Sarra Wade
Summary
Efficient and accurate medical coder and biller with full awareness of the ICD 10 HCPCS and CPT coding systems. Vast knowledge of medical terminology, anatomy and physiology procedures within a physician billing revenue cycle and hospital health care setting. I have over 20 years of experience in a fast paced environment dealing with different insurance companies, denials and appeals. Processed over a hundred claims per day, with revenue exceeding over 1 million dollars per month. I consistently met and exceeded my designated monthly goals. Sound knowledge and in-depth understanding of patient information management. Draft invoices, resolve billing disputes, and maintain accurate clinical records. Team player with outstanding organizational skills.
Overview
18
18
years of professional experience
Work History
Medical Coder
SSM Healthcare
St Louis, Missouri
12.2023 - Current
- Primarily focuses on coding of moderate complexity such as outpatient or inpatient evaluation and management and minor procedures.
- Manages assigned charge review and coding-related claim edit work queues to ensure timely and accurate charge capture.Accurately deciphers charge error reasons and plans follow-up steps.
- Reviews medical record documentation in the electronic health record.Identifies, enters and posts CPT-4 and ICD 10 codes to the electronic health record.Ensures all coded services meet appropriate Medicare National Correct Coding Initiative (NCCI) or payer-specific guidelines.
- Consults with physicians/providers as needed to clarify any documentation in the record that is inadequate, ambiguous, or unclear for coding purposes.Provides education around documentation improvement for maximum patient care.
- Reviews manage and resolves charge sessions that fail charge review edits, claim edits and follow up denials.
Medical Coder
United Healthcare Optum (SSMHC)
02.2023 - 12.2023
- Communicated with healthcare personnel, including practitioners to promote accuracy.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Reviewed patient medical records for accuracy, completeness and compliance with coding regulations.
- Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
- Maintained confidentiality of patient information according to HIPAA regulations.
- Maintained high accuracy rate on daily production of completed reviews.
- Verified accuracy of procedure codes to ensure proper reimbursement levels.
- Coded diagnoses and procedures from patient medical records using ICD-10-CM and CPT-4 codes.
- Managed coding for multiple specialties, ensuring specific codes are accurately applied.
- Maintained updated knowledge of coding requirements, which included continuing education and certification renewal.
Claims Analyst/Medical Coder
Praesum Healthcare
Lake Worth, FL
09.2021 - 10.2023
- Reviewed and auditedpatient medical records and assign codes to diagnoses and procedures performed by service providers.
- Prepared all billing forms to send to 3rd party biller for timely insurance claim submission.
- Ensured accuracy encompassing billing coding and insurance requirements
- Organized and manage patient’s health information data
- Prepared daily charges and claims to be submitted electronically to clearing house and insurance carriers.
- Claim denial management with electronic clearinghouse.
- Utilizes CPT,HCPCS, and ICD-10 codes for appropriate billing to insurance carriers.
- Posses the ability to critically analyze documentation assigning proper codes.
- Appeal coordinator, appealed cases on a daily for substance abuse.Nineteen locations for Detox and Counseling Centers-All levels of appeals
Medical Coder/Billing Specialist
NATIONWIDE LABORATORY SERVICES
Boca Raton, FL
02.2021 - 08.2021
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Prepared billing statements for patients, ensuring correct diagnostic coding.
- Contacted patients for unpaid claims for HMO, PPO and private accounts and performed friendly follow-ups to ensure proper payments were made according to contracts.
- Remained up-to-date with all insurance requirements, including details of patient financial responsibilities, fee-for-service and managed care plans by participating in training programs.
- Maintained timely and accurate charge submission through electronic charge capture, including billing and account receivables (BAR) system and clearing house.
- Accurately coded diagnostics and prepared billing statements for patients.
- Analyzed and interpreted patient medical and surgical records to determine billable services.
- Determined prior authorizations for medication and outpatient procedures.
- Performed quality control of data entry system to verify proper posting of claims and payments.
