Experience

HCM: Healthcare Claims Management

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Revenue Cycle Supervisor

  • May 2022 - Present



SCA Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Account Representative

  • Jun 2014 - May 2022



Community Health Network

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Patient Account Representative

  • Oct 2005 - Jun 2014

  Primary coder/biller for Medical and Radiation Oncology claims for the entire network. Worked closely with physicians, pharmacists, and nurses to ensure proper documentation to support medical necessity of charges billed to insurance payers. Created new policy and procedure for medical necessity verification of high dollar services under direction of the Director of Patient Financial Services. Thoroughly investigated past due invoices and minimized number of unpaid accounts. Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses. Wrote clear and detailed clinical phone messages for physicians. Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered. Acquired insurance authorizations for procedures and tests ordered by the attending physician. Retrieved physician correspondence from dictation service and made edits when necessary. Resolved and clarified issues with patient medications and collaborated with local pharmacies. Accurately entered procedure codes, diagnosis codes and patient information into billing software. Consistently ensured proper coding, sequencing of diagnoses and procedures. Quickly responded to staff and client inquiries regarding CPT codes. Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information. Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes. Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature. Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system Show less