Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Susan Ouellette

Spring Hill,FL

Summary

Certified Medical Coder (CPC) with 5+ years experience in a Clinical Laboratory and 3 + years experience in Primary Care Physician Coding and HCC coding. Knowledgeable medical office professional talented at correcting and resubmitting claims and reviewing health records to identify proper diagnosis codes for billing. Experience with HCC coding and quality measures. Manages multiple tasks, utilizes electronic medical record systems, and provides excellent customer service to patients and staff. Adheres to medical records policies and procedures to comply with HIPAA regulations. Track record of effectively troubleshooting issues and maintaining patient confidentiality. CPMA (Certified Professional Medical Auditor) , CDEO (Clinical Documentation Expert Outpatient), CRC (Certified Risk Adjustment Coder), COC (Certified Outpatient Coder) and CPCO (Certified Professional Compliance Officer) certified through AAPC. . Polished professional manages multiple tasks, utilizes electronic medical record systems, and provides excellent customer service to patients and staff. Adheres to medical records policies and procedures to comply with HIPAA regulations. Track record of effectively troubleshooting issues and maintaining patient confidentiality.

Overview

9
9
years of professional experience
5
5
Certification

Work History

Certified Coding Specialist

West Florida Medical Associates
Beverly Hills, FL
08.2019 - Current
  • Ensure all chronic conditions and complications are documented, assessed, and coded correctly
  • Reviewed charts and flagged incomplete or inaccurate information.
  • Review and submit documentation for Patient Agendas for Sunshine Health and Optum
  • Review and submit documentation to close Care Gaps for United Healthcare, Florida Blue, and Sunshine Health
  • Meet monthly with various insurance companies
  • Perform monthly chart audits for our Rural Healthcare Providers
  • Provide coding and guideline education to providers and staff
  • Used classification manuals to gain additional knowledge of disease and diagnoses processes.
  • Proficient in EClinicalworks
  • Process Payroll for company BI-Weekly
  • Review claims for missing documentation and incorrect coding.

Billing Specialist

Proper Medical Billing
Eustis, FL
09.2017 - 08.2019
  • Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments
  • Identified, researched and resolved billing variances to maintain system accuracy and currency
  • Posts payments to patient accounts
  • Assign correct diagnosis (ICD 10) and procedure codes (CPT) to claims
  • Submit claims electronically
  • Generated financial statements and reports detailing accounts receivable status
  • Promoted consistent accuracy of billing information by reconciling accounts monthly
  • Worked AR
  • Familiar with answering Payor Audits and taking corrective action

Billing Supervisor

Histopath lab PA
Lecanto, FL
12.2013 - 06.2017
  • Verified patients' eligibility and claims status with insurance agencies
  • Precisely completed appropriate claims paperwork, documentation and system entry
  • Correctly coded and billed medical claims for the lab
  • Performed full-cycle medical billing
  • Diligently filed and followed up on third party claims
  • Posted payments to appropriate patient accounts
  • Produced monthly reports using Excel spreadsheet functions
  • Strictly followed all federal and state guidelines for release of information
  • Carefully reviewed medical records for accuracy and completion as required by insurance companies
  • Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation
  • Consistently complied with applicable laws and regulations and ensured facility adhered to Medicare and Medicaid regulations
  • Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge
  • Maintained updated knowledge of coding requirements, through continuing education and certification renewal
  • Scanned documentation and entered into the database
  • Trained new employees on medical billing programs and data entry software

Education

Certified Professional Compliance Officer

CPCO - AAPC
Utah
12.2022

Certified Outpatient Coder

COC - AAPC
Utah
04.2021

Certified Risk Adjustment Coder

CRC - AAPC
Utah
08.2020

CDEO - Certified Documentation Expert Outpatient

AAPC
Utah
2019

CPMA - Certified Professional Medical Auditor

AAPC
Utah
2019

CPC - Certified Professional Coder

AAPC
Utah
2019

Certificate - Medical Coding

Career Step
Utah
2018

Certificate Program - Medical Billing and Coding

Ashworth College
2015

Certificate Program - Certified Medical Administrative Assistant

Withlacoochee Technical College
2013

Skills

  • Medisoft and EClinicalWorks experience
  • United Healthcare Link, Availity and SPOT proficient
  • HCC Experience
  • Coding error resolution
  • Insurance claims analysis
  • Records review
  • ICD-10 (International Classification of Disease Systems)
  • Processing Payroll Bi-weekly for approximately 170 employees with Paylocity
  • Insurance and collections procedures
  • Detail oriented
  • Coding Error Resolution
  • Charting and Clinical Documentation
  • Code Assignment Research
  • Process Payments
  • Medical Billing and Collections

Certification

  • CPCO, 2022, AAPC
  • COC, 2021, AAPC
  • CRC, 2020, AAPC
  • CPC, 2019, AAPC
  • CPMA, 2019, AAPC
  • CDEO, 2019 AAPC
  • RHC Coding and Billing Specialist, 2021 , Archpro Coding
  • Career Step, Graduated with Honor, Medical Coding
  • National Healthcareer Association Certified Billing and Coding Specialist Certification
  • National Healthcareer Association Certified Medical Administrative Assistant Certification
  • National Technical Honor Society
  • Florida Ready to Work
  • CMS Certificate of Completion , LCD coverage criteria for drug assays, 04/28/2016
  • CMS Certification of Completion, Medicare Part B changes and regulations 09/21/2016
  • CMS Certification of Completion, Current Procedural Terminology 02/02/2017

Timeline

Certified Coding Specialist

West Florida Medical Associates
08.2019 - Current

Billing Specialist

Proper Medical Billing
09.2017 - 08.2019

Billing Supervisor

Histopath lab PA
12.2013 - 06.2017

Certified Professional Compliance Officer

CPCO - AAPC

Certified Outpatient Coder

COC - AAPC

Certified Risk Adjustment Coder

CRC - AAPC

CDEO - Certified Documentation Expert Outpatient

AAPC

CPMA - Certified Professional Medical Auditor

AAPC

CPC - Certified Professional Coder

AAPC

Certificate - Medical Coding

Career Step

Certificate Program - Medical Billing and Coding

Ashworth College

Certificate Program - Certified Medical Administrative Assistant

Withlacoochee Technical College
  • CPCO, 2022, AAPC
  • COC, 2021, AAPC
  • CRC, 2020, AAPC
  • CPC, 2019, AAPC
  • CPMA, 2019, AAPC
  • CDEO, 2019 AAPC
  • RHC Coding and Billing Specialist, 2021 , Archpro Coding
  • Career Step, Graduated with Honor, Medical Coding
  • National Healthcareer Association Certified Billing and Coding Specialist Certification
  • National Healthcareer Association Certified Medical Administrative Assistant Certification
  • National Technical Honor Society
  • Florida Ready to Work
  • CMS Certificate of Completion , LCD coverage criteria for drug assays, 04/28/2016
  • CMS Certification of Completion, Medicare Part B changes and regulations 09/21/2016
  • CMS Certification of Completion, Current Procedural Terminology 02/02/2017
Susan Ouellette