- Posted and adjusted payments from insurance companies.
- Completed appeals and filed and submitted claims.
- Identified errors and re-filed denied or rejected claims quickly to prevent payment delays.
Coder/Coding Specialist
MOREHOUSE SCHOOL OF MEDICINE
Atlanta, Ga
11.2019 - 06.2020
- Worked as a medical coder to review clinical statements and assigned standard codes using CPT, ICD-10-CM or HCPCS Level II system.
- Reviewed clinical documentation and diagnostic results as appropriate to validate and ensure correct procedural and diagnostic coding.
- Comply with Revenue Cycle policies and procedures.
- Worked assigned tasks lists, work queues, work files and/or reports.
- Translated health care services into coded medical claims for submittal to insurers.
- Maintain current knowledge of third party payor reimbursements and managed care contracts.
- Maintain knowledge and is familiar with physician billing accounts receivable and EHR systems.
- Accurately counts and tracks all daily activity or communication on accounts.
- Kept all files secure and confidential to protect the patients and comply with HIPAA and internal requirements.
- Processed medical reports and clinical action notes, transcribing details from audio files into the patient's chart.
Medical Coder/ Billing Clerk
OPTUM 360/UNITED HEALTHCARE
Melville, NY
07.2015 - 09.2019
- Reviewed patient charts, lab and consult reports for identifying documented diagnosis.
- Accurately assigned ICD and CPT codes from patient medical records.
- Completed administrative duties, including answering the phones, managing simultaneous projects and maintained calendars to ensure deadlines are met as well as monetary monthly goals.
- Verified insurance for potential billing.
- Followed up on claims status, denials, appeals, claim accuracy and submission EOB's.
- Created UB04, HCFA, and submitting with medical records.
- Utilized Workers Comp fee schedules, submitted PAS and APG rates for multiple hospitals.
Third Party Billing Specialist
NORTHWELL HEALTH SYSTEMS, HEALTH SYSTEMS
Melville, NY
02.2007 - 07.2015
- Researched EOB's to identify misapplied payment and request proper posting of payment.
- Critically analyzed medical records, documentation and insurance correspondence to maximize third party reimbursement.
- Received billing issues and gathered relevant data to resolve billing matters.
- Insured accurate processing and completion of denied claims.
- Exercised proficiency in coding disciplines of outpatient, facility and physician care.
- Worked in the billing department of a busy regional hospital as part of a coding and administrative team.
- Remained in frequent contact with medical companies to expedite smooth processing.
- Submitted Medical bills to third party insurance companies.
- Billed for hospitals outpatient services as well as physician practices.
- Requested and reviewed medical records.
- Reviewed EOB's, and correspondence in a timely matter.
- Supplied customer service when needed.
- Compared account charges with documentation to ensure correctness for final claim submission.
Education
High School Diploma -
Baldwin High School
Baldwin, NySkills
- Ability to verily and ensure the accuracy, completion and appropriateness of diagnosis codes
- Certified professional coder AAPC-CPC
- Ability to read analyze and interpret medical records
- Posses full knowledge of Hippa regulations and patient confidentiality
- Certified medical biller
- Proven solid time management
Timeline
Medical Coder
SSM Healthcare
12.2023 - Current
Medical Coder
United Healthcare Optum (SSMHC)
02.2023 - 12.2023
Claims Analyst/Medical Coder
Praesum Healthcare
09.2021 - 10.2023
Medical Coder/Billing Specialist
NATIONWIDE LABORATORY SERVICES
02.2021 - 08.2021
Coder/Coding Specialist
MOREHOUSE SCHOOL OF MEDICINE
11.2019 - 06.2020
Medical Coder/ Billing Clerk
OPTUM 360/UNITED HEALTHCARE
07.2015 - 09.2019
Third Party Billing Specialist
NORTHWELL HEALTH SYSTEMS, HEALTH SYSTEMS
02.2007 - 07.2015
High School Diploma -
Baldwin High School
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