Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Starlette McCain

Smyrna,TN

Summary

Competent Certified Medical Coder with 15+ years of experience in handling wide variety of medical coding and billing tasks. Sophisticated and hardworking individual with excellent analytical and multitasking abilities. Coordinates with insurance companies and expedites claims processes. Expertise in accurately inputting procedure and diagnosis codes into billing software to generate invoices.

Overview

9
9
years of professional experience
1
1
Certification

Work History

Clinical Denials Coding Review Specialist

Parallon
06.2023 - Current
  • Enhanced claim processing efficiency by thoroughly reviewing and analyzing denial trends.
  • Streamlined denial resolution procedures for faster reimbursement and improved cash flow.
  • Identified patterns in payer denials, implementing corrective actions to prevent future occurrences.
  • Maintained up-to-date knowledge on payer guidelines and regulations, ensuring compliant claims submissions.
  • Negotiated successful appeals for complex denials, recovering lost revenue for the organization.
  • Verified, coded and added modifiers to diagnoses.
  • Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
  • Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
  • Resourcefully used various coding books, procedure manuals, and on-line encoders.

Certified Medical Coder

Community Health Network
02.2019 - 05.2023
  • Improved accuracy of medical coding by thoroughly reviewing patient records and assigning correct codes for diagnoses and procedures.
  • Maintained compliance with industry regulations by staying up-to-date on the latest changes in medical coding guidelines and conventions.
  • Streamlined billing processes by effectively collaborating with healthcare providers, insurance companies, and patients to resolve any discrepancies or issues.
  • Enhanced revenue cycle management by identifying under-coded services and submitting accurate claims for reimbursement.
  • Audit providers charts making sure coding guidelines were met by reviewing chart documentation.
  • Verified, coded and added modifiers to diagnoses.
  • Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
  • Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
  • Resourcefully used various coding books, procedure manuals, and on-line encoders.
  • Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
  • Interacted with physicians and other healthcare staff to ask questions regarding patient services.
  • Communicated with insurance companies to research and resolved coding discrepancies.
  • Correctly coded and billed medical claims for various hospital and nursing facilities.

Reimbursement Specialist

R1 Rcm
11.2014 - 02.2019
  • Contributed to increased team productivity by consistently meeting or exceeding individual processing goals.
  • Reduced claim denial rates by thoroughly reviewing documentation before submission to insurance providers.
  • Contributed to overall team productivity, maintaining a high level of accuracy in coding assignments.
  • Conducted thorough research on complex cases, ensuring appropriate coding decisions were made.
  • Worked closely with interdisciplinary teams to address billing disputes and resolve them efficiently.
  • Consistently met or exceeded monthly productivity goals while maintaining high levels of accuracy in coding tasks.
  • Regularly reviewed payer-specific guidelines to ensure optimal reimbursement for services provided by the organization.
  • Evaluated medical records thoroughly, assigning accurate ICD-10-CM codes based on clinical documentation.
  • Researched and resolved claim denials, pre-bill edits and pre-bill errors.

Education

Associate of Science - Health Claims Examiner

Indiana Business College
Indianapolis, IN
03.2005

Skills

  • Medical Claims Coding
  • CPT Coding Knowledge
  • Auditing and Quality Assurance
  • Claims Processing Efficiency
  • Teamwork and Collaboration
  • Time Management Aptitude
  • Attention to Detail
  • Anatomy and Physiology Understanding
  • ICD-10 Proficiency
  • Medical Billing Procedures
  • Proficiency in Excel, Microsoft Word
  • Knowledgeable in Epic, Cerner, IDX, SMS, JDA, Sorian, Onbase, Athena, Relay

Certification

  • CPC - Certified Professional Coder

Timeline

Clinical Denials Coding Review Specialist

Parallon
06.2023 - Current

Certified Medical Coder

Community Health Network
02.2019 - 05.2023

Reimbursement Specialist

R1 Rcm
11.2014 - 02.2019

Associate of Science - Health Claims Examiner

Indiana Business College

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Starlette McCain