medical coding and billing specialist resume example with 11+ years of experience

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

Knowledgeable medical office professional talented at correcting and resubmitting claims, preparing patient charts and reviewing health records to identify proper diagnosis codes for billing. Offers background in reviewing, analyzing and managing medical record information to obtain prior authorizations from insurance companies and ensure payment. Organized and professional boasting with 10 years of comprehensive experience in financial and medical industries Committed to maintaining 100% accuracy in job performance. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

  • Management accounting
  • Financial Data
  • Insurance Verification
  • Medical Records
  • Medical Billing
  • Microsoft Office skills
  • International Classification of Diseases (ICD-10)
  • Healthcare Common Procedure Coding System (HCPCS)
  • Current Procedural Terminology (CPT)
  • Medical Terminology
  • Computer Skills
  • Communication Skills, Attention to Detail & Organization Skills
  • Active Listening, Problem-Solving Skills & Time Management
  • Proactivity and Self-Motivation
  • Collaboration and Teamwork
  • Adaptivity and Agility
  • Reporting skills.
  • Business Forecasting
  • Investment Consulting and Planning
  • Report Preparation and Presentation
  • Operational Efficiency
  • Adobe Software
  • Compiling Data
  • Data Research and Analysis
  • Monthly Forecasting
  • Budgeting and Variance Analysis
  • Expense and Revenue Analysis
  • Accounts Payable and Receivable
  • Organizational Management Principles
  • Business Administration
Work History
Medical Coding and Billing Specialist, 01/2021 - Current
Pacific Dental Services Castro Valley, CA,
  • Independently researches, analyzes, generates, and corrects Veteran's First Party co-payments for care as it pertains to variety of complex VA programs
  • Accesses, retrieves, manages, and processes various revenue reports
  • Accesses various menu options to identify, review, analyze, process and complete First Party and Third-Party encounters and billing-related activities
  • Resolves operational problems as it applies to Veterans accounts in other units within CPAC
  • Applies analytical and evaluation techniques to determine if First Party co-payment bills are appropriate
  • Promoted consistent accuracy of billing information by reconciling accounts monthly
  • Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity
  • Reviewed patient records identified medical codes and created invoices for billing purposes
  • Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
  • Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
  • Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
  • Used software to assign procedure and diagnostic codes to patient records for billing purposes.
  • Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient and inpatient medical records.
  • Billed Observations and Inpatient Professional Services at average rate 16 per hr.
  • Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications
  • Researches and analyzes data needs for reimbursement
  • Analyzes medical records and identifies documentation deficiencies
  • Serves as resource and subject matter expert to other coding staff
  • Reviews and verifies documentation supports diagnoses, procedures and treatment results
  • Identifies diagnostic and procedural information
  • Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes
  • Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines
  • Identifies discrepancies, potential quality of care, and billing issues
  • Assists lead or supervisor in orienting, training, and mentoring staff
  • Provides ongoing training to staff as needed
  • Handles special projects as requested
  • Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
Reception and Billing Team Leader, 05/2018 - 04/2020
Optum Care City, STATE,
  • Answer questions and help other employees on procedures, policies, directives
  • Give training to established and new employees in accordance with established procedures and practices
  • Distribute workload among employees, assure that each employee has enough work to keep busy
  • Provide support to team members with creative solutions to complex challenges regarding scheduling, conflict resolution and medical care
  • Pending of the status and progress of team members work, and adjust in accordance with priorities, obtaining assistance from the manager on problems that may arise
  • Reviews encounter data forms for accuracy of procedure codes and diagnostics codes, required modifiers, and other encounter data
  • Coordinated patient scheduling, check-in, check-out and payments for billing
  • Scheduled, rescheduled and handled cancelled appointments for patients
  • Assessed and forwarded procedure and service details to correct coding staff to best categorize for insurance purposes
  • Completed and filed financial documentation for accounting purposes
  • Participated and led employee staff meetings, reporting trends in procedures, advising leadership on resources needed and receiving information to be disseminated
  • Completed clerical duties and tasks for clinic administration
  • 00am – 6:00pm
  • Adeptly managed multi-line phone system and pleasantly greeted all patients.
  • Balanced employee availability, customer schedules and maximum load levels when scheduling appointments.
  • Assisted internal staff with clerical and administrative needs to maximize efficiency and team productivity.
  • Prepared variety of different written communications, reports and documents.
  • Monitored and screened visitors to verify accessibility to inter-office personnel.
  • Collected and distributed messages to team members and managers to support open communication and high customer service.
  • Answered questions and addressed, resolved or escalated issues to management personnel to satisfy customers.
  • Resolved customer problems and complaints.
Sales & Financial Analyst, 03/2010 - 04/2018
Banco Popular Of Puerto Rico City, STATE,
  • Evaluated competitor data and statistics to develop business investment strategy and drive growth
  • Created business plan and identified target customers by interacting on phone and in person, handling basic inquiries and providing quotes
  • Developed and delivered engaging sales presentations to convey product benefits
  • Broadened territories and negotiated successful contracts by seeking out new clients and utilizing leadership skills
  • Recommended accurate and effective solutions to customers after identifying problems
  • Evaluated inventory and delivery needs, optimizing strategies to meet customer demands
  • Utilized professional sales techniques to persuasively communicate with clients
  • Devised and implemented product strategies for filling market gaps and driving consistent sales
  • Implemented marketing strategies and techniques, increasing revenue and customer satisfaction
  • Efficiently solved complex problems that impacted management
  • Met frequently with technical, product management and service personnel to stay current on company offerings and business policies.
  • Engaged with customers to build rapport and loyalty.
  • Trained and developed new hires in company processes, product knowledge, customer service and selling techniques.
BBA: Business Administration And Management, Expected in 06/2006
Sistema Universitario Ana G Mendez - Universidad Del Este - Carolina, PR
Status -
BBA: Human Resources Management , Expected in 06/2024
Sistema Universitario Ana G Mendez - Online - Cupey, PR
Status -
English :
Professional Working:
Negotiated :
Spanish :
Native or Bilingual:
Negotiated :

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Resume Overview

School Attended

  • Sistema Universitario Ana G Mendez - Universidad Del Este
  • Sistema Universitario Ana G Mendez - Online

Job Titles Held:

  • Medical Coding and Billing Specialist
  • Reception and Billing Team Leader
  • Sales & Financial Analyst


  • BBA
  • BBA

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