Coloreferee
New
Kurt M Smith
1377 Sandwich Drive, Sandwich, IL 60548
Pirkurt.smith@gmail.com
Ph: 224-246-5814
Professional Summary
As an accomplished and energetic healthcare professional, I would like to work in support and favor of the esteemed organization I would be working for. I would be devoting my time and extra effort to work for the advancement and progress of the organization.1377 Sandwich Drive, Sandwich, IL 60548
Pirkurt.smith@gmail.com
Ph: 224-246-5814
Professional Summary
Skills
Customer and Personal Service Critical Thinking Service OrientationActive Listening Coordination Active Learning
Administration and Management Time Management Computers and Electronics
Experience
Dreyer Medical Clinic / Advocate Health Care Aurora, ILCoding Specialist II Aug 2017 – Present
- Outpatient Coding experience in the following specialties: Lab, Podiatry, Orthopedics, and Primary Care
- Resolves charge entry edits for all payers and all groups: Radiation Oncology, Dreyer Medical Group, and the Ambulatory Surgery Center.
- Corrects TES and Claims Manager edits by updating encounters in EPIC. Informs clinical departments of any errors that need to be corrected.
- Validates all diagnoses and procedures utilizing the ICD-10CM codebook or organization-selected software in compliance with government-mandated regulations.
- Locates and utilizes the necessary resources to solve coding questions from physicians and Dreyer Medical Clinic staff as they arise during the performance of daily activities.
- Suggest edit rules and updates for templates and other tables in Claims Manager and TES to ensure optimal performance of system.
- Reviews all documentation within the medical record to identify all relevant diagnoses and procedures; ensures all documentation is present prior to revising/assigning coding.
- Maintains current knowledge of ICD-10 CM, CPT-4 and HCPCS coding systems, Encoder Pro, EPIC and IDX.
- Attends internal and external educational seminars, conferences and in-services when applicable.
- Act as a backup for Coding Hotline calls. Answer Staff messages and assists with Coding Reviews.
Dreyer Medical Clinic / Advocate Health Care Aurora, IL
Denials/Appeals Analyst Dec 2016 – Aug 2017
- Collect Denied Reimbursement due to Dreyer Medical Clinic from Federal/State/Local Regulations and Contractual Obligations. Perform analysis of denied claims in order to determine appropriate course of action.
- Process appeals in a timely fashion in accordance with payer guidelines and Dreyer Medical Clinic's policies and procedures
- Identifies, analyzes and researches denials root causes and trends; assists in the development of corrective action plans for resolution of denials.
- Minimize internal inaccuracies resulting in false denials to increase our revenue, streamline our operations, and to enhance the patient experience.
- Communicate problematic variances, delays, and any other issues impacting reimbursement to management, contracting, payers and other internal and external stakeholders.
- Complete special projects as assigned by the Supervisor of Denials or Manager of Coding & Compliance, accurately, without need of supervision and in a timely manner.
Dreyer Medical Clinic / Advocate Health Care Aurora, IL
Claims Examiner II Mar 2015 – Dec 2016
- Determines covered medical insurance losses by studying provisions of policy or certificate.
- Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims
- Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.
- Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.
- Maintains quality customer services by following customer service practices; responding to customer inquiries.
- Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
- Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
Dreyer Medical Clinic / Advocate Health Care Aurora, IL
Patient Account Representative Sep 2013 – Mar 2015
- Review claim specific data on patient’s accounts from explanation of benefits received from electronically from commercial insurance payers to include Humana, Blue Cross Blue Shield of Illinois, Railroad Medicare, Medicare, Aetna, and Cigna.
- Manually post claim specific data on patients accounts from explanation of benefits received from workman’s compensation Insurance companies, third party payers and other insurance companies
- Support cash applications with posting patients copays, payments on accounts, collections, time of service payments, returned checks and fees when requested
- Review accounts that show credit balances and determine if money can be allocated to other invoices or request a refund to the patient.
Dreyer Medical Clinic / Advocate Health Care Aurora, IL
Patient Service Representative Dec 2012 – Sep 2013
- Coordinate communication between patients, family members, medical staff, administrative staff, or regulatory agencies
- Interview patients or their representatives to identify problems relating to care.
- Investigate and direct patient inquiries or complaints to appropriate medical staff members and follow up to ensure satisfactory resolution.
- Explain policies, procedures, or services to patients using medical or administrative knowledge.
Certifications
Certified Professional Coder - AAPC Aug 2017Education
Bachelors of Science: Healthcare Management Sep 2016
University of Phoenix Phoenix, AZ
Certificate: Healthcare Management Mar 2015
University of Phoenix Phoenix, AZ
Associate of Arts: Healthcare Management Aug 2014
Georgia Medical Institute Marietta, GA
Certificate: Medical Coding and Billing