Experienced coding and billing specialist with a proven track record in managing patient accounts and conducting compliance audits. Adept at analyzing EOBs and resolving discrepancies, contributing to enhanced operational efficiency and patient satisfaction.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Coder II Dual Practice Skilled
HCA Healthcare Inc.
Nashville, TN
09.2014 - Current
Interpreted medical terminology and pharmacological data for precise coding translations.
Reviewed clinical data to effectively assign ICD, CPT, and HCPCS codes.
Assigned additional diagnosis codes based on laboratory and radiology findings.
Utilized ICD-10, CPT, and HCPCS systems to enhance claims processing efficiency.
Achieved high accuracy rate in daily production of completed reviews.
Conducted code reviews to ensure compliance with coding standards.
Patient Account Representative
Mission Healthcare
Asheville, North Carolina
10.2014 - 09.2017
Submitted claims to insurance companies both electronically and manually.
Analyzed EOBs for accuracy and compliance with contractual agreements.
Communicated with insurance representatives to facilitate claims processing and resolve issues.
Completed appeals while filing and submitting necessary claims.
Resolved discrepancies in billing documents through thorough research and negotiation.
Managed patient account payments, ensuring accurate posting and collection.
Applied payments, adjustments, and denials into medical manager system.
Assisted in resolving patient complaints related to account balances, insurance coverage, and payment plans.
Created new patient files according to established procedures and protocols.
Verified accuracy of medical coding for services rendered by healthcare providers.
Office Manager
Sharon DeMocker MD Family/Intergrated Medicine
Hendersonville, North Carolina
05.2004 - 01.2015
Developed and implemented office policies and procedures.
Managed accounts receivable for the practice, ensuring timely payments from insurance companies and patients.
Provided support to physicians by organizing patient charts prior to scheduled appointments.
Conducted regular audits of medical records to ensure accuracy and completeness of documentation.
Scheduled appointments for patients in accordance with their individual needs and preferences.
Resolved disputes between vendors providing services or products to the practice in a timely manner.
Reviewed contracts for accuracy prior to signing off on behalf of the company.
Medical Billing Manager
Quality Healthcare
Hendersonville, North Carolina
04.1998 - 12.2003
Provided technical assistance for coding inquiries from internal teams.
Created reports detailing trends in revenue cycle management, including denials and rejections.
Negotiated contracts with payers to optimize reimbursement rates for services.
Managed medical billing staff to ensure accuracy of patient accounts.
Collaborated with IT on software upgrades to enhance operational efficiency.
Monitored accounts receivable aging reports to proactively reduce outstanding balances.
Coordinated departmental efforts for patient follow-up related to denials.
Developed training programs for staff to improve performance and efficiency.
Education
Associate of Science -
Blue Ridge Community College
Flat Rock, NC
06-1993
Skills
Revenue cycle management
Patient billing
EOB analysis
Compliance auditing
Team collaboration
Time management
Attention to detail
Certification
Certified Professional Coder AAPC
Affiliations
Vice President Local Chapter AAPC Asheville NC Jan 2017-Dec 2017
Vice President Local Chapter AAPC Hendersonville NC Jan 1998-Dec 1998
Secretary/Treasurer Local Chapter AAPC Hendersonville NC Jan 1996-Dec 1997