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A Certified Medical Coder, Claims Auditor, AR Specialist, Biller, and Customer Service Representative with over 9 years of experience in US healthcare environment.
CERTIFICATIONS:
> CPC (Certified Professional Coder by AAPC)
MEDICAL CODING SPECIALIZATION
- Command over CPT, ICD-10 CM, HCPCs-II, HCC V24 and V28 risk adjustment models.
- Highly skilled in analyzing and validating patient information, diagnosis, procedures and coding them with the highest specificity and accuracy.
- Identify and code Hierarchical Condition Categories (HCC) based on documented conditions to ensure proper risk adjustment and reimbursement accuracy.
- Have complete understanding and knowledge of compliance regulations, HIPAA and PHI requirements.
MEDICAL BILLING SPECIALIZATION
- Processing of insurance claims, claims creator, follow up on claims, sending appeals for denied claims.
- Assess patient's eligibility for insurance claims.
- Review all insurance credit-balances through take back initiation, refund and payment re-application.
- Monitor and execute work on assigned claim work lists and Account Receivable (AR) worklists.
- Contact payers for appeals, documentation needs, reconsiderations, adjustments, claim corrections and any other activity that pertains to resolution of claim issues.
SOFTWARE's and APPLICATIONS Expertise
* EPIC
* MEDITECH
* CERNER
* DATAVANT
* EMR/EHR Billing Softwares
* CITRIX
* VMWare
* Availity
* Navinet
* NThrive
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