Logical and efficient Medical Coder and Billing Professional with skills in abstracting information and assigning codes and procedures related to medicine, surgery, radiology and pathology with experience of complete billing cycle. Analytical skills necessary to interpret and apply knowledge.
*Well-organized, able to manage time and priorities in multi-task environments. Exceptional interpersonal communication skills - fosters effective working relationships with clients, coworkers, and supervisors.
*Demonstrated ability to liaise with insurance companies.
*Well versed with ICD10/CPT /HCPCS coding terminology, anatomical and physiology
*Thorough understanding of computerized billing, ability to process insurance claims, authorizations and complete life cycle of an insurance claim and posting to patients accounts.
* Ability to work with limited supervision accurately and efficiently at all times, including those of high processing volume.
*Ability to multi-task and manage time efficiently under the pressure of deadlines.
*Highly motivated to work in team-oriented and collaborative environment. Sensitivity to the confidential nature of the data and proprietary company information. In depth knowledge of medical records, ethics and HIPPA
Patient Services ICD-10-CM
Insurance Verification CMS 1500
CMS 1450 (UB-04)
EOB / COB
Collections Government Payers
Third- Party Payers
Electronic Medical Records (EMR / EHR)
Greenway Connect, Practice Fusion, Advance MD
Co-Payments and Deductibles
Anatomy & Physiology
Managed Care (HMO, PPO, and POS)
Insurance Claim Processing
Insurance Billing Procedures
MS Word / Office / Excel
Medical Office Procedures
10-Key Skills, HEDIS
PHYSICIANS BUSINESS GROUPDecember 2016 to September 2017Biller and Coder Specialist Tampa, FL
Conducts physician chart audits to identify incorrect coding, prepares reports of findings and any compliance issues.
Communicate with physicians and center administrators regarding billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation.
Posting charges, following up on outstanding claims, receiving and posting insurance and patients payments, preparing and filing appeals, account reconciliation and researching account balances.
Work denied claims.
Read and understand an EOB and remits.
Calling Insurance companies to inquire about the denials.
Worked with Practice Fusion and Advanced MD.
FREEDOM HEALTH PLANSSeptember 2016 to November 2016Customer Service Representative Tampa, FL
Performing Investigation, analysis and follow-up member's account for Freedom and Optimum health plans.
Answering member's questions about health insurance plan, copayments and deductibles,.
EOB-EOP, Enrollment for 2017.
Explaining Claims and Authorizations.
Verify HIPAA forms, POA verifications.
Working with IKA program, IMG program, DMS, CRM Medicare applications.
Verifying the correct ICD-10 and CPT codes was posted in the 1500 form.
Dr. Julia Barriga, Pediatrician EXTERNSHIP PRACTICEAugust 2016 to September 2016Reviewed EOB/EOP Tampa, FL
Update monthly and Daily activities in the Super bills Reconciliation.
Insurance verifications for different insurance plans.
CitigroupApril 2003 to August 2013Customer Service Representative Gray, TN
Performed investigation, analysis and follow-up for collection of overdue accounts and customer service.
Secured collection of accounts, negotiated payment arrangements, and accepted payments.
Answered account inquiries and ensured accuracy of information.
Complied with Federal and state laws and provisions.
Answered members questions about their Home Depot Credit Card.
Education and Training
Ultimate Medical Academy07/2016Medical Billing and CodingTampa, FLMedical Billing and Coding 4.00
Electronic Data Processing CollegeBachelor Degree: Computer ProgrammingSan Juan, PRComputer Programming
Electronic Data Processing CollegeAssociate Degree: Business AdministrationSan Juan, PRBusiness Administration
Bilingual - Fluent in English and Spanish
Activities and Honors
▪ ▪ ▪ National CPC-A Certification ▪ ▪ ▪
10-Key, account reconciliation, Anatomy, Billing, CMS, CPT, Credit, CRM, customer service, Data Entry, Documentation, Electronic Medical Records, Fluent in English, filing, forms, Government, ICD-10, ICD-9, Insurance, Medical Billing, Medical Coding, Medical Terminology, Excel, Office, MS Word, Office Management, Physiology, policies, POS, coding, Read, receiving, researching, Scheduling, Spanish