Sheryl Adams
Newnan,GA
Summary
Knowledgeable medical office professional talented at correcting and resubmitting claims, preparing patient charts and reviewing health records to identify proper diagnosis codes for billing. Offers background in reviewing, analyzing and managing medical record information to obtain prior authorizations from insurance companies and ensure payment.
Overview
10
10
years of professional experience
3
3
Certification
Work History
Insurance and Billing Medical Coding Specialist
Peachtree Cardio Vascular and Podiatry
06.2023 - 10.2023
- Medical Claim processing filing using proper CPT and ICD codes, claim review, claim denials.
- Auditing medical charts for proper coding practices
- Download and review EOB's
- Processing Authorizations
- Insurance verification.
- Reduced claim denials by consistently ensuring accurate and compliant coding practices in line with regulatory standards.
- Streamlined billing processes for improved efficiency by maintaining up-to-date knowledge of coding guidelines and procedures.
- Collaborated with healthcare providers to clarify ambiguous or incomplete documentation, resulting in more precise medical codes.
- Ensured timely submission of claims by diligently meeting deadlines for coding assignments, reducing risk of delayed payments from insurers.
- Maintained strict adherence to HIPAA regulations by protecting confidential patient information during coding process.
Prior Authorization Specialist/Surgery Coordinator
Georgia Pain and Spine Care
Newnan, GA
10.2019 - 07.2022
- Maintaining email resource and internal log and working closely with supervisors and managers
- Serve as professional representative of ASC and scheduling team
- Contacting insurances (by phone, e-mail and regular mail) for eligibility, benefits, network status and authorization, documenting information
- Verify eligibility within database system to members and providers
- Analyze faxed requests and documentation to determine coverage and approval utilizing criteria; utilize nurses for medical reviews when necessary
- Process requests for Prior Authorization
- Acts as liaison between payer and clinic schedulers/medical support staff
- Code each procedure and diagnosis of service and procedures according to standards
- Responsible for obtaining prior and ongoing authorization for service in timely manner
- Manage receipt, investigation and resolution of standard complaint and appeal issues in timely and highly effective manner
- Reviews billing questions with Billing Department Manage receipt, investigation and resolution of standard complaint and appeal issues
- Ensure all needed medical clearances are in patients' charts prior to procedure being scheduled
- Coordinate patients throughout scheduling process (from time of ordering to check in at ASC
- Assist with patient balances per EMR ledger and documenting in schedule
- Responsible for patient's benefits eligibility verification and calculation of patients amount due at time of procedure.
Surgery Scheduler Coordinator
ENT Institute
11.2018 - 03.2019
- Schedule inpatient and out surgical procedures
- Review surgical order to ensure that the surgical facility and anesthesia screening requirement are met
- Knowledgeable with the current anesthesia screening requirements and other written guidelines as they relate to the patient age and existing medical conditions
- Communicate the patents needs to the practitioner to ensure compliance
- Verify Insurance eligibility, Insurance deductible, perform pre-authorization, verify the medical codes are correct and nothing is missing, work on the pre-certification for the medical codes and their diagnostic codes
- Coordinate joint cases with various surgical services both internal & external
- Pathology
- Coordinate scheduling of pre-op procedures
- Schedules sequential appointments for the member both pre and post operatively
- Communicate with patients and coordinate all encounters that are required during the peri-operated pre-op office appointment, provide procedural instructions per departmental guidelines to include diet restriction, medication restriction and directions to the surgery site
- Schedule post operative appointments
- Ensure that pre-op lab results and clearance statement are available for review pre-operatively by the surgeon or his/her designee
- Document all member communication in the electronic medical record
- Communicate any changes in the member's medical condition, as reported/stated by the member, to surgeon or his/her designee according to department guidelines.
