Follow Up Specialist

• Jun 2020 - Present

Policy and Coding Coordinator

• Nov 2018 - Dec 2019

Team Lead

• Nov 2009 - Nov 2018

I am responsible for CPT/HCPCS coding edits as they relate to provider reimbursement. I also respond to questions from providers, claims auditors and other areas regarding correct coding and billing issues, My job duties also include tracking workflow for the department and handling on the job training for co-workers as well as one on one meetings with team members to review priorities, assist with work related issues and status of projects. I also initiate requests for corrections to system… Show more I am responsible for CPT/HCPCS coding edits as they relate to provider reimbursement. I also respond to questions from providers, claims auditors and other areas regarding correct coding and billing issues, My job duties also include tracking workflow for the department and handling on the job training for co-workers as well as one on one meetings with team members to review priorities, assist with work related issues and status of projects. I also initiate requests for corrections to system problems that arise.

Home Health Care Analyst

• Mar 2000 - Nov 2009

Review Home Medical and Home Infusion claims for correct coding, pricing and coverage. Work with HME/Infusion providers on claim issues.

Claims adjustment auditor

• Nov 1991 - Feb 2000

Processing claims for adjustment due to incorrect benefits/payments applied. This entailed reviewing claims for correct member benefits based on their contracts as well as correct payment based on fee schedules applied to providers. Required in depth member contract knowledge. Issues for adjustment included coordination of benefit, claims denied and/or paid in error and inquiries from Customer Service Marketing and Legal departments.

Claims Auditor

• Aug 1983 - Nov 1991

Enter claims into the processing system via CRT and later PC. Handle errors and make sure claim information is correct and they process correctly according to member benefits. Required knowledge of ICD-9 codes, CPT, HCPCS and UB revenue codes. Ability required to assign the appropriate revenue codes to inpatient claims from itemized bills. Quality and production standards applied,

Claims data entry

• Nov 1980 - Aug 1983

Entry all claims types into Medicare Part A system for processing. Release claims once approval obtained for payment. Enter admission information.

Mail Clerk

• Oct 1979 - Nov 1980

Process all incoming mail including claims. Add ICD-8 codes to inpatient claims. Separate and stamp all claim times to get ready for data entry. Research all returned mail for valid beneficiary addresses.

Records technician

• Sep 1977 - Aug 1979