CPC-A looking for position in San Diego, CA

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Brooke Waugh
825 E Palomar St #705
Chula Vista, CA 91911
(619) 655-8026
brookejwaugh@gmail.com
__________________________________________________________________________

Professional Profile

I am a certified CPC-A through American Academy of Professional Coders. I am a certified in medical billing and coding through Lord Fairfax Community College. I did an internship with Medical Billing Associates for college. I am looking for a challenging role where I can utilize my skills to make a strong, positive impact.

Summary of Qualifications

• ICD-9-CM
• CPT
• HCPCS
• MS Office
• Medisoft
• Authorizations
• EOB's
• Claims
• Eligibility and Benefits
• Advanced MD
• Medical Terminology
• Anatomy and Physiology
• Medical Insurance
• Confidentiality


Work Experience

01/2012 to 04/2012 Kelly Services/HAI of CA San Diego, CA
Responsible for answering incoming calls from providers and members as they relate to eligibility, benefits, EAP services, claims, and authorization of services while maintaining confidentiality. I provided assistance to Magellan's members and providers regarding programs, policies, and procedures, and an explanation of these programs and services. I referred patients/EAP clients to the Magellan's Care Management team for a provider, EAP affiliate, or Facility referral for substance abuse and mental health issues. Assembled and entered patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs. Responded to Crisis calls and continued assistance with the Clinician until the call has been resolved. I informed providers and members on Magellan's appeal process. I educated providers on how to submit claims and when/where to submit a treatment plan. I gave Magellan's in-network and out of network provider status, provided information on the application process for becoming in-network. I was also responsible for the administrative intake documentation on each call.

09/2011 to 12/2011 Total Med Staffing/UBH San Diego, CA
Responded to complex customer calls. Resolved customer service inquiries which included
benefit and eligibility information, billing and payment issues, customer material
requests, physician assignments, authorization for treatment, explanation of benefits
(EOB). Provided excellent customer service, constantly met established productivity,
schedule adherence, and quality standards. Utilized and navigated a computer with Windows PC applications, while on the phone. Multi-task, including ability to understand multiple products and multiple levels of benefits within each product.

11/2010 to 08/2011 Day Care Services Front Royal, VA
I provided day care services for Gary Lamb's granddaughters while he was at work. Helped with the homework ,cleaned and cooked.

07/2010 to 10/2010 Staffworks/American Specialty Health San Diego, CA
Provided customer service to Members, Providers and clients nationwide. Responded to their inquiries and, provided information regarding all aspects of their participation in the ASH Benefit Plan. Responded to, in-bound calls from members, providers, and clients. Verified patient benefits and eligibility, and advised member and providers of plan limits and exclusions. Determined authorization and claim status for, members and providers. Determined customer service issues of members and providers and resolved the issue according to the established guidelines and procedures.

05/2010 Medical Billing Associates Winchester, VA
Internship for school, trained on an internal medicine clinic account, provided ICD-9-CM and CPT codes for diagnosis and procedures, posted payments to clients accounts using Advanced MD software, filing and scanning, answered phones

09/2004 to 03/2008 AB&C Group, Inc. Ranson, WV
As a customer service representative received inbound sales calls for several different companies, processed orders, donations, holiday cards and magazine subscriptions, provided detailed product information, tracked orders, handled refunds, returns, reshipments, resolved customer issues, up sold unadvertised sales specials.


Education

CPC-A American Academy of Professional Coders May 2010
Medical billing/coding Lord Fairfax Community College May 2010

References

Linda McCarthy
Human Affairs International of CA
Supervisor
(619) 929-4700

Greg Spangle
Total Med Staffing
Supervisor
(866) 288-8001

James Thomas
AB&C Group, Inc.
Human Resources
(540) 327-5703
 
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