I am a Medical Coding Specialist with over 11 years? experience working in various fast-paced, results driven, healthcare environments. My current position involves reviewing medical records to capture ICD-9 codes from the 2013 service year. These codes are then submitted to CMS as part of the HCC Risk Adjustment program which in return pays WellCare Health Plans to provide medical coverage for the member. I also have extensive experience with medical billing and coding, working insurance rejections, medical claims processing. I work closely with internal and external customers to encourage excellent customer service and maintain continued business relations; eager to contribute advanced communications and problem solving skills toward optimizing the goals of a progressive employer.
Certification
CPC
Membership
AAPC (February 2012- Present)
Education
Ultimate Medical Academy
Tampa, FL
November 2010 to February 2012
Medical Billing & Coding Specialist
Graduating GPA: 3.0
Skills
? Attention to detail and ability to perform well in a fast-paced environment.
? Experienced in multi-account management
? Medical Terminology, Authorization Processes, Case/Disease Management, ICD-9, Preparing for ICD-10,CPT, CMS/HIPPA Guidelines and HCPCS
? Positive attitude and a strong commitment to customer service
? Excellent analytical/decision-making skills, verbal and written communication skills
? Claim coding, claim processing or billing in a healthcare environment
? Strong knowledge of electronic medical records/billing systems
? Billing expertise in UB04, CMS-1500 and/or other healthcare services
Employment History
3/2015 to 6/2015 Moffitt Cancer Center Tampa, FL
Claims Coding Analyst
Resolve denials related to billing/coding issues in regard to the Outpatient Code Editor (OCE) and the Correct Coding Initiative (CCI) by reviewing medical documentation, medical coding classification systems, and specific insurer/payor requirements for compliance with billing regulations. Analyze denials and provide feedback to Supervisor of Denial Recovery. Coordinate solutions with Patient Financial Services, Health Information Management, Information Technology, and Revenue Integrity. Analyzes records of discharged patients to ensure compliance with hospital policy and regulatory requirements. Audits medical records and other documentation; write appeals to facilitate reversal of denied claims. Conducted analytical research and provides expertise on pricing/reimbursement and market access for new and existing products.
6/2014 to 3/2015 WellCare Health Plans Tampa, FL
Medical Coding Specialist
Codes, abstracts and analyzes inpatient and/or outpatient medical records using International Classification of Diseases, Ninth Revision (ICD-9). Follow the Official ICD-9 guidelines for Coding, Reporting and CMS risk adjustment guidelines. Understands the impact of ICD-9 codes on the CMS HCC risk adjustment Codes to the highest level of specificity, productivity and accuracy standards.
6/2013 to 6/2014 WellCare Health Plans Tampa, FL
Claims Coding Specialist
Review, research, and respond to written and emailed correspondence from providers, both professional and institutional, regarding claim denials based on clinical coding policies. Act as a subject matter expert and handles more complex provider issues. Thoroughly research post payment claims and take appropriate action to resolve identified issues within turnaround time requirements and quality standards. Helped on special projects when requested, training of new associates and creating test scenarios for iCES. Act as a liaison with other departments when additional clarification is needed about claims payment policy disputes. Act as the teams Celebration Committee Coordinator to help promote a positive work environment.
8/2012 to 6/2013 WellCare Health Plans Tampa, FL
Member Engagement Representative
Conducts outreach calls to Member that may be potential Case/ Disease Management candidates. Performs assessment to ensure the potential Member qualifies for a program. Answer inbound calls in reference to potential Case/Disease Management Candidate. Answers routine telephone calls and direct to appropriate person/department. Collect and verify information concerning eligibility, provider status, benefit coverage, coordination of benefits and subrogation. Apply policies and procedures, regulatory requirements and accreditation standards.
