Shantal Boucher
Middletown
Summary
Dynamic Medical Biller and Coder with proven expertise at CTGI in claim processing and auditing documentation. Adept at resolving billing discrepancies and training staff, ensuring compliance with healthcare regulations. Recognized for high accuracy in coding and effective communication, contributing to streamlined revenue cycle management and enhanced patient satisfaction.
Overview
12
12
years of professional experience
Work History
Medical Biller and Coder
CTGI
Rocky Hill
08.2021 - Current
- Processed medical claims using billing software to ensure accurate submissions.
- Reviewed patient records for coding accuracy and compliance with regulations.
- Collaborated with healthcare providers to resolve billing discrepancies effectively.
- Maintained up-to-date knowledge of coding guidelines and insurance policies.
- Trained new staff on coding practices and billing procedures for efficiency.
- Assisted in audits by providing necessary documentation and coding information.
- Ensured timely filing of all claims within established guidelines.
- Analyzed patient accounts for errors, inaccuracies or discrepancies in billing documentation.
- Filed and submitted insurance claims.
- Verified accuracy of patient information and insurance data in billing system.
- Submitted claims to insurance companies electronically or by mail.
- Maintained current CPT, HCPCS codes library as well as ICD-9, 10 CM diagnostic codes.
- Processed corrections and adjustments as needed to ensure accurate payment from third party payers.
- Developed an understanding of how various insurance plans process claims for reimbursement purposes.
- Expertly assigned charges and payments for medical procedures.
- Worked closely with physicians to obtain additional clinical information when needed for accurate coding assignments.
- Resolved denied claims by researching payer requirements and preparing appeals.
- Documented and filed patient data and medical records.
- Interpreted physician orders, notes, lab results, radiology reports. for appropriate code assignment.
- Reviewed medical records and identified diagnosis codes, procedures, services and supplies for coding.
- Responded promptly to requests from insurance companies regarding clarification on claim submissions.
- Maintained up-to-date knowledge of coding regulations and changes in reimbursement policies.
- Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
- Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
- Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes.
- Maintained high accuracy rate on daily production of completed reviews.
- Verified proper coding, sequencing of diagnoses, and accuracy of procedures.
- Quickly responded to staff and client inquiries regarding CPT codes.
- Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
- Utilized ICD-10, CPT, and HCPCS coding systems to process claims and billing.
Patient Service Representative
Hartford Hospital
West hartford
11.2020 - 11.2021
- Managed patient scheduling and appointment confirmations efficiently.
- Assisted patients with insurance inquiries and billing questions promptly.
- Maintained accurate patient records using electronic health record systems.
- Collaborated with healthcare providers to coordinate patient care plans effectively.
- Handled incoming calls and directed inquiries to appropriate departments swiftly.
- Educated patients on hospital services and procedures clearly and professionally.
- Resolved patient complaints by providing timely support and solutions.
- Trained new staff on operational procedures and customer service standards effectively.
- Answered incoming calls in a professional manner.
- Verified insurance information, collected payments, and scheduled appointments.
- Adhered to HIPAA regulations when handling confidential patient information.
- Assisted with scheduling follow-up appointments according to provider availability.
- Inputted patient demographic data into electronic health record system.
- Scanned completed forms, identification and insurance cards, maintaining patient documents folder.
- Registered patients by verifying records to update computer system and patient charts.
- Greeted patients upon arrival and directed them to the appropriate area.
- Ensured all necessary paperwork was completed prior to patient visits.
- Maintained a clean and organized reception area.
- Performed administrative duties such as filing, faxing, photocopying.
- Informed patients about payment options, billing policies, and procedures related to their visit or procedure.
- Obtained proper authorization and identification to release confidential medical records.
Office Assistant, Scheduler, on call Caregiver
Comfort Keepers
Bloomfield
10.2013 - 09.2015
- Functional knowledge of compiling and maintaining office records
- Computer savvy, Microsoft Office Suite Administration Software, Outlook, QuickBooks
- Able to make quick and effective decisions
- Hands on experience in working with diverse group of people
- Managing calendars for clients and employee's
- Conduct internet research to locate potential job candidates
- Scan resumes
- Assist with planning new employee orientations
- Compiles materials and maintain employee database records
- Billing and invoicing, as well as filing
- Certified Nurse's Aide
Amberwoods
Farmington
07.2014 - 09.2013
- Efficient ability to record important signs that incorporate respiration, body temperature, pulse and blood pressure
- Ability to observe Privacy/Hippa regulations along with direct patient care functions
- Ability to ensure patient safety and personal hygiene at all times
- Ability to prioritize work and demonstrate state-of-the-art organization and time management abilities
- Capability to consistently abide by the predetermined protocols
- Competent knowledge about infection disorders and elementary methodologies employed for infection control
Education
Medical biller - Associates
American Institute
West Hartford 08-2021
Certified Nurse Aide -
E.T.W
Wethersfield, CT01.2004
High School Diploma - Hairdressing
E.C Goodwin Tech
New Britain, CT01.2000
Skills
- Medical coding
- Claim processing
- Auditing documentation
- CPT coding
- Healthcare compliance
- Data entry accuracy
- Regulatory knowledge
- Problem solving
- Attention to detail
- Effective communication
- Staff training
- Anatomy and physiology
- Medical coding expertise
- CMS-1500 form completion
- ICD-10 proficiency
- Claim submission
- Diagnostic coding
- HIPAA compliance
- Medicare and medicaid billing
- HCPCS level II coding
- Revenue cycle management
- Medical billing procedures
- Denial management
- Code assignment research
- Inpatient records coding
- Record assessment
- Workflow management
- Coding error resolution
- Medicare insurance regulations
- Medical record security
- Medical claims coding
- Insurance coding (ICD-9 and CPT)
- Regulatory guidelines
- Training and mentoring
- Anatomy
References
Available upon request
References
References available upon request.
Timeline
Medical Biller and Coder
CTGI
08.2021 - Current
Patient Service Representative
Hartford Hospital
11.2020 - 11.2021
Amberwoods
07.2014 - 09.2013
Office Assistant, Scheduler, on call Caregiver
Comfort Keepers
10.2013 - 09.2015
Medical biller - Associates
American Institute
Certified Nurse Aide -
E.T.W
High School Diploma - Hairdressing
E.C Goodwin Tech
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