Susie Washington
Surprise,AZ
Summary
Medical claims and coding professional with over 2 years of experience in applying ICD-10 and CPT codes across diverse medical claims. Skilled in coding and auditing processes to ensure compliance and accuracy, with a solid grasp of medical terminology. Demonstrated ability to meet productivity and quality benchmarks while adhering to HIPAA and federal regulations.
Overview
2
2
years of professional experience
Work History
Health Claims Examiner
NTT Data
09.2024 - 05.2025
- Assigned ICD-10 and CPT codes to over 100 Medicaid and Medicare claims weekly, ensuring compliance with coding standards.
- Conducted quality audits on outpatient and inpatient claims via Cerner PowerChart to identify discrepancies.
- Interpreted medical diagnoses and procedures, utilizing regulatory knowledge for precise coding and reimbursement.
- Maintained productivity benchmarks with a consistent accuracy rate of 98%.
- Reviewed clinical data from medical records to assign ICD, CPT, and HCPCS codes.
- Verified account information to ensure accuracy of patient and insurance details.
Medical Claims Examiner
First Source
12.2023 - 08.2024
- Adjudicated over 100 daily outpatient and inpatient claims using QNXT claims management system.
- Ensured precise documentation and compliance with HIPAA and federal regulations through expert knowledge of ICD-10, ICD-9, CPT, and HCPCS codes.
- Resolved complex claim denials by adjusting charges to enhance reimbursement while adhering to coding standards.
- Conducted thorough research of medical records to gather additional information for claim processing.
- Assessed coding accuracy utilizing ICD-10, CPT, HCPCS codes, and modifiers for optimal outcomes.
Medical Claims Processor
The Cigna Group
01.2023 - 09.2023
- Assigned and verified ICD-10, ICD-9, and CPT codes for commercial medical claims, ensuring accuracy for outpatient and limited inpatient records.
- Reviewed medical documentation, EOBs, and remittance advice while maintaining confidentiality and data security.
- Conducted monthly audits of over 200 claims to enhance charging accuracy and reimbursement rates.
- Calculated payments due based on allowed charges compared to billed charges according to contract terms.
Education
Medical Billing and Coding Essentials -
Coursera
06.2025
A.S. - Liberal Arts and Criminal Justice
Faulkner State Community College
Bay Minette, AL08.2008
High School Diploma -
Leflore Magnet High School
Mobile, AL05.2006
Skills
- ICD-10 and ICD-9 coding
- CPT and HCPCS coding
- Outpatient and inpatient coding
- Coding audits and compliance
- Cerner PowerChart and Amisys
- QNXT proficiency
- Medical terminology expertise
- Anatomy and physiology knowledge
- Claims analysis and adjudication
- Insurance policy understanding
- Regulatory compliance knowledge
- Medical billing procedures
- Health information management
- Data entry accuracy
- Documentation standards
- Productivity and quality standards
- Confidentiality and data security
Timeline
Health Claims Examiner
NTT Data
09.2024 - 05.2025
Medical Claims Examiner
First Source
12.2023 - 08.2024
Medical Claims Processor
The Cigna Group
01.2023 - 09.2023
Medical Billing and Coding Essentials -
Coursera
A.S. - Liberal Arts and Criminal Justice
Faulkner State Community College
High School Diploma -
Leflore Magnet High School
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