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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Stratford Skies Ln
Houston, TX Street Address
PHONE NUMBER AVAILABLE
EMAIL AVAILABLE
EMAIL AVAILABLE
Objective
To join a company that offers me a stable and positive atmosphere. An opportunity that inspires me to enhance and innovate the work culture for the departmental business; allowing flexibility with work schedules to balance work/life in a positive system for the organization s employee productivity and morale.
Experience
Houston Methodist
On Audit and Onboarding Specialist 10/19/2015-present
Provide guidance to central business office staff to ensure consistency in communication and practice and to foster professional development. Assists department and/or central business office in communicating physician billing compliance issues.
Audit and reconcile services and items included in the patient s chart with services and items included on patient s bill in a timely manner.
Provide business practice billing compliance department management with status reports of progress against the annual monitoring and assessment plan and other goals such as cycle time targets.
Analyze data/reports from compliance monitoring activities to identify trends, issues and recommendations that are value added and cost effective.
Collaborates with the central business office to communicate audit results.
Performs audits of billed claims optimal reimbursement and identifies areas that represent a high risk with respect to compliance issues.
Monitor provider progress as directed by management to ensure adherence to regulations, policies and procedures.
Coordinates the physician onboarding process to ensure physician compliance and competency in following physician operations policies and procedures.
Provide quality assurance, direction and guidance to physician operations departments.
Demonstrate industry, billing compliance knowledge, skills and abilities in the review of evaluation and management, procedural coding assessment, auditing, reporting and follow up processes; capable of handling moderately complex healthcare review projects with minimal supervision.
Getix Healthcare
Remote Coder 12/2014-11/09/2015
Review charge encounters for professional physician services for OB/GYN and Primary Care in EPIC
Apply ICD 9 codes and CPT 4 codes for all encounters including primary care, OB/GYN, Postop and EKG s.
Review documentation to ensure services meet the services billed/submitted
Report to supervisor any questions or trends within the work queue
Maintain daily productivity requirement
UT Health Science Center at Houston Family Medicine Department, Houston, TX
Clinical Billing Manager, 2010-2014
Ensures prompt submission of charges to insurance carriers.
Establishes sound processes for capture and reconciliation of physician service charges.
Develops and monitors tracking mechanism to ensure proper and prompt submission and receipt of charge documents.
Monitors key performance metrics including but not limited to
1. Charge activity (by physician and division) on a weekly basis;
2. Elapsed time between dates of service and dates of charge submission;
3. Charge document submission and receipt cycle time;
4. Coding patterns by specialty and division; and
5. Receivables, denials and collections.
Ensures that the data entry and charge documents are captured correctly and promptly.
Investigates and reports variances from expected levels.
Monitors billing provider lists and ensures that profile information is set-up, maintained, and current in the system.
Trains new physicians on charge capture and billing processes.
Serves as the department s primary resource for all coding and billing questions particularly in the area of Medicaid reimbursement.
Serves as primary liaison with billing company for requests of additional information and research documents.
May work with Billing Coordination & Compliance dept. on faculty billing & documentation issues, as well as coding compliance training, and policy interpretation.
Generates monthly operational reports.
Stays current with changes/updates related to standardized and specialty coding conventions, 3rd party payers, and other relevant coding and billing guidelines.
Working knowledge of top 3rd party payers.
May serve as a liaison with 3rd party payers.
Communicates billing policies and procedures to staff.
Other duties as assigned.
UTHSCH-Department Otorhinolaryngology-Head Neck Surgery, Houston, TX
Sr. Certified Coding Specialist, 2006-2010
Provides supervision for assigned staff within the department.
Acts as first-line liaison on behalf of Billing Compliance Coordination Department, as directed.
Oversight of personnel performing routine correct coding applications utilizing ICD-9-CM, CPT-4, and HCPCS codes required for the patient charge encounters when reviewing physician generated codes, ensuring compliance with regulatory agencies, correct coding initiatives and regulatory guidelines for clinical documentation.
