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medical billing specialist coding specialist resume example with 16+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary

Accurate Billing/Coding Specialist performs all aspects of medical billing, including coding, charge entry, transmission, correction and resubmission. Brings 14 years of experience in working hand-in-hand with front office to validate proper information for claims processing. Detail-oriented and helpful professional with expertise in resolving billing issues and reviewing claim denials.

Dedicated employee known for punctuality, pursuing employment options where good customer service and positive attitude will make a difference.

Skills
  • Knowledgeable in Advanced Md, EHS Success Greenway, Intergy, Medical Manager, TDOCS, Dentrix
  • Excel
  • Microsoft word
  • Medical record security
  • Documentation oversight
  • Data entry
  • Healthcare claim coding
  • Dental claim coding
  • Patient data identification
  • Medical terminology
  • Insurance billing
  • Insurance Verification
  • Billing procedures
  • Organizational skills
  • Friendly, positive attitude
  • Basic math
  • Working collaboratively
Experience
Medical Billing Specialist/Coding Specialist, 04/2019 - Current
Community Health System Crestview, FL,
  • Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
  • Maintained updated knowledge of coding requirements, which included continuing education.
  • Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
  • Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
  • Verified proper coding, sequencing of diagnoses and accuracy of procedures.
  • Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
  • Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
  • Utilized Level 1 HCPCS and Level 2 HCPCS systems to complete coding tasks.
  • Maintained strict confidentiality with adherence to HIPAA guidelines and regulations.
  • Reviewed claims for coding accuracy.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.
  • Submitted and accurately processed insurance claims with related medical code verifications and assessments.
  • Handled billing for full complement of practice providers.
  • Called insurance companies to verify patient benefits.
  • Applied HIPAA privacy and security regulations while handling patient information.
  • Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
  • Scheduled patients and updated insurance, payment history and personal information.
  • Reviewed overpayments and processed refunds to be sent to patients and insurance companies.
  • Documented payment denials in appropriate billing system and updated account managers swiftly.
  • Downloaded, printed and batched electronic funds transfers and remits. Payers Bc/Bs, Medicare Part A & B, Commerical plans, Manage Care Plans HMO, PPO, Medicaid, Tricare.
  • Handled all electronic and manual payments and adjustments, ensuring that data was accurately posted.
  • Answer all patient questions regarding account balances.
  • Transmit electronic statements.
Medical Billing Manager, 03/2007 - 03/2019
Pulmonary Medical Clinic Of Jackson, P.C City, STATE,
  • Posting provider charges, assigning proper E&M code, Diagnosis codes and if a modifier is required.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.
  • Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
  • Maintained updated knowledge of coding requirements, which included continuing education.
  • Helped patient's to bring accounts into good standing by implementing payment plans.
  • Prepare and work any rejected claims before submitting to clearinghouse. Verified final claim submissions.
  • Download all electronic insurance remits.
  • Posting of all insurance Eob's and working any denials. Payers Bc/Bs, Medicaid plans, Tricare, Medicare Part A & B, Manage care plans HMO,PPO, Commerical plans.
  • Followed detailed end-of-month accounting procedures to verify proper balancing of accounts and readiness for new month.
  • Completed month-end and year-end closings, kept records audit-ready and monitored timely recording of accounting transactions, which was reported to the office manager.
  • Completed daily computer backups.
  • Helped customers to bring accounts into good standing by implementing payment plans.
  • Maintained strict confidentiality with adherence to HIPAA guidelines and regulations.
  • Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
  • Maintained updated knowledge of coding requirements, which included continuing education and certification renewal.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.
  • Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
  • Verified final claim submissions by comparing account charges with documentation.
Dental Insurance Biller, 11/2005 - 03/2007
Buchanan Dental Center City, STATE,
  • Accurately input procedure codes, diagnosis codes and patient information.
  • Checked claims coding for accuracy with ICD-10 standards.
  • Reconciled codes against services rendered.
  • Assessed billing statements for correct diagnostic codes and identified problems with coding.
  • Submitted claims to insurance companies.
  • Prepared and posted weekly payments from insurance plans. Managed all payments processing, and collections tasks.
  • Collected, posted and managed patient account payments.
  • Generated statements.
  • Enforced compliance with organizational policies and federal requirements regarding confidentiality.
  • Performed insurance verification, pre-certification and pre-authorization.
  • Eliminated inaccuracies in accounts payable payments by verifying information prior to generating checks and electronic payment transfers.
  • Performed accurate and fully compliant monthly closing processes, accruals and journal entries.
  • Maintained accounting ledgers by verifying and posting account transactions.
  • Gathered information to produce accounts payable reports for review.
  • Answered Patient questions to maintain high satisfaction levels.
  • Managed all payments processing, invoicing and collections tasks.
  • Enrolled provider in
  • Completed and processed applications for enrollment of various insurance plans and re-credentialing.
  • Prepared Daily bank deposits.
Education and Training
High School Diploma: , Expected in 05/1984
-
South Side High School - Jackson, TN
GPA:
Status -
: , Expected in
-
Jackson State Community College - Jackson, TN
GPA:
Status -
CPC: , Expected in 03/2022
-
American Academy of Professional Coders - ,
GPA:
Status -

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Resume Overview

School Attended

  • South Side High School
  • Jackson State Community College
  • American Academy of Professional Coders

Job Titles Held:

  • Medical Billing Specialist/Coding Specialist
  • Medical Billing Manager
  • Dental Insurance Biller

Degrees

  • High School Diploma
  • Some College (No Degree)
  • CPC

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