I’ve been in the health insurance industry for over 7 years handling US healthcare accounts. Experienced in medical coding, process training/coaching, team management, quality analyst and customer service.
Studied ICD-9-CM, ICD-10-CM, CPT, HCPCS
Duties and Responsibilities • Perform billing tasks, making sure that all the CPT codes are complete and accurate based on the submitted therapy notes. • Provide accurate timing for admission and discharge date and time based on the provided services. • Ensure that ICD-10 codes are properly coded and sequenced based on the approval • Monitors accuracy in using benefit limit for approved therapy sessions. • Coordinate with the reception and registration team for the closed bills for no approvals. • Coordinate with the accounting team to provide necessary information for the calculation of revenues and loses. • Performs discussion with the billing/coding team regarding the errors detected during the quality audit • Performs claims submission through Greenrain and QuickConnect and monitors claims payments and rejections. • Ensures completeness and accuracy of claim information before submission • Performs resubmission of claims, taking appropriate action for the rejections • Provide discussions for the billing team on the usual rejection and how to properly bill them to prevent same rejections. • Generate monthly report for the provided sessions and expected revenues.
Duties and Responsibilities • Reviewed progress notes, specialist notes, and other reports for new and more specific conditions. • Assigned ICD-10 codes for every current diagnosis captured from charts. • Performed quality audits to check coders’ compliance on coding guidelines • Provided action plans and coaching sessions for performance enhancement • Provided discussions and refreshers on particular topics and updates • Provided real-time supports through email or one-on-one coaching • Reviewed medication list related to the patient’s conditions. • Adhered to and maintained required levels of performance in both coding accuracy and productivity. • Accurately followed coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies. • Abstracted additional data elements during Chart Review process when coding, as needed. • Attended educational events as required to remain current on coding issues. • Transcribed recordings from physicians and other healthcare professionals before forwarding to the coding team for proper coding.
Duties and Responsibilities • Directly managed a team in handling insurance claims and benefits. • Performed quality audits to check agents’ compliance on the process • Provided coaching sessions/actions plans for performance improvement of the agents. • Performed discussions and refreshers for some topics and updates. • Generated clerical reports for the upper management about the team performance • Scrubbed random calls, surveys and quality audits. • Took member call escalations to maintain excellent call experience. • Checked the accuracy of the claims information, including CPT and ICD-10 codes before forwarding the claims for processing • Checked if the claims were processed correctly. • Forwarded the claims for adjustment with incorrect processing. • Performed necessary outreach calls to providers, members, insurance companies, and internal departments to fully resolve claims issues.
Duties and Responsibilities • Performed call quality audits as required by clients to ensure and maintain compliance with the policies and guidelines (twice a month). • Performed call quality audits necessary for coaching team members on the strengths and opportunities in call handling (daily). • Performed call quality audits for client calibration (every Friday). • Performed discussions with team members regarding department policies and process updates. • Performed coaching with team members about the call errors and provide proper advice of the proper resolution. • Acted as Help Desk Representative and aids Jamaican agents on their inquiries about how to properly handle provider’s concerns. • Checked if CPT and ICD-10 codes were correctly billed. • Took first hand calls and provide the healthcare providers with information about status of their claims and deal with the rejections and complaints. • Coordinated with the member’s state plan for benefits and eligibility info. • Checked if claims were processed correctly and sent for adjustment if incorrect.