2018 John Smith Resume 1 PDF

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JOHN SMITH,

CPC-A

[email protected] 777-777-7777

PROFESSIONAL SUMMARY BOARD CERTIFIED

MEDICAL CODER

Board Certified Medical Coder that thrives in providing exceptional support, ensuring claims are completed accurately, on time with extreme confidentiality. I am a detailed oriented and highly organized professional with strong skills in records management, document preparation, and written communications. In a matter of a week my duties are mostly performed independently, successfully and with no or little supervision. I am a business-minded team-player with a powerful sense of initiative to resolve billing accounts and increase profitability. I offer immediate extensive knowledge in claims billing, health insurance knowledge and collections. I poses leadership skills yet I am very teachable. I am also efficient in most computer programs and proficient in Internet and electronics troubleshooting.

SKILLS

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Knowledge and Application of CPT-5 Coding Guidelines Adept in analyzing medical charts Skilled in attaining the least amount of denials Superb in appending the most accurate Codes to maximize allowable reimbursement Knowledge and Application of ICD-10 Guidelines at the Sections, Subsection, and Category Levels HCPCS Coding System Abstracting from the report Medicare NCCI Edits Office of Inspector General Auditing RAC & OIG Modifier CPT & HCPCS HCC Codes & Medicare Law & Ethics Advanced Anatomy & Physiology Benefits & Eligibility Reimbursement Strategies Collections & Appeals Cobra

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Microsoft Office Suite Data entry, and typing of 50 wpm Front Desk Equipment Operations Experience in handling confidential paperwork Proficient in internet researching Good filing and organizational skills Medical Record Transcription Professional customer service skills Mastery of Medical terminology, physiology and pharmacology Pre-authorizations Familiarity with TPP Commercial Insurance Medicare & ABN Medicaid BLS CPR knowledge OPPS CMS-1500 HEDIS Measures HIPAA / OSHA trained

LICENSING & CERTIFICATION AAPC MEMBER, 2016 Member ID # 77777777 Medical Coding Academy, 2017 Intensive CPC Program, Anatomy & Physiology I & II / Medical Terminology I & II

PROFESSIONAL EXPERIENCE Elite Foot & Ankle (April 2015 – Present) Medical Office Specialist / Medical Assistant • • • • • • • • • • • • • •

Explained Co-pay, Deductibles, EOBs, Benefits, etc. to patients Obtained accurate info billing: photo id, insurance card & other state documentation Verified Patients Benefits & Out of Pocket Expenses & collected payments Verified patient insurance benefit coverage via phone & online portals Refiled insurance claims for proper processing and escalation Accepted Payments or Set-up payment arrangements with Patients Compiled and condensed technical and statistical data for reports and records Ensured patient complaints were handled quickly and appropriately Assisted with validating dispute reasons following Explanation of Benefits (EOB) and Electronic Response Admittances (ERA) to review Demonstrated excellent communication skills proven by the ability to lead and interact with people from diverse backgrounds Determined the cause of EOB denials and pulled supporting data from the patient charts Regularly performed compliance reviews of processors work identifying key areas for quality improvement for optimal success also providing constant feedback Performed proactive reviews of process and procedure identifying key areas requiring improvement and implementing solutions for optimal account and billing success Managed workflow and prioritized tasks to ensure top productivity and work around solutions

• Recommended innovative approaches, policies and procedures to continually improved efficiency of the department and collection processes • Answered the daily multi-phone line system for a high-volume system • Assisted with monitoring patient portal / database • Assisted with providing coaching, learning and growing to new hires • Provided coding, posting, and processing of payments • Triaged and reviewed medical history with patients & scanned documents to EHR • Inventoried medical and office supplies monthly and ordered the appropriate materials for the clinic • Assisted with office procedures, such as: Nail avulsions, diabetic wound care, diabetic nail care, wart removal, fiberglass casting application and removal, cortisone injections • Prepared and sterilized of medical instruments via the autoclave for the scheduled procedures per that day • Conducted various STEM therapy sessions for patients with minor injuries or postoperative patients • Multi-tasked and performed duties with speed, accuracy and without supervision • Assisted and solved complex customer needs with successful solutions and listening skills • Prepared all records neatly and accurately for next day • Identified, analyzed and audited departmental issues and adapted easily to changes • Successfully completed all tasks prior to deadline to ensure increase positive cash flow • Assisted with the development and implementation of departmental policies and • Provided customer education with compassion, respect and kindness

