CPC looking for work in Atlanta or Remote, 12 years Revenue Cycle Exp HB and PB, CRCR

Atlanta, Georgia
Best answers
Atlanta, GA 30328


• Certified Professional Coder (CPC)
• Certified Revenue Cycle Representative (CRCR)
• Revenue Cycle Operations; Accounts Receivable, billing, collections, payer appeal processes
• ICD-9, ICD-10, CPT, and HCPCS
• Proficient in Microsoft Applications, Emdeon, Epic, Navicure, Nextgen, Cerner, Epremis, McKesson, MDX, Meditech, Revenue Cycle Pro, Encoder Pro
• Type 60 wpm with rapid accurate entry of data, 10-key by touch
• Maintains a current knowledge in all coding, billing, and insurance regulatory updates
• In-depth knowledge of medical terminology, anatomy and physiology and a thorough understanding of the content of the clinical record
• Maintain strictest confidentiality; adhere to all HIPAA guidelines and regulations
• Understands and adheres to state and federal regulations, and to company policies regarding to compliance, integrity, patient privacy and ethical billing practices
• Excellent written and oral communication skills, detail-oriented, analytical skills, effective presentation, grammar, spelling, usage
• Superior customer service skills, high standard of ethics, integrity and professionalism
• Excel within a team environment, problem solver, high degree of independence
• Proactively prioritize initiatives and have the ability to multi-task
• Proven leader with measurable results of objectives and goals set forth by an organization


Piedmont Healthcare May 2016 – July 2016
Third Party Accounts Receivable Representative
• Manage daily work related to resolution of third party payer A/R
• Analyze and research assigned unpaid claims using Epic and Emdeon
• Followed worklist prioritization of accounts as established by department policies and procedures when
resolving accounts.
• Request relevant information from appropriate Revenue Cycle and clinical departments as required through the course of the A/R follow-up process
• Responsible for verifying and making necessary adjustments to patient demographic, insurance, and account balance information
• Focused on attaining productivity standards, recommended new approaches for process improvements

Milton Hall Surgical Associates 2015 – 2016
Medical Accounts Receivable Specialist
• Certified Revenue Cycle Representative responsible for financial operations with ENT practice
• Responsible for and maintained up-to-date information on payers' billing requirements and covered services to include Medicare and Medicaid
• Utilized Nextgen and Navicure program to document findings and bill professional claims
• Responded to patient billing inquires, updated patient insurance and demographics
• Accounts Receivable aging analysis
• Managed claim denials, appeals, and filed claims utilizing CMS-1500
• Reviewed, analyzed, and resolved high and low dollar balances, credit balances, rejections
• Review and post daily charges
• Assisted with special projects to include new hire training and projects using key performance indicators

United Health Group/Optum 360 2014 – 2015
Reimbursement Specialist/Accounts Receivable Specialist
• Proactively identified Medicaid denials on UB-04 and CMS-1500 using accounting systems, billing
Systems, and web portals
• Extensive knowledge of State Medicaid program guidelines
• Direct contact with payers to overturn denials and process of insurance claims
• Submit payer specific documents to resolve denials via appeal process such as Medical Records, proof of
untimely filing
• Review, audit and research unapplied posting to patient accounts
• Provide support to Team and Department Management along with tasks as directed by
• Trained system environment in EFR, EFR6, Emedon, Cetrix, SMS, AS400, Cirius, Misys, Cerner,
Epremis, McKesson, STAR, HP, SSI, Artiva, HIE, TrimsNet, HOST, DDE, Optum Cloud, Invision
SMS, Revenue Cycle Pro, Encoder Pro

Grady Health System- (Nationwide Recovery Service) 2013 – 2014
Vendor Liaison – Medical
• On-site Vendor Liaison for Bad Debt Agency
• Responsible for professional communication between client and agency to resolve bad debt accounts
• Updated patient insurance coverage and request rebill including (WMC and MVA)
• Follow up on status of billed claims (overturn denials)
• Daily management of outstanding accounts
• Submitted Bankruptcy and Death Certificate write-offs

ERMI, Inc., Atlanta, GA 2013
Durable Medical Equipment (DME) Medical Collections – Temporary
• Responsible for claim follow-up for ancillary claims for Blue Cross and Blue Shield
• In charge of resolving matters between insurance payers to ensure provider has been paid based on non-contract
• Aging Reports
• Identified billing errors, short payments, over payments, unpaid claims, and resolved issues accordingly
• Correspondence review, claim denials, and denial resolution

Health Care Corporation of America (HCA), Norcross, GA 2007 – 2012
Medical Government Denial Analyst/Government Collector/Compliance
• Completed accounts actions using HOST, CWF, SSI, DEI, MEDITECH, ARTIVA, RCOM, SYNERGY, MDX and SELFPAY TOOL along with other systems for Medicaid and Medicare assigned accounts where documentation of actions were entered and account stepped to next follow-up date
• Followed up on claim appeals via web using provider resources for CMS, PGBA, HP, QIO, Medi-Cal and other payers
• Overturn denials by working assigned facilities dispositions ranging from billing, appeals, medical records, possible payments, recoups, and unworked accounts according to out of compliance for Medicaid and Medicare
• Appeal accounts with medical records and supporting documentation to overturn denials for numerous payers including GA, SC, NV, CA, AZ, AK and OOS Medicaid payers
• Advanced Skills in level of Appeal Determinations, DMA forms and Data-Entry Correction Forms
• Account Representative for assigned facilities using company software Artiva and DET to correspond with numerous Facility Queue(s) for updates of notes for account completion
• Reviewed unpaid and/or denied claims, appeals and follow-up on accounts to zero status

Medical Resource Management, L.L.C. Norcross, 2005 – 2007
Medical Billing Specialist/ Patient Account Representative

Redan Hairston Pediatrics & Adult Medicine, Stone Mountain, GA 2004 – 2005
Medical Billing Specialist


Certified Professional Coder (CPC) – American Academy of Professional Coders 2016

Certified Revenue Cycle Representative (CRCR) – Health Financial Management Association 2015

Georgia Perimeter College, Dunwoody, GA Current
Health Information Management (HIM)

Georgia Medical Institute, Atlanta, GA 2004
Medical Insurance Billing and Coding

Northeastern Technical College, Cheraw, SC 2002
Office Procedures and Technology
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