I am a certified AAPC and AHIMA medical coder with 8 years of experience and counting. I am very familiar and updated with the most current ICD-10 coding guidelines, CPT codes, modifiers, performance measurement codes (HEDIS/ Category II codes), HCPCS code (Supplies codes). As a Registered nurse, I have a strong background in the applications of medical terminologies and procedures in outpatient and inpatient settings. One of my most significant career advancements is becoming a Claim denial management specialist which gave me a holistic view of revenue cycle management phases.
Understands issues when coding guidelines, government policies, state laws, CMS/Medicare,
private insurance policies, and the facility policies are sometimes against the good interest of each other which we need to explain and inform our employers to come up with the decision we will follow.
Became a lead coder and point of contact in my previous job and currently holding a managerial position in my current job.
Very interested in researching services updates to help increase reimbursements and to be updated with ever-changing codes and policies to fix and prevent denials and hasten reimbursements.
Insurance Billing Process and guidelines, clearinghouse rejections, credentialing, prior authorization, insurance verification, etc.
Work Experience
Ensures Timely filing/submission of claims.
Performs documentation review.
Performs Billing Quality Assessment.
PProvides training tools and evaluation forms.
functions of Medical billing.
1. Patient Registration
2. Insurance Verification
3. Pre Authorization Request and verification
4. Charge Posting / Super bill review
5. Evaluation of valid HCPCS codes, ICD 9-10 and Modifier
6. Fixing Rejected Electronic claims
7. Checking clearing house reports (Phicure, Trizedo, Availity)
8. Provider PIN calling ( for verifying provider TAX id, NPI and billing address)
9. EOB and check search via websites and batches
10. Payment Posting of Insurance and Patient
11. AR Follow up on denied claims via call or websites
12. Appeal project
13. Collection / Refund / Over-Payment
14. Scheduling new patients
Project Specialization
1. Daily Audit of sample size.
2. Publishing weekly/monthly dashboard, production ,and accuracy report to clients
3. Working on new ideas to improve process accuracy and productivity.
4. Doing calibration with QCA, Team and Client to reduce process variances.
5. Tracking or identifying root causes of insurance denials and low revenue.
6. Conducting PKT (Process knowledge test) to bridge the knowledge gap.
7. Suggesting corrective actions, implementing solutions and reviewing implementation
8. Providing feedback and refresher training to iindividualsand tteams
9. Doing remotely and side by side aaudits of associates
10. Analyzing trends in quality check and fixing the bulk issue right away.
I have worked for below mentioned specialties of provider’s claim.
Specialties
1. Physical Medicine and Rehabilitation
2. Behavioural Care Solution/Mental Health
3. Weight loss
4. Genetic Testing Laboratory
5. DME
6. Dental
7. Physical Therapy
8. Skill Nursing Facility
9. Doctor's clinic or office setting
-----------ernal Medicine
Work Experience of Software
I have work experience of below mentioned software in medical billing. I have very good grasping power so it does not take much time to navigate new software. I am comfortable and adaptive with using many different types of medical billing software.
1. Waiting Room Solutions
2. AdvancedMD
3. Zendesk
4. Xifin
5. Phicure
6. Trizetto
7. EZ Claim
8. Office Ally
9. Kareo
10. Simple Practice
Major follow up Insurance
1. Medicare
2. Medicaid
3. BCBS
4. Aetna
5. UHC
6. Cigna
7. Molina
8. Tricare
9. ChampVA
10. Humana
