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Click here or scroll down to respond to this candidateSKILLSPROFESSIONAL SUMMARYWORK HISTORYCandidate's Name
(240) 586-2816 EMAIL AVAILABLE Lake In The Hills, IL 60651 Committed, responsible, and organized Medical Biller and Coder with more than16 years of experience in interacting with staff, patients, and insurance companies. Hardworking, educated, and willing to go extra mile to complete tasks. Knowledgeable medical office professional talented at correcting and resubmitting claims, preparing patient charts, and reviewing health records to identify proper diagnosis codes for billing. Analyzing and managing medical record information to obtain prior authorizations from insurance companies and ensure payments.Competence in CPT Coding andModifiers,ICD10-CM, HCPCS andPCS / Outpatient and InpatientCodingKnowledge of Insurance Rules andRegulationsMedical Billing ProcessingPast Due Balance ManagementCompetence in MedicalTerminology,Anatomy, Physiologyand PharmacologyComplex Problem-SolvingTeamworkActive and Fast LearningFamiliarity with HIPPA andMedical Release of Information ROITime ManagementAccuracy and Attention to DetailsExcellent Communication AbilitySep 2022 - CurrentCrystal Lake, ILDirector of Billing Operation / Northern Illinois Foot & Ankle Specalists Managing onsite billing department employees and outsourced billing department team members in Philippine. (Hello-Rache Virtual Assistant) Managing coding and billing of charges for 13 locations and 22 active doctors.Implementing new processes and procedures in billing department resulting in significant decrease in overdue claims and 85% increase in timely payment rates.Improving billing operations by analyzing data and identifying areas for improvement.Direct training and management of new Billing Department staff. Supervising of Revenue Cycle Management and Account receivable. Interacting with physicians and other healthcare staff to train and make them up to date with insurances policies and coding guidelines by publishing Billing Bulletin bi-weekly.Assisting in resolving unpaid claims and denials.Maintaining NextGen EHR File Maintenance, updating new CPT codes, Fee schedules and ... as needed.Acquiring up-to-date knowledge of coding and billing requirements through continuing education courses and certification renewal Jan 2019 - Sep 2022Chicago, United StatesMedical Coding and Billing Specialist / Talcott Foot And Ankle Specialist Increased rate of sending clean claims out by 97% to third party payers Interacted with physicians and other healthcare staff to ask questions regarding patient services. Checked ICD10-CM, CPT, HCPCS codes to prevent using unbundled codesAdded appropriate modifiers to CPT codes for improved reimbursement Reviewed outpatient records and documents to identify diagnoses and proceduresIdentified reasons for rejected claims and correcting and resubmitting them Processed insurance company denials by auditing patient files, searching procedures and diagnostic codes again to determine proper reimbursement Posted payments and sending bills to patientsPerformed billing and coding procedures for inpatient and outpatient servicesObtained Authorization for Sx, Orthotics, Diabetic Shoes, MRI, etc. Checked eligibility and benefits through Ins. web portals or phone calls to Insurance CompaniesSupervised receptionists and data entry processing Aug 2010 - Apr 2013 Admission and Medical Records Depatment Manager / Jam Hospital Invited to Jam Hospital to improve and upgrade Its Admission and Medical Records Department to prepare it for hospital Accreditation Facilitated hospital to obtain highest grade of accreditation in the same year Direct day-to-day administrative and operational functions for 300-bed facility, providing guidance and leadership to over 30 employees and received daily direct reports from more than 5 departments Analyzed quality control assessment findings and developed and implemented methods to improve performance (Clinical Governance) Created and maintained safeguards against unauthorized access and use of computer-based medical recordsAbstracted information from records as authorized or requested by insurance companies and other third-party payersSuccessfully negotiated client contract renewals to create increased revenue Secretary of Mortality and Morbidity CommitteeDirector of Health Information CommitteeMember of Root Cause Analysis (RCA) CommitteeJan 2006 - Nov 2010 Health Information Specialist / Parsian Hospital Initiated MR system in collaboration with MR Manager at time of hospital openingInteracted with physicians and other healthcare staff to ask questions regarding patient servicesReviewed, analyzed and managed coding of diagnostic and treatment EDUCATIONCERTIFICATIONSprocedures contained in outpatient and inpatient medical records Resourcefully used various coding books (ICD10, PCS, HCPCS, CPT) and on-line encodersInitiated, performed, and documented quarterly coding audits for physicians Jan 2002 - Jan 2005 Medical Billing Clerk / Jam E Jam Imaging Center Prepared billing statements for patients and verified correct diagnostic codingCommunicated with insurance providers to resolve denied claims and resubmitted themCollected payments and applied to patient accounts Posted payments and collections on regular basisManaged billing calendar and scheduled claims for payments May 2022River Grove, ILSchool of Continuing Education in Medical Billing And Coding Triton CollegeAug 2008Tehran-IranMaster of Science in Health Information Informatics Tehran University of Medical ScienceJun 2005Tehran-IranBachelor of Science in Health Information Management Tehran University of Medical ScienceCBCS - Certified Billing and Coding Specialist 2022 NHA - National Healthcare's Association 2022Crisis Management 2012Balanced Strategy Management 2012 |