CONEXIS (July 2003 – July 2011) Account Supervisor • Managed a team of 20 employees • Ensured and reinforced quality and assurance goals to meet contracted expectations such as average speed to answer of 30 seconds or below • Trained, counseled and monitored agents to meet necessary goal • Worked up from customer service to supervisor of four years for the company, with top fortune companies • Gathered, compiled and verified source documents to organize and streamline workflow • Ensured the accuracy of data before entering, following standard operating procedures • Read source documents and entered analytical data in specific data fields using keyboards or scanners • Compared data with source documents in verification format to detect errors and correct them manually • Stored completed documents in the appropriate locations to ensure that information is intuitively and readily accessible by others • Reviewed files, records and other documents to obtain information for a response to requests regarding a benefit plan or personal participant account status/activity • Conducted work in a manner that was ethical by adhering to company and department standards and policies and complying with applicable laws and regulations • Maintained confidentiality of account data • Responded to telephone, fax or email inquiries from carriers, clients and/or participants regarding status of benefits eligibility and/or account status and activity • Determined eligibility based on client specific rules and data contained in participant records and provides information as appropriate • Assisted in resolving issues for clients which included conducting research on client/participant issues that were moderately-complex in nature • Interacted with customer service and account management teams to resolve eligibility issues • Upon achieving issue resolution, entered data in the system to reflect current and correct information • Followed up with clients, participants or carriers to relay information and provide resolution within established time frames

• Reported eligibility status (active or terminated) to carriers on a weekly, monthly, daily or urgent basis for applicable clients • Worked on special projects assigned by client services • Assisted with mid-year and annual reviews for agents, scheduling, timecards, disciplinary actions, and the content management system • Was part of the very first bilingual team for calls

Verizon Wireless (April 2001 – October 2001) Account Assistance Operator • Built strong relationships with customers and internal partners • Executed day-to-day transportation needs, including scheduling, tracking and tracing shipments, and communicating status updates with the broader team • Identified issues and utilized resources to determine the best course of action • Implemented solutions to rectify customer processes and identify areas for improvement • Responded to customer inquiries and provided updates in a timely manner • Maintained daily reporting schedule utilizing internal data systems • Generated and maintained up-to-date and accurate customer records and shipment documentation • Participated in in-service training as directed by the supervisor • Helped patients make payment arrangements on their accounts • Identified and corrected billing errors and re-submitting claims to insurance carriers • Used tools provided to contact, update database information • Sent appropriate letters to customers regarding their accounts • Provided phone listings and offered directions while promoting positive client relationships

Convergys (March 2000 – September 2000) Account Customer Service Representative • Acted as Floor supervisor for the company that was a third-party contractor • Used daily problem solving/critical thinking skills to assist clients with policy concerns • Reviewed, processed, edited, and approved claims for filing either electronically or on paper • Resolved reimbursement issues related to outstanding claims • Audited proper completion of required consent for treatment and payer compliance forms and the copying/scanning of patient insurance cards • Ensured accurate payment posting in all systems • Performed accurate registration using thorough interview technique to ensure that information was 100% complete and accurate • Ensured that all compliance requirements were met, and the registration was properly created and/or updated for anticipated billing • Performed cash collections at time of service, consistent with financial counseling procedures • Utilized billing system payment and receipt on all applicable encounters • Served on bilingual team for international calls • Handled escalated calls for difficult requests – i.e. correcting rate disputes, setting up payment plans for delinquent customers, complaints

Roberto Lay Ballroom Dance Instruction (July 2011 – present) Professional Ballroom Latin Dance instructor • Founded dance company and brand from the ground up to include up to 85 members across Dallas, Austin, Houston and Norman, Oklahoma • Maintained checks and balances for team accounts • Assisted member-clients in establishing effective fitness/wellness goals and developed the most effective training plans to achieve those goals

• Contributed to self-marketing strategies by creating unique branding including creating logos and messaging • Offered accurate and up-to-date information and advice on fitness • Motivated clients and maintained professional relationships • Maintained a safe and clean exercise environment within studio regulations • Followed all quality assurance and other policies and procedures of the studio • Maintains all required certifications • Adjusted schedule as needed to accommodate the needs of new existing memberclients • Updated and reviewed client files; prepare for upcoming workouts and proactively schedule client re-assessments • Attend & participated in all staff and individual development meetings; including continuing education and training sessions • Continuously strived for excellence in my work productivity • Served as a knowledgeable and responsible information source to all clients • Worked effectively with co-workers, often communicating with other instructors to hep assist with client’s functional improvement • Reported any facility problems to the management team • Provided one-on-one training to members • Negotiated agreements with assistant instructors to lead out-of-town teams • Individually assessed each team member's skill level and adapted lessons accordingly to achieve maximum performance levels • Developed workshops that were taught across the nation for rooms of up to 300 dancers • Collaborated with world-renowned instructors to apply best practices

REFERENCES DELISSA ORTEGA INSTRUCTOR 469-877-0774 DANIELLE SMITH

UNIT SECRETARY 777-777-7777 LEE ROY SUPERVISOR 777-777-7777 JAY MASON PROFESSIONAL A CQUAINTANCE 777-777-7777...