Patient Access Representative
ENT Institute
09.2017 - 11.2018
- Responsible variety of administrative functions and patient care activities in support clinic to include, checking-in/outpatients, collecting co-pays, verifying insurance, scheduling appointments and assisting clinical staff to provide support for efficient delivery of patient care
- Responsible of incoming referrals to practice, including Hospital consults from provider's
- Responsible for Medicaid patients, requesting additional visit for their professional services, keeping up with their authorizations
- Accurately and completely register and admit patients having services, treatment or procedures in healthcare system
- Maintain acceptable quality assurance rate during monthly quality assurance reviews
- Complete all hospital and department annual or quarterly training required timely
- Provide service excellence during every patient encounter or when providing internal customer service
- Help translate medical forms for patients and providers, translate for patient while in clinic with provider and nurses.
Insurance Specialist
West Georgia Orthodontics
07.2008 - 12.2012
- Responsibilities include but are not limited to verification of benefits, processing claims, and insurance billing, helping patients check in and out, transferring patients in and out of office
- Consistently follow up with insurance companies in regards to payments, posting payments, and maintaining account updates
- Successfully achieve high rate of payment collections accounts by closely working with patient's and collection companies
- Train fellow staff members on office way to process claims and understanding how they work.
Education
Certificate - Medical Coding and Billing
Allen School of Health Sciences
New York, NY01.2013
Certificate - Bodily Injury Adjuster
Sacred Heart University
Santurce, PR01.2003
Certification - Commercial Auto, Commercial Property and Civil Liability
Caribbean Institute of Insurance
Hato Rey, PR01.2002
Environmental Science -
Bayamon Central University
Bayamón, PR01.1999
Skills
- Medical Records
- Microsoft Office
- Athena Net
- Excel
- IMS
- Pain Management
- Medical Scheduling
- CPT Coding
- ICD-9
- Medical terminology
- Medical records
- EMR systems
- Medical coding
- Customer service
- CPT coding knowledge
- ICD-10 Proficiency
- HIPAA Compliance
- Medical Coding Certification
- Procedural coding accuracy
- Diagnostic Coding Accuracy
- Claims Processing
- Professional ethics
- Insurance Verification
- Denial Management
- Payment posting
- Appeals Process
- Outpatient coding experience
- Clinical Documentation
- Training and mentoring
- Data Entry
- Insurance claims analysis
- Data Verification
Certification
- Certified Medical Coder and Billing Specialist, 01/01/13
- Certificate in Bodily Injury Adjuster, 08/01/02
- Certification on Commercial Auto, Commercial Property and Civil Liability, 01/01/02
Personal Information
Title: Prior Authorization Specialist/Surgery Coordinator
Languages
Spanish
Native or Bilingual
Timeline
Insurance and Billing Medical Coding Specialist
Peachtree Cardio Vascular and Podiatry
06.2023 - 10.2023
Prior Authorization Specialist/Surgery Coordinator
Georgia Pain and Spine Care
10.2019 - 07.2022
Surgery Scheduler Coordinator
ENT Institute
11.2018 - 03.2019
Patient Access Representative
ENT Institute
09.2017 - 11.2018
Insurance Specialist
West Georgia Orthodontics
07.2008 - 12.2012
Certificate - Medical Coding and Billing
Allen School of Health Sciences
Certificate - Bodily Injury Adjuster
Sacred Heart University
Certification - Commercial Auto, Commercial Property and Civil Liability
Caribbean Institute of Insurance
Environmental Science -
Bayamon Central University
- Certified Medical Coder and Billing Specialist, 01/01/13
- Certificate in Bodily Injury Adjuster, 08/01/02
- Certification on Commercial Auto, Commercial Property and Civil Liability, 01/01/02
Similar Profiles
Ciarra CavallaroCiarra Cavallaro
Cardiovascular Sonographer at Cardio & Vascular associatesCardiovascular Sonographer at Cardio & Vascular associates
Michelle SmithMichelle Smith
Medical Billing, Insurance, and Scheduling at St. Bernard's Cardio and VascularMedical Billing, Insurance, and Scheduling at St. Bernard's Cardio and Vascular
Kristie MrazKristie Mraz
Director of Human Resources at Nevada Heart and Vascular Center/Cardio Management ServicesDirector of Human Resources at Nevada Heart and Vascular Center/Cardio Management Services