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Candidate's Name
CPCProfessional CertificationCPC (Certified Professional Coder)AAPC ( American Academy of Professional Coders)E D U C A T I O NAnthem College OnlinePhoenix, AZ04 / 2006 - 05 / 2008Associates in ScienceMedical Billing and CodingBuckingham County High SchoolBuckingham, VAGraduation Date: 06 / 2000SkillsCertified in Medical Coding and Billing from AAPCTrained in Medisoft software, EPIC, A2K3,Midas,Atrivia, Vista, Vista Gui, CPRS,OnBase, Navi health, Meditech, HIS Soft Med and IDX programsEPIC Super UserKnowledge of insurance verification,authorizations, billing, claims, and paymentsKnowledge of medical coding with the CPTmanual, ICD-9, and HCPS book Medical TerminologyMicrosoft Word, Excel, Access, PowerPoint,Outlook, and One NoteKnowledge of regular and commercial insurance, Medicare, and Medicaid Great communication skillsCan type 60-65 words per minuteExperience with EMR systemsInsurance websites, Availity, Navient, Medicaid, Medicare, Kepro Atrezzo, United Healthcare, Coventry, Evicore, Tricare, Molina Healthcare, and Humana.W O R K E X P E R I E N C EAdvanced Medical Support AssistantPrimary Care- CBOC CharlottesvilleU.S. Department of Veteran AffairsCharlottesville, VA11 / 2023  PresentAdvises clinical staff on current administrative processesCoordinates administrative functions regarding emergent and non-emergent transfers to other V.Afacilities or private hospitalsCollaborates with clinical team members to determine daily clinic needsCoder/Billing SpecialistJuels Therapeutic Solutions, LLCRemote03/2022  PresentReviews medical record documentation to determine appropriate ICD-10-CM/CPT codes and modifiers inaccordance with official coding guide.Communicate effectively with staff when clarifying diagnosis codes and CPT assignment-Provide feedback tostaff on billing/coding related matters.Submit claims to insurance companies and follow up on unpaid claims.Resolve any issues that arise with claims or paymentsAnswer patient inquiries regarding billing and paymentMaintain accurate records of billing and collection activitiesGenerate monthly reports to track billing and collection performanceCoder/Billing SpecialistAccess Associate SeniorInfectious Disease Clinic - University of Virginia Medical CenterCharlottesville, VA08 / 2022  10/2023Educates patients and families on managed care processes; Communicating authorizations and reviewingpotential financial obligations necessary.Schedules single and multi-visit appointments to the correct provider, including all correspondinginformation.Assists customers in obtaining access to medical services at UVA Health Systems. Investigates,documents, resolves, and/or refers appropriate issues and conflicts.Trains new employeesExperienced in Epic User WebCall Center Advanced Medical Support AssistantMcGuire Holmes Physical & Rehab DepartmentU.S. Department of Veteran AffairsRichmond, VA04 / 2022 - 08 / 2022Advises clinical staff on current administrative processesCoordinates administrative functions regarding emergent and non-emergent transfers to other V.Afacilities or private hospitalsCollaborates with clinical team members to determine daily clinic needsMedical Office SpecialistNephrology Clinic - University Physicians GroupUniversity of Virginia Medical CenterLynchburg, VA08/ 2021 - 04 / 2022Responsible for ensuring efficient administrative operations in coordination with leadership.Responsible for obtaining approval of professional and technical services which may include obtaininginsurance referrals, procedure authorizations, or pre-certifications required for patients to receivephysician services, medical procedures, equipment, supplies and medications.Answers telephones, screens calls, confirms appointments, maintains appointment schedule followingOffice scheduling procedures. Refers callers to appropriate individuals, and gives routine informationin accordance with established procedures.Checks in patients upon their arrival and verifies patient information; updates patient tracking, providespatient with medication list, assures accuracy and completeness of co-pays, charges and insuranceinformation.  Checks out patients at their departure and schedule follow-ups.Assigns codes to documented patient care encounters (inpatient facility and/or professional services)Selects and assigns codes from the current version of several coding systems to include current versionsof the International Classification of Diseases (ICD 10), Current Procedural Terminology (CPT), and/or HealthcareCommon procedure Coding System (HCPCS).Access Associate SeniorInfectious Disease Clinic - University of Virginia Medical CenterCharlottesville, VA09/ 2020 - 08 / 2021Educates patients and families on managed care processes; Communicating authorizations and reviewingpotential financial obligations necessary.Schedules single and multi-visit appointments to the correct provider, including all correspondinginformation.Assists customers in obtaining access to medical services at UVA Health Systems. Investigates,documents, resolves, and/or refers appropriate issues and conflicts.Trains new employeesExperienced in Epic User WebUtilization Review CoordinatorAcute Inpatient - Hospital Corporation of America (HCA)Richmond, VA06 / 2017 - 05 / 2020Verifies pre-certifications for all inpatient admissions and surgeriesAnalyzes information to complete inpatient admission pre-certifications with insurance carriers.Assigns codes to documented patient care encounters (inpatient facility and/or professional services)Selects and assigns codes from the current version of several coding systems to include current versions of theInternational Classification of Diseases (ICD 10), Current Procedural Terminology (CPT), and/or Healthcare Commonprocedure Coding System (HCPCS).Pre-Certification Authorization CoordinatorRadiology - University of Virginia Medical CenterCharlottesville, VA09 / 2014 - 05 / 2017Obtains pre-certifications for all inpatient admission and pre-authorizations for all outpatient diagnostictests.Analyzes information required to complete pre-certifications and/or authorizations with insurancecarriers, service area contacts and workmans compensation carriers. Demonstrates skill in theproficient use of PC and UVA software systems.Assigns codes to documented patient care encounters (inpatient facility and/or professional services)Selects and assigns codes from the current version of several coding systems to include current versionsof the International Classification of Diseases (ICD 10), Current Procedural Terminology (CPT), and/orHealthcare Common procedure Coding System (HCPCS).Patient Access Insurance Verification SpecialistUniversity of Virginia Medical CenterCharlottesville, VA06 / 2005 - 09 / 2014Verifying outpatient insurance by telephone or internet.Experience in running ADHOC reports