Hi, I’m
Tonya Marie Wallace-Cameron
Medical Billing & Coding
Utica,NY
Summary
I’m a hard-working person with an A.A.S. in Health Information Technology from Mohawk Valley Community College (2020) with 21 years of military work experience. Aiming to leverage to successfully fill the Medical Billing & Coding role at your company. Frequently praised as focused by my peers, I can be relied upon to help your company achieve its goals. Resourceful Specialist offering expertise in problem-solving, data analysis and customer service. Adept at quickly learning new technologies and processes for driving success. Proven track record of successfully managing multiple projects and developing innovative solutions.
Overview
32
years of professional experience
Work History
Access Medical Solutions, Inc (40 hours per week)New Hartford, NY
Medical Billing & Coding Specialist, Inc
04.2023 - Current
Job overview
- Provided technical support and troubleshooting assistance for various coding related issues.
- Implemented best practices for managing complex data sets while ensuring compliance with applicable regulations.
- Investigated discrepancies between source documents and coded information in order to correct any errors that may have occurred.
- Prepared comprehensive documentation outlining step-by-step instructions for using various codes as well as their corresponding meanings.
- Utilized Level 1 HCPCS and Level 2 HCPCS systems to complete coding tasks.
- Investigated rejected and denied claims, correcting applicable coding.
- Submitted clean claims to insurance companies electronically to secure payments.
- Translated patient information into alphanumeric and numeric medical codes
- Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
- Maintained high accuracy rate on daily production of completed reviews.
- Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
- Verified proper coding, sequencing of diagnoses and accuracy of Cardiology procedures.c
- Verified proper coding, sequencing of diagnoses and accuracy of Cardiology procedures.
- Acted as liaison between business department, billers and third party payers in resolving billing and reimbursement accuracy.
Mohawk Valley Cardiology P.C. (40 hours per week)
Billing/Authorization Specialist
11.2022 - 04.2023
Job overview
- Demonstrate knowledge of HIPAA by appropriately managing patient confidentiality
- Utilize CMS and InterQual criteria to establish authorizations for members requiring medical services for a Medicare Advantage insurance company
- Build authorization, match ICD-10 codes with their procedure codes
- Obtain verification of insurance coverage and authorizations for clinical visits and surgical procedures for patients
- Perform all components of the official registration including arrival, check-in, and future appointments
- Assign appropriate ICD-10 codes to all to identify diagnoses, research and enter prescriptions as instructed
- Verify daily billing submission reports for insurance, including HCPCS codes, ICD-10 codes, and modifiers
- Enter ICD-10 codes for quotes and authorizations on inpatient outpatient procedures and referrals to outside providers
- Check clinical records for diagnosis and obtain additional clinical information as needed to ensure the prescription authorization meets CMS guidelines
- Document authorization in the EMR system
- Require familiarity with Medent and company base criteria sets
- Maintain HIPAA standards and ensure confidentiality of protected health information
- Coordinate with the insurance company authorization department to resolve CPT code discrepancies.
Rome Health Group (40 hours per week)Rome, NY
Billing Specialist
03.2022 - 11.2022
Job overview
- Processed medical billing using Allscripts and Medent for Rome Medical Group and Article 28 facilities in the CNY region, achieved 98% accuracy and limited client account error
- Created claim appeals against United Health Insurance, utilizing medical records to prove the necessity of procedures, resulting in a 50% overturn of previously denied claims and acquisition of an average of $500 per patient account
- Organized accounts receivable payments from insurance companies and communicated with patients to establish payment plans with overdue customers
- Interact with Billing Supervisors and Auditors on a frequent basis
- Excel in preparing and presenting monthly education for the billing department
- Achieved 98% accuracy in the entry of hospital round charges, following current CPT and ICD-10 code regulations, while ensuring the accuracy of patient’s demographic information.
Upstate Cerebral Palsy (40 hours per week)Utica, NY
Revenue Cycle Specialist/ Medical Biller
01.2021 - 01.2022
Job overview
- Monitors, updates, and processes third-party insurance to guarantee timely reimbursement; maintains an accuracy rate of 99.0%
- Trustworthy expert on best practices, departmental workflows, and billing guidelines
- Expert in medical finance concepts
- Thoroughly research denied claims and provides quick and practical resolutions; results in ZERO delayed or denied claims within areas of responsibility
- Identifies and reports issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and codes that do not conform to approved coding guidelines
- Employed billing system Millin and clearinghouse OnBase to drive daily posting of paper and electronic payments
- Leveraged skills and attention to detail to minimize billing errors by 75% from prior billers
- Maintain updated policies on new EHR/EMR software within 2 weeks.
Upstate Family Health Center (40 hours per week)Utica, NY
Clinic Billing Specialist/Secretary
08.2020 - 11.2020
Job overview
- Protect the security of medical records to ensure that confidentiality is maintained
- Review records for completeness, accuracy, and compliance with regulations
- Retrieve patient medical records for physicians, technicians, or other medical personnel
- Release information to persons or agencies according to regulations
- Plan, develop, maintain, or operate a variety of health record indexes or storage and retrieval systems to collect, classify, store, or analyze information
- Process patient admission or discharge documents
- Enter data, such as demographic characteristics, history and extent of disease, diagnostic procedures, or treatment into computer
- Post medical insurance billings
- Perform multiple billing related/support activities including obtaining physicians’ signatures and spreadsheet development to track outstanding orders, data collection/ analysis and reporting, and compliance with filing mandates.