5/2011 to 8/2012 WellCare Health Plans Tampa, FL
Intake Ops Coordinator
Effectively handles authorization requests and inquiry phone calls from providers, balancing excellent customer service with efficiency. Utilized online tools to determine authorization requirements based on the type of service requested, the location of the service and the provider specifics. Accurately enters authorization requests into EMMA. Based on authorization rules and urgency, either approves the authorization request or escalates to a nurse for review. Communicated authorization specific to providers either verbally on the phone calls or written through fax. Helped with the training of new associates.
Certification
CPC
Membership
AAPC (February 2012- Present)
Education
Ultimate Medical Academy
Tampa, FL
November 2010 to February 2012
Medical Billing & Coding Specialist
Graduating GPA: 3.0
Skills
? Attention to detail and ability to perform well in a fast-paced environment.
? Experienced in multi-account management
? Medical Terminology, Authorization Processes, Case/Disease Management, ICD-9, Preparing for ICD-10,CPT, CMS/HIPPA Guidelines and HCPCS
? Positive attitude and a strong commitment to customer service
? Excellent analytical/decision-making skills, verbal and written communication skills
? Claim coding, claim processing or billing in a healthcare environment
? Strong knowledge of electronic medical records/billing systems
? Billing expertise in UB04, CMS-1500 and/or other healthcare services
Employment History
3/2015 to 6/2015 Moffitt Cancer Center Tampa, FL
Claims Coding Analyst
Resolve denials related to billing/coding issues in regard to the Outpatient Code Editor (OCE) and the Correct Coding Initiative (CCI) by reviewing medical documentation, medical coding classification systems, and specific insurer/payor requirements for compliance with billing regulations. Analyze denials and provide feedback to Supervisor of Denial Recovery. Coordinate solutions with Patient Financial Services, Health Information Management, Information Technology, and Revenue Integrity. Analyzes records of discharged patients to ensure compliance with hospital policy and regulatory requirements. Audits medical records and other documentation; write appeals to facilitate reversal of denied claims. Conducted analytical research and provides expertise on pricing/reimbursement and market access for new and existing products.
6/2014 to 3/2015 WellCare Health Plans Tampa, FL
Medical Coding Specialist
Codes, abstracts and analyzes inpatient and/or outpatient medical records using International Classification of Diseases, Ninth Revision (ICD-9). Follow the Official ICD-9 guidelines for Coding, Reporting and CMS risk adjustment guidelines. Understands the impact of ICD-9 codes on the CMS HCC risk adjustment Codes to the highest level of specificity, productivity and accuracy standards.
6/2013 to 6/2014 WellCare Health Plans Tampa, FL
Claims Coding Specialist
Review, research, and respond to written and emailed correspondence from providers, both professional and institutional, regarding claim denials based on clinical coding policies. Act as a subject matter expert and handles more complex provider issues. Thoroughly research post payment claims and take appropriate action to resolve identified issues within turnaround time requirements and quality standards. Helped on special projects when requested, training of new associates and creating test scenarios for iCES. Act as a liaison with other departments when additional clarification is needed about claims payment policy disputes. Act as the teams Celebration Committee Coordinator to help promote a positive work environment.
8/2012 to 6/2013 WellCare Health Plans Tampa, FL
Member Engagement Representative
Conducts outreach calls to Member that may be potential Case/ Disease Management candidates. Performs assessment to ensure the potential Member qualifies for a program. Answer inbound calls in reference to potential Case/Disease Management Candidate. Answers routine telephone calls and direct to appropriate person/department. Collect and verify information concerning eligibility, provider status, benefit coverage, coordination of benefits and subrogation. Apply policies and procedures, regulatory requirements and accreditation standards.
5/2011 to 8/2012 WellCare Health Plans Tampa, FL
Intake Ops Coordinator
Effectively handles authorization requests and inquiry phone calls from providers, balancing excellent customer service with efficiency. Utilized online tools to determine authorization requirements based on the type of service requested, the location of the service and the provider specifics. Accurately enters authorization requests into EMMA. Based on authorization rules and urgency, either approves the authorization request or escalates to a nurse for review. Communicated authorization specific to providers either verbally on the phone calls or written through fax. Helped with the training of new associates.