Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Toni Eastham

Sacramento,CA

Summary

Medical Billing and Coding Specialist with 20 years providing administrative and patient support in hospital and medical office settings. Advanced knowledge of private insurance processes and codes.

Overview

16
16
years of professional experience
1
1
Certification

Work History

Medical Biller/Medical Coder

Mercy Medical Group
Sacramento , CA
2013.09 - 2019.11
  • Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
  • Interacted with 5 cardiac surgeons and other healthcare staff to ask questions regarding patient services.
  • Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
  • Resourcefully used various coding books, procedure manuals and on-line encoders while successfully coding and billing all cardiac surgeries 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.
  • Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
  • Entered orders into EMR system efficiently and without errors.

Medical Biller/Prior Authorization Specialist

Prenatal Diagnosis Of Northern California
Sacramento , CA
2003.10 - 2013.09
  • Reached out to insurance carriers to obtain prior authorization for testing and procedures.
  • Input all patient data regarding claims and prior authorizations into system accurately.
  • Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
  • Tracked referral submission during facilitation of prior authorization issuance.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Fielded in excess of 50 telephone inquiries per day on authorization details from plan members and medical staff.
  • Researched denied claims and contacted insurance companies to resolve these issues.
  • Reviewed insurance coverage for patients to determine which party was liable for payment.
  • Collaborated with Hospital Staff to process patients lacking coverage for planned procedures.
  • Authorized surgical and post-op requests in accordance with applicable plan guidelines.
  • Interviewed applicants and explained scope of different available benefits.

Education

High School Diploma -

CK McClatchy High School
Sacramento Ca
06.1987

Skills

  • Medical Billing Processing
  • Certified Professional Coder
  • CPT Code Modifiers
  • Coverage Determination
  • Workers' Compensation Forms
  • Call Documentation
  • Efficient and Detail-Oriented
  • Customer Service and Assistance
  • Understanding Customer Needs
  • Data Entry and Maintenance

Certification

  • CBCS - Certified Billing and Coding Specialist

Timeline

Medical Biller/Medical Coder

Mercy Medical Group
2013.09 - 2019.11

Medical Biller/Prior Authorization Specialist

Prenatal Diagnosis Of Northern California
2003.10 - 2013.09

High School Diploma -

CK McClatchy High School
  • CBCS - Certified Billing and Coding Specialist
Toni Eastham