Motivated HIM specialist with over 8 years of experience in direct patient care, health operations management, insurance verification and authorization, billing, and coding. Expertise in DRG-patient assignment, ICD-10, CPT, and HCPCS coding. Highly skilled in analyzing and validating patient information, diagnoses, and billing data. Demonstrated leadership skills that enable the processing of high volumes of patient information to achieve results driven success.
Skills
Regulatory compliance understanding
CMS guidelines
Revenue cycle management
Insurance Billing
Insurance Forms Processing
Benefits Explanation
Insurance Authorizations
Certified Medical Coder
ICD-10 Coding
CPT coding
DRGs Patient Assignments
HCPCS Compliance
EMR Systems
Epic Systems
Records Management
Records Review
Compliance Verification
Microsoft Office
Experience
Insurance Coordinator, 11/2015 - Current Lehigh Valley Hospital & Health – Phillipsburg, PA,
Validated insurance and advised patients of benefits and coverage.
Verified patients had proper insurance coverage prior to procedures or appointment scheduling.
Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
Followed specific security rules and guidelines to protect sensitive data, including patient medical records and payment card information.
Checked documentation for appropriate coding, catching errors and making revisions.
Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
Complied with insurance regulations dictated by local, state and federal agencies.
Secured pre-authorizations and pre-certifications for procedures.
Filed insurance claims by obtaining and entering data related to patient, insurance provider and medical code for procedures and services provided.
Office Staff Nurse, 12/2014 - 11/2015 Regal Cinemas Corporation – Fort Walton Beach, FL,
Reviewed patient chart information before visit, ordered necessary laboratory tests, escorted patient to examination room, obtained vital signs and conducted interview to update records.
Responded to routine patient inquiries, assessed patient needs, conferred with physician regarding care plan and assisted physician with sensitive components of examinations.
Measured average of 30 patients' weight, height, body temperature, pulse rate and blood pressure each day.
Inoculated and vaccinated patients to immunize against communicable diseases.
Prepared and administered vaccines, medications, controlled substances and narcotics as prescribed and sterilized and stored instruments, equipment and supplies.
Completed electronic documentation, prior insurance authorizations and scheduling of appointments for patients prescribed for diagnostic and therapeutic services from specialists.
Educated patients in regards to office policies, medical procedure steps, recovery measures and medication instructions.
Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
Coordinated with healthcare team to establish, enact and evaluate patient care plans.
Stocked clinical workstations and procedure rooms with necessary supplies.
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