# Proficient Medical Biller and Coder with HEDIS Experience



## elizabeth_stone1962@yahoo.com (Apr 13, 2016)

Elizabeth M. Stone

elizabeth_stone1962@yahoo.com

Professional Summary

Highly efficient Medical Biller with experience in Cardiology, Gastroenterology, Internal Medicine, Mental Health, Pediatrics, Surgery, and Urology. Excellent multi tasker and demonstrated team player with a positive attitude. Seeking a position in Billing and Coding.


Skilled Highlights

HIPAA compliance                                                                                         Strong planning skills and work ethics
Quality assessment of coded data                                                             Deadline driven
ICD-9 and ICD-10, CPT, HCPCS and PCS coding                                        Good written and oral communication
Electronic Medical Record (EMR) software                                               Exercises good judgement
Anatomy/Physiology knowledge

Accomplishments

Successfully fulfilled a temporary position cleaning up coding and billing errors to collect old claims while staff transitioned into EPIC software. Hired permanent before project ended.
Found a need for Insurance SOP’s within the office and obtained approval to implement. This allowed staff to perform daily tasks while being informed of constant changes in the billing world.
Gained trust in department as a go-to person when needing questions answered
Gained trust from Management in the ability to take large accounts that failed to get paid and have the claim issues resolved, resulting in payment

Professional Experience

Wake Med Health and Hospitals Specialty Physicians Group
Patients Account Representative-Physicians Billing Follow-up                05/2014-present
919-350-8000                                                                                            
•	Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
•	Accurately entered procedure codes, diagnosis codes and patient information into billing software.
•	Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature.
•	Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.
•	Consistently ensured proper coding, sequencing of diagnoses and procedures.
•	Quickly responded to staff and client inquiries regarding CPT codes.
•	Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house.
•	Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.
•	Maintain strictest confidentiality; adhering to all HIPAA guidelines/regulations.

Altegra HEDIS Project Coder   e4e Staffing  (contract remote)                                      present

Review medical records for measure requirements code for metrics and analysis, for provider and patient compliance with Insurance plan are met. Thus to insure star ratings for the insurance company are high enough to me the global standards. 


United Healthcare, Cary North Carolina (Randstad Staffing) Contract	                             
Clinical Quality Performance Management Assistant (HEDIS)               01/2013 -03/2014          

•	Obtained medical records from Providers via phone contact and faxes
•	Active interaction with Provider practices
•	Used ISETS, ILEADS, RightFax,UDI Fax, EXCEL, PowerPoints and various internet sites to research information for effectiveness and completion
•	Ability to identify correct and missing data from Medical Records for Healthcare Effectiveness Data Information Sets (HEDIS)
•	Team Player resource for other team members

Saguaro Management and Accounting LLC, Raleigh North Carolina	11/2011 –05/2012 
Accounts Receivable Billing Specialist    (919) 256-0824                                         laid off
•	Worked primarily with Medicare and Medicaid Insurances
•	Reviewed CPT and ICD-9 codes for accuracy and completeness
•	Entered data through various programs to submit via Gateways for scrubbing 
•	Pulled reports for write offs, denial and aged accounts, cross referenced RA’s and EOB’s with patient’s accounts for completion  
•	Claim follow-up and denials
•	Utilized IVR, NECS and various insurance company sites to insure benefits available, to check claim status; NPI’s checked via NPI registration
•	Charge Entry, Payment Posting, Registration and Insurance Verification

Contracted and Temporary Positions       05/2005-07/2011

Waverly Hematology and Oncology Cary, North Carolina Medical Assistant			
Student Kaplan University   Associates Medical Office Management     Student          
Laboratory Corporation of America Cary, North Carolina   Patient Service Technician Specialist 	      
On Assignment Staffing Cary North Carolina Traveling Phlebotomist for US Marshall Office	                      
Veterans Administration Hospital Fayetteville NC     Volunteer in Laboratory     

Education
Kaplan University   Davenport, Iowa    2011
Associate of Applied Science in Medical Office Management    
Graduated Cum Laude with GPA 3.65, Academic Scholar Award, Presidents List and Deans List

Fayetteville Technical College      Fayetteville, North Carolina       2015                                         
 ICD-10 Coding

Central Carolina Community College    Lillington, North Carolina    2005
Phlebotomy/Electrocardiogram certificate
QuickBooks 2012

 Software

Excel, PowerPoint, Microsoft word 2007 Adobe and other programs, Internet, Microsoft Outlook, Quick Books 2012

EMR programs: EPIC, Alscripts, 3M, RealMed,  I Know Med, E-Clinical, Padegonia, Kareo, Pod Med, MISYS, NexGen; Medical Claims programs: iLEAD, iSET, Hybrid Health (QSHR), QMARK; Online resources: HMEdata, Palmetto E-Service-Medicare, HHS-Medicaid, various insurance sites,


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