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Click here or scroll down to respond to this candidateCandidate's Name
Glenn Heights, TX Street Address
PHONE NUMBER AVAILABLE EMAIL AVAILABLEPROFILEDetail-oriented Medical Billing and Coding Specialist with extensive experience as a Utilization Review Licensed Vocational Nurse(LVN). Demonstrated expertise in medical coding, billing procedures, and claims management, coupled with a strong background in utilization review and patient care. Adept at ensuring accurate documentation, compliance with healthcare regulations, and efficient revenue cycle management. Known for strong analytical skills, effective communication, and a commitment to improving healthcare operations and patient satisfaction. Seeking to leverage clinical and administrative experience to contribute to a dynamic healthcare team. SKILLSComprehension of CPT, ICD-10-CM, HCPCS/Modifiers and AuditingCurrent Procedural Terminology (CPT-4) CodingFamiliar with CMS-1500, EOB, SOAP Notes and office proceduresMedical Records AbstractingCompetent in insurance claims processing for outpatient professional services as well as inpatient facility servicesUnderstanding of Medical Insurance, Billing, Collections and Reimbursement EDUCATIONCollege of Health Care Professions, Dallas, TX June 2024 Medical Coding and BillingAmarillo Junior College, Amarillo, TXNursing80 College hoursWest Texas A & M University (formerly West Texas State University), Canyon, TX Nursing80 College hoursAmarillo College of Vocational Arts, Amarillo, TXVocational NursingAnatomy, Physiology and PathophysiologyVocational Nursing skillsWORK EXPERIENCEGatesCo Medical Supply, Dallas, TX April 2024 - June 2024 Medical Coding and Billing ExternLeveraged advanced billing software to accurately generate, process, and submit insurance claims, ensuring timely reimbursement and adherence to regulatory requirementsConducted meticulous data entry to maintain and update spreadsheets and comprehensive reports, ensuring accuracy and consistency in record-keeping and financial documentationProvided administrative support by managing phone calls, organizing and filing documents, and scheduling appointments, contributing to the efficient operation of the officeExpertly assigned and verified diagnostic and procedural codes using ICD-10, CPT, and other relevant coding systems, ensuring precise coding for accurate billing and compliance with healthcare regulations Anthem/AMERIGROUP Community Care, Grand Prairie, TX January 2006 - November 2020 Utilization Review LVNEvaluated and processed treatment and procedure authorization requests, ensuring compliance with medical necessity criteria and consulting with the Medical Director as neededCreated detailed guidelines and cheat sheets for Medical Director Reviews, streamlining processes and improving efficiencyInitiated and analyzed a Customer Service Satisfaction Survey for therapy providers, leading to enhanced service qualityConducted thorough training and orientation for new associates, including one-on-one sessions, WebEx conferences, classroom instruction, and on-the-job trainingAuthored instructional materials for therapy providers and maintained an up-to-date contact list, ensuring accurate and effective communicationCERTIFICATIONSNational Associate for Health Professionals April 2024 Medical Billing and Coding - NRCSAmerican Red Cross December 2023 - December 2023CPR/AEDHIPAA September 2023 - September 2023LICENSESVocational Nursing License September 1988 - September 1989 Vocational Nursing License |