Identifies and reports correct code selection from physician documentation, to include, but not be limited to; chart notes, abstracting from medical records documentation, medical diagnostic and/or interventional reports, ensuring compliant coding selections are reported, as needed.
Provides periodic assessment and audit to insure quality assurance is provided to assigned department.
Reviews and reports all denials related to coding, by report, assigning and indicating reason codes for coding denials.
Assists in the development and delivery of appropriate specialty specific coding education for providers within their respective departments.
Identifies provider specific educational needs relative to professional coding and documentation.
Reviews and updates charge encounter forms, rounding slips and documentation templates, assessing for compliance and completeness.
Attends and participates in all coding related educational activities, as directed by the Department of Billing and Compliance Coordination and disseminates applicable information to departmental physicians/residents, and staff.
Act as a resource in the clinic setting for providers, practitioners and staff for queries related to coding convention and compliance questions.
Liaison with outsourced account managers as related to coding endeavors within their departments.
Other duties as assigned.
MD Anderson Cancer Center, Physician Billing Services, Houston TX
Certified Coding Specialist, 2001-2006
Applied ICD-9 on Radiology charges via EXCEL Spreadsheet
Coded and Audited all governmental patient cases utilizing CPT and ICD-9 codes for the Departments: Head and Neck, Ophthalmology and Leukemia clinics
Maintained weekly production quota.
Attended monthly accredited tutorials for CEU s
Attended weekly staff meetings
UT Health Science Center at Houston, Houston TX
Insurance Follow-up Clerk 1999-2001
Maintain daily workfile productivity monitored by PCS in IDX
Maintain a weekly quota productivity turned into supervisor at end of week
Work invoices by the highest dollar value working on an descending order/pattern
Attended weekly staff meetings
UT Health Science Center at Houston, Houston, TX
Reimbursement Analyst-1998-1999
Responsible for reconciliation for Departmental Special Accounts and Departmental offsite clinic activity
Responsible for charge reconciliation and charge capture for all International and Departmental Clinic Activity for State Funded accounts as well as City of Houston
Registered patients when needed
Responsible for maintaining month end account activity
UT Health Science Center at Houston, Houston, TX
Pathology and Laboratory Medicine Coder-1996-1998
Applied CPT 4 and ICD-9 codes to Surgical Pathology, Cytology, Blood Bank and Bone Marrow patient cases
Performed data entry
Worked correspondence and denials for Pathology and Lab department
Performed other duties as assigned
UT Health Science Center at Houston, Houston, TX
Explanation of Benefit/Denial Department, MSRDP 1994-1996
Processed denials for departments Pathology and Laboratory Medicine, Emergency Medicine and Surgery
Met with Billing Managers for each department and provided overview of top 10 denials for governmental carriers
Appealed and resubmitted corrected procedures with Billing Manager/Director of Management Operations authorized signature
Provided daily feedback on coding and follow up for pending/denied patient cases
Attended weekly meetings to keep Supervisor abreast of departmental issues/concerns
Skills
10 key by touch, typing 45 wpm, Microsoft Word, Excel, IDX Billing System, Allscripts, Care 4, Microsoft Outlook, EPIC, HealthQuest, Cerner, Citrix, Encoder Pro (Optum 360), Clinic Station, NetPass, Physicianlink, MDAudit, GE Centricity, Medtech, Harris Health System, ICD 9, CPT, ICD 10 CM, Athena, MPF and Method Hospital Systems.
Education
Westbury Sr. High School, Houston, TX
Diploma, May 01, 1985
National Education Center, Houston, TX
Legal Secretary Associates Degree, October 3, 1989
The University of Texas Health Science Center-Houston completion 3M ICD 10 Education Modules 07/2014
MDAnderson Cancer Center completion 3M ICD 10 Education Modules 05/2015
Certification
CPC with American Academy of Professional Coders, December 05, 2005
Membership current
ICD 10 CM Proficiency through American Academy of Professional Coders
Certification 07/28/2015 |
