Susan Dillon
Boise,ID
Summary
Dynamic Senior Coding Denial Specialist with extensive experience at St. Luke's Regional Medical Center. Expert in appeals processing and medical coding, ensuring data integrity and compliance. Proven ability to resolve complex claims issues while fostering strong provider relations. Adept at utilizing billing software to enhance operational efficiency and accuracy.
Overview
30
30
years of professional experience
Work History
Senior Coding Denial Specialist
St. Luke's Regional Medical Center
09.2018 - Current
- Adjusted client accounts by entering discretionary billing items, requesting rebills and updating billing entity records.
- Identified root cause of denials to provide plans for denial resolution.
- Determined appropriateness of payers to protect organization and minimize risk.
- Maintained confidentiality of patient finances, records, and health statuses.
- Checked documentation for accuracy and validity on updated systems.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Correct any CPT or ICD-10 errors and resubmit corrected claim for reconsideration.
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Conducted in-depth analysis of inquiries and complaints to compose appeal letters for clients.
Oncology Outpatient Coder
St. Luke's Regional Medical Center
09.2017 - 09.2018
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Utilized active listening, interpersonal, and telephone etiquette skills when communicating with others.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Communicated with insurance companies to research and resolved coding discrepancies.
- Transcribed and entered patient medical information into electronic medical records systems.
- Maintained accuracy, completeness, and security for medical records and health information.
ED Outpatient Coder
St Luke's Healthcare System
06.2016 - 09.2017
- Correctly coded and billed medical claims for various ED Outpatient facilities.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Monitored changes in coding regulations to provide recommendations for compliance.
- Used classification manuals to gain additional knowledge of disease and diagnoses processes.
- Followed up with medical staff regarding missing information in patient records.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
Lead Family Medicine Coder
St Luke's Healthcare System
01.2013 - 09.2017
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Correctly coded and billed medical claims for various Family Medicine Clinic (17 clinic)
- Trained and mentored junior coders to support growth and development and apply high-quality coding practices.
- Utilized electronic medical record systems to store, retrieve and process patient data.
- Verified accuracy of patient information in medical records.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
Professional Outpatient Coder
Kaiser Permanente
07.1995 - 12.2012
- Correctly coded and billed medical claims for various outpatient clinics
- Researched and resolved medical record discrepancies.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Utilized electronic medical record systems to store, retrieve and process patient data.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Used classification manuals to gain additional knowledge of disease and diagnoses processes.
Education
No Degree - HIT - Health Information Techology
Santa Barbara City College
Santa Barbara, CA06-2003
Skills
- Appeals processing
- Provider relations
- Medical billing
- Medical coding
- Insurance verification
- Claims analysis
- Computer proficiency
- Data integrity
- Medical terminology
- Claims processing
- Billing software
- Regulatory compliance adherence
Timeline
Senior Coding Denial Specialist
St. Luke's Regional Medical Center
09.2018 - Current
Oncology Outpatient Coder
St. Luke's Regional Medical Center
09.2017 - 09.2018
ED Outpatient Coder
St Luke's Healthcare System
06.2016 - 09.2017
Lead Family Medicine Coder
St Luke's Healthcare System
01.2013 - 09.2017
Professional Outpatient Coder
Kaiser Permanente
07.1995 - 12.2012
No Degree - HIT - Health Information Techology
Santa Barbara City College