Stephen Valencia
Lakewood,WA
Summary
Detail-oriented Medical Billing and Coding Specialist with extensive experience in medical terminology, insurance policies, and CPT/ICD-10 coding techniques. Proficient in navigating private insurance processes, ensuring precise and efficient reimbursement for healthcare services. Demonstrates a strong track record of settling complex patient billing accounts while maintaining a quality-focused approach. Leverages advanced technological skills to adeptly resolve billing disputes and enhance overall operational efficiency.
Overview
10
10
years of professional experience
Work History
Medical Billing Specialist
Muckleshoot Health and Wellness Center
Auburn, WA
11.2024 - Current
- Updated patient accounts with information obtained from internal departments or external sources.
- Maintained detailed records of all billing activities including denials, adjustments, and payments received.
- Reviewed patient records for accuracy and completeness of information in medical billing system.
- Analyzed rejected claims and corrected errors as necessary before resubmitting them for payment.
- Adhered to HIPAA regulations when handling confidential patient information.
- Submitted appeals for denied claims when appropriate according to the insurance company's criteria.
Medical Coder
Empowered Managment Solutions
San Diego, CA
01.2021 - 06.2024
- Increased coding accuracy by diligently reviewing medical documentation and applying appropriate codes.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
MEDICAL CODER/BILLER
MILESTONE RESEARCH
01.2019 - 09.2020
- Answer AMA CPT coding questions daily
- HCPCS and revenue coding
- Medicare national average reimbursement
- Navigate insurance websites for coverage info
- Assist patients and providers in appealing denied procedural cases
- Provide presentations for physicians' offices regarding coding and reimbursement.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Maintained a high level of productivity while consistently meeting deadlines for claim submissions.
MEDICAL CODER/BILLER
SPLIES HEALING CENTER
Ventura, CA
09.2015 - 11.2019
- Code entry in ICD-10 and bill with Office Ally
- Patient bill out, appointment rescheduling
- Handle accounts, finances
- Maintain and organize front office and patient rooms.
- Increased coding accuracy by diligently reviewing medical documentation and applying appropriate codes.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Reduced claim denials by maintaining thorough knowledge of payer-specific requirements and guidelines.
- Communicated with insurance companies to research and resolved coding discrepancies.
MEDICAL CODER/BILLER
KEITH ENGLISH FAMILY MEDICINE
10.2015 - 09.2019
- Code entry in ICD-10 and bill with Office Ally
- Patient bill out, appointment rescheduling
- Handle accounts, finances
- Maintain and organize front office.
- Increased coding accuracy by diligently reviewing medical documentation and applying appropriate codes.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Reduced claim denials by maintaining thorough knowledge of payer-specific requirements and guidelines.
- Reduced turnaround time for appeals by preparing comprehensive supporting documentation for denied claims.
- Communicated with insurance companies to research and resolved coding discrepancies.
MEDICAL CODER/BILLER
ON DEMAND EMPLOYMENT
03.2018 - 10.2018
- Provide RAC medical coding, and spot checking for a network of medical doctors
- Review home nurse claims
- Provide assistance with coding and amendments.
Education
CPC -
AMERICAN ACADEMY FOR PROFESSIONAL CODERS
Online11.2019
Associate of Arts -
Ventura Junior College
Ventura, CASkills
- ICD-10-CM
- CPT
- HCPCS
- Commercial insurance policies (HMO, PPO, Medicare & Triwest)
- HIPPA compliance requirements
- ASC Expert
- MediRegs
- MS Office (Word, Excel, Outlook)
- Certified Professional Coder (CPC)
- MHS Genesis
Timeline
Medical Billing Specialist
Muckleshoot Health and Wellness Center
11.2024 - Current
Medical Coder
Empowered Managment Solutions
01.2021 - 06.2024
MEDICAL CODER/BILLER
MILESTONE RESEARCH
01.2019 - 09.2020
MEDICAL CODER/BILLER
ON DEMAND EMPLOYMENT
03.2018 - 10.2018
MEDICAL CODER/BILLER
KEITH ENGLISH FAMILY MEDICINE
10.2015 - 09.2019
MEDICAL CODER/BILLER
SPLIES HEALING CENTER
09.2015 - 11.2019
CPC -
AMERICAN ACADEMY FOR PROFESSIONAL CODERS
Associate of Arts -
Ventura Junior College
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