Summary
Overview
Work History
Education
Skills
Certification
References
Hobbies and Interests
Websites
Affiliations
Timeline
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Tamara Wilson

Tamara Wilson

Highland,CA

Summary

Experienced medical coder with thirteen years in healthcare, specializing in ICD-10-CM and CPT coding. Proven track record of high productivity and accuracy in coding tasks, ensuring timely submission of medical claims. Strong analytical problem-solving skills and adaptability in diverse healthcare environments. Committed to maintaining precision and efficiency in all coding processes.

Overview

12
12
years of professional experience
1
1
Certification

Work History

Medical Coder

Optum Services
01.2022 - Current
  • Analyzed and coded claim information to ensure quality data for timely reviews.
  • Consistently met or exceeded departmental benchmarks while adhering to industry standards.
  • Communicated with reviewing physicians regarding coding determinations and CMS policy coordination.
  • Maintained professional skills aligned with company goals and vision.
  • Coordinated assignments across departments to achieve timely turnaround (TAT).

Patient Account Rep

Epic Management/Optum Services
05.2020 - 12.2021
  • Conducted outreach to patients for retrieval of missing information.
  • Maintained collection calls, verified insurance eligibility, and dispatched patient billing statements.
  • Researched CMS and payor-specific guidelines to stay updated on policy changes.
  • Investigated claim denials and rectified coding errors as necessary.
  • Appealed claim denials based on DOFR, individual contracts, and current CMS protocols.
  • Contacted insurance companies to verify payment status.

Utilization Management Specialist

Epic Management/Optum Services
05.2018 - 01.2021
  • Verified eligibility and benefits for referral requests to ensure policy compliance.
  • Maintained turnaround time compliance during authorization processes.
  • Entered faxed referrals into database, conducting primary accuracy reviews.
  • Requested provider notes for additional information during evaluation as necessary.
  • Identified carve-out services and coordinated care among multiple providers.
  • Processed special reports for internal and external stakeholders efficiently.
  • Delivered professional customer service while resolving health services inquiries effectively.
  • Assisted in training new specialists to strengthen team capabilities.

Medical Biller & Coding Specialist

Efficient Physician
04.2013 - 05.2018
  • Contacted patients to obtain missing information for accurate records.
  • Maintained collection calls and verified insurance eligibility while sending patient statements.
  • Researched CMS guidelines and policy changes to ensure compliance.
  • Analyzed claim denials and corrected coding errors for resolution.
  • Appealed claim denials based on DOFR, individual contracts, and current CMS guidelines.
  • Communicated with insurance companies to verify payment status efficiently.
  • Coordinated patient cost information across departments to enhance transparency.

Education

Bachelor of Science - Public Health

Western Governors University
Salt Lake City, UT
02-2026

Skills

  • Claim analysis
  • Effective communication
  • Clinical documentation
  • Organization and prioritization
  • Policy research
  • Microsoft Office Suite expertise
  • Claims processing
  • ICD-9, CPT-4, and ICD-10 knowledge
  • Code assignment research
  • Regulatory guidelines
  • Data entry and management
  • Procedural coding
  • Medical claims coding
  • Coding appeals
  • Proficiency in Epic, Hyperspace, McKesson, and KS

Certification

  • CPC / 2020 San Diego / CA / AAPC
  • CPB / 2020 San Diego CA / AAPC

References

  • Linda, Gilbert, Owner, 909. 322. 6265, Efficient Physician
  • Christi, Rodriguez, Supervisor, 562. 742. 5114, Efficient Physician
  • Felicia, Iturralde, Admin Asst, fiturralde@epiclp.com, 909. 583. 2731, Epic Management

Hobbies and Interests

Medicine and Healthcare, Wellness, Cooking, Traveling

Affiliations

AAPC Member ID 01389672

Timeline

Medical Coder

Optum Services
01.2022 - Current

Patient Account Rep

Epic Management/Optum Services
05.2020 - 12.2021

Utilization Management Specialist

Epic Management/Optum Services
05.2018 - 01.2021

Medical Biller & Coding Specialist

Efficient Physician
04.2013 - 05.2018

Bachelor of Science - Public Health

Western Governors University

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