LutheranCare Nursing Home (40 hours per week)Clinton, NY
Unit Secretary
08.2019 - 11.2019
Job overview
- Answer telephones and direct calls to appropriate staff
- Schedule and confirm patient diagnostic appointments, surgeries, or medical consultations
- Greet visitors, ascertain the purpose of the visit, and direct them to the appropriate staff
- Transmit correspondence or medical records by mail, e-mail, or fax
- Maintain medical records, technical library, or correspondence files
- Perform various clerical or administrative functions, such as ordering and maintaining an inventory of supplies
- Arrange hospital admissions for patients
- Complete insurance or other claim forms
- Release-of-Information Coordinator
- Perform clerical duties such as typing, filing, emailing, and proofreading as required
- Protect examinee rights by maintaining the confidentiality of personal and financial information at all times and in accordance with HIPAA regulations.
United States Army (Active duty)
Medical Logistics Sergeant
04.1992 - 04.2013
Job overview
- Maintain and develop positive business relationships with a customer's key personnel involved in or directly relevant to a logistics activity
- Develop an understanding of customer’s needs and take actions to ensure that such needs are met
- Direct availability and allocation of materials, supplies, and finished products
- Collaborate with other departments as necessary to meet customer requirements, take advantage of sales opportunities, or, in the case of shortages, minimize negative impacts on a military business
- Protect and control proprietary materials
- Review logistics performance with customers against targets, benchmarks, and service agreements
- Direct team activities, establish task priorities, schedule, and track work assignments, provide guidance, and ensure the availability of resources
- Report project plans, progress, and results
- Develop proposals that include documentation for estimates
- Support the development of training materials and technical manuals
- Redesign the movement of goods to maximize value and minimize costs
- Stay informed of logistics technology advances and apply appropriate technology to improve logistics processes
- Train, supervise, and mentor Soldiers and civilians
- Conducted humanitarian mission in Somalia (1992-93) and deployed to Iraq in 2006 and another deployment in 2009 all with deployable combat support hospitals supporting medical supplies and equipment when needed
- Dealt exclusively with military doctors and nurses on medical supply issues for the different wards and clinics in combat support hospitals and resolved these issues successfully under high levels of deployment stress.
Education
Bryant and Stratton College (Online)
Medical Billing and Coding Diploma
06.2023
University Overview
GPA: 4.0
Mohawk Valley Community College
Associate in Applied Science (A.A.S) Health Information Technology
06.2020
University Overview
- Relevant Coursework: ICD-10-CM & ICD-10 PCS Coding Course, CPT and HCPCS Level II Coding Course, Health Information Management Leadership Course, Medical Billing knowledge, Medical Insurance knowledge, HIPAA Compliance knowledge
- GPA: 3.0
Jefferson Community College
Associate in Science (A.A.S) Pre-Nursing
06.2013
University Overview
- Relevant Coursework: Anatomy & Physiology I, Anatomy & Physiology II, Intermediate Algebra
- GPA: 2.6
Skills
- Extensive international travel and interacts well with all cultures and backgrounds
- Master Fitness Trainer/ US Army
- Antiterrorism Officer/ US Army
- Excellent computer skills - proficient with Microsoft Office Suite and Google Suite
- Long distance runner having finished in the top 10 in 2 out of 5 marathons
- Extensive knowledge of HIPAA Compliance
- Loves working and motivating people
- Extensive knowledge of Medical Billing
- Extensive knowledge of Medical Coding
Work Preference
Work Type
Full TimeWork Location
RemoteOn-SiteImportant To Me
Work-life balanceCareer advancementTeam Building / Company RetreatsTimeline
Medical Billing & Coding Specialist, Inc
Access Medical Solutions, Inc (40 hours per week)
04.2023 - Current
Billing/Authorization Specialist
Mohawk Valley Cardiology P.C. (40 hours per week)
11.2022 - 04.2023
Billing Specialist
Rome Health Group (40 hours per week)
03.2022 - 11.2022
Revenue Cycle Specialist/ Medical Biller
Upstate Cerebral Palsy (40 hours per week)
01.2021 - 01.2022
Clinic Billing Specialist/Secretary
Upstate Family Health Center (40 hours per week)
08.2020 - 11.2020
Unit Secretary
LutheranCare Nursing Home (40 hours per week)
08.2019 - 11.2019
Medical Logistics Sergeant
United States Army (Active duty)
04.1992 - 04.2013
Bryant and Stratton College (Online)
Medical Billing and Coding Diploma
Mohawk Valley Community College
Associate in Applied Science (A.A.S) Health Information Technology
Jefferson Community College
Associate in Science (A.A.S) Pre-Nursing
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