Coretta Weaver CPC, CPMA
Medical Reimbursement Code Specialist at University of Illinois at Chicago College of Dentistry- Claim this Profile
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Topline Score
Bio
Credentials
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Certified Medical Coder
AAPC -
Certified Professional Medical Auditor
AAPC
Experience
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Medical Reimbursement Code Specialist
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Sep 2017 - Present
Interpret codes or procedure(s) performed according to coding standards, which may require the interpretation and selection of codes provided by or to the insurance carrier Coding for ER visit, Outpatient clinic and Inpatient hospital for oral maxillofacial surgery Post and allocate third party payer payments to patient accounts Review and analyze itemized claims/bills or non-complex claim forms for consistency and investigate discrepancies to determine the appropriate course of action required to accurately complete the claim, processing, billing procedure or adjudication process Contest insurance denials of procedures follow up of non-response from insurance companies on claims Maintain understanding of current policies and procedures of billing regulations for medical and dental coding Review inpatient and/or outpatient documentation to assign the appropriate, ICD-10, CPT, and/or HCPCS diagnosis and procedures codes while adhering to coding guidelines and applied terminology. Keeps abreast of bulletins, newsletters, and periodicals; attends workshops to stay current on coding issues, trends, and changes in regulations governing medical record coding documentation. Is responsible for abstracting codes and other information from the hospital system for billing and reporting purposes. Identifies and makes recommendations for coding edits. Assists in development of policies and procedures related to coding of medical providers, ancillary, and/or hospital services using, ICD-10, HCPCS, and/or CPT and CDT. Assists in resolving day-to-day coding related issues; serves as a resource person for billing/coding purposes. Review charge tickets and/or documentation to determine accuracy of CPT/ CDT and diagnosis coding. Train lower level staff, residents, fellows, etc.; participate in the interviewing new people and hiring process. Reviews, analyzes and corrects or resolves claim denials EPIC and Axium dental software. Show less
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Insurance Specialist
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Apr 2017 - Sep 2017
Provides customer service to various healthcare contract customers Prepares, researches and collects from various contracted health insurance payers Reads through healthcare contracts and contract language and ensures proper contract workflows Researches remits and EOB’s for complete accurate payments or denials Provides or arranges for additional information when needed Submits corrected claims or appeals Requests appropriate adjustments, when required Ensures legal compliance by following company policies and guidelines; as well as state and federal insurance regulations Additional duties as assigned Show less
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Centene Corporation
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United States
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Hospitals and Health Care
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700 & Above Employee
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Referral Specialist
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Apr 2015 - Mar 2016
• Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations. Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. • Route to appropriate staff when needed. • Verify eligibility and benefits • Answer phone queues and process faxes within established standards • Data enters authorizations into the system. • Pre Authorization • Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations. Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. • Route to appropriate staff when needed. • Verify eligibility and benefits • Answer phone queues and process faxes within established standards • Data enters authorizations into the system. • Pre Authorization
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Roseland Community Hospital Foundation
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Hospitals and Health Care
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1 - 100 Employee
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Medical Billing Specialist
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Jun 2013 - Apr 2015
● Follow up with commercial payers regarding claim status ● Collect and bill for Medicaid ● Resolve hospital claim issues for patients with Medicaid ● Check status of claims using the Emdeon and Ecare/ NEBO Systems Emdeon, Ecare/ NEBO Status ● Submit paper claims for Inpatient/ Outpatient, HMO/Managed Care, and late charges ● Contact insurance companies to investigate status of denied claims and initiate appeal ● Medicare and Medicaid/ commercial crossover/insurance verification ● Commercial billing and follow up on claim also correspondences ● Pre certification Show less
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Rush Oak Park Hospital
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United States
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Hospitals and Health Care
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200 - 300 Employee
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Customer Service Representative/ Commercial Collector/Biller
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Oct 2005 - Feb 2010
● Greeted and assisted all patients visiting the business office ● Answered inbound calls from patients inquiring about their hospital accounts ● Assisted law offices with hospital account inquires ● Assisted attorneys with bankruptcy and worker compensation requests ● Processed refunds to patients and insurance companies for overpayments ● Processed adjustments (EOB, Bankruptcy, Patient Accounts) ● Assisted insurance companies/collection agencies regarding hospital accounts ● Contacted insurance companies to collect payments on patients’ bills ● Followed up with commercial payers for payment status ● Billed commercial payers Show less
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Office Assistant
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Nov 2003 - Nov 2005
● Collected premium payment from agent for client’s life insurance policy ● Filing, typing, data entry, answered multiple phone lines, payment posting ● Cash drop off and disbursements to bank, accounts receivable ● Prepared office reports and sent them to the corporate office ● Collected premium payment from agent for client’s life insurance policy ● Filing, typing, data entry, answered multiple phone lines, payment posting ● Cash drop off and disbursements to bank, accounts receivable ● Prepared office reports and sent them to the corporate office
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BIOCONCEPT
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Cameroon
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Environmental Services
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Medical Billing Specialist
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Sep 2002 - Nov 2003
● All billing (private insurance, Medicare, Medicaid, hospital) ● Collections, filing, data entry, payment posting ● Medical records, payment entry and patients statements ● Appointments, hospital, clinics calls, accounts receivable ● All billing (private insurance, Medicare, Medicaid, hospital) ● Collections, filing, data entry, payment posting ● Medical records, payment entry and patients statements ● Appointments, hospital, clinics calls, accounts receivable
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Education
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2008 - 2010
Moraine Valley Community College
Health Services/Allied Health/Health Sciences, General -
2011 -
South Suburban College
Health Services/Allied Health/Health Sciences, General
Community
