinator
Apidel Technologies/CVS Caremark - Contingent Workforce
08.2025 - Current
Co-Pay Card Coordinator
Apidel Technologies, Inc. - CVS Caremark, Monroeville, PA - Contingent Work Force
12.2023 - 09.2024
Medical Biller, Coder & Practice Management Spc.
M&B Medical Billing, Inc.
08.2004 - 07.2023
Associate of Applied Science - Medical Assisting, Medical Billing & Coding
Rhetts Technical College