Professional Objective
To utilize my medical bill review operation’s specialty skills and certifications to improve processes and best practices in areas of customer care, client satisfaction, coding, auditing and billing.
Summary of Qualifications
Experience: 15+ years of success in Medical Bill Review Operations
Areas of DWC fee schedules post/current Medical Billing
Expertise: Medical Codes (CPT, HCPCS, ICD9) Auditing Claims
AAPC Professional Coder Certification Adjuster License (All-Lines) HCFA, UB92/UB04 Forms Acute Care Inpatient Guidelines Ambulatory Surgical Center Guidelines Medicare Regulations
Computer Comp Advisor, Powertrak, BR4, billing software and auditing,
Literacy: Microsoft suite, Windows/95/2000/XP
Professional Experience
2004-2011 Coventry Worker‘s Comp Formerly Concentra Integrated Services Plano, Texas
Business Analyst
Perform quality reviews on complex claims and adjustments for all physician, facility and specialty claims in accordance with company policies. Responsibilities includes completing audit reports outlining quality statistics and assessing, investigating and resolving error rebuttals from claims processing and non-claims processing functional areas. Monitor various state agencies websites for fee schedule updates. Assist in training of new auditors.
Data Integrity Analyst
Perform quality reviews on complex claims and adjustments for all physician, facility and specialty claims in accordance with company policies. Responsibilities includes completing audit reports outlining quality statistics and assessing, investigating and resolving error rebuttals from claims processing and non-claims processing functional areas. Process and audit worker compensation claims with various jurisdictions. Monitor various state agencies websites for fee schedule updates. Answer service calls from providers and clients concerning payment recommendation and bill status.
2001-2003 Fair Isaac Formerly HNC Solutions Coppell, Texas
Specialist
Responsible for reviewing and auditing worker compensation bills, according t...
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