debi7478
Networker
I have vast experience in Medical billing, coding and nursing. Have been coding for the past 8 years and doing billing and consulting work for the past 20 years plus. Would like to get out of California. Looking for the ideal job. Passionate about teaching physicians coding and documentation. I have attached my resume.
Hope to hear from some soon....
RESUME OF DEBRA BALES
507 S. Euclid Spc 82
Santa Ana, CA 92704
(714) 497-7938 (cell)
OBJECTIVE
Utilize my experience, education and clinical expertise to educate physicians and increase revenue due to inexperience or lack of billing /coding education.
JOB HISTORY
05/07 to present Bristol Park Medical Group
Tustin, CA
Coding Specialist/LVN
Auditing and coding from EMR ICD9, CPT and HCPCS codes according
to the contract at Bristol Park Medical group and CPT, ICD9 guidelines.
Working closely with the Director of Billing Services to capture lost
revenue based on audits done. Educating the clinical staff and physicians
on coding guidelines and risk adjustment coding for optimal
reimbursement. Extracting ICD9 codes for Risk Adjustment sweeps by
insurance plans. Conducting inservices for all accounts receivable and
data processing staff on billing issues, coding issues and updated coding
and billing guidelines as they become effective. Maintaining all Appeal
letters and collections guidelines in accordance to collections laws.
Assisting with projects from medical director on physician education for
proper coding. Member of the Risk Adjustment HCC task force.
01/06 to 09/06 Physician WebLink/ Monarch Healthcare
Irvine, CA
Risk Adjustment Specialist/CPC/LVN
Chart auditing of all senior members for HCC Codes. Abstracting ICD-9
codes for risk adjustment. Teach physicians and their staff the
importance of documentation. Full knowledge of the HCC risk
adjustment model through CMS. Teach the physicians and their staff in
proper documentation for patient encounters and to accurately code the
encounters. Conduct inservices to exclusive providers. Submit the
encounter data in a timely manner according to the sweep dates by CMS
and other insurance plans into a spreadsheet for future transmissions.
Monitor the physician offices risk scores and keeping them updated.
Conducting audits twice per year. Responsible for all 400 North County
Physician offices for Monarch HealthCare.
10/04 to 01/06 ArborMed Corp.
Orange, CA
Account Manager
Manage a team of six employees with a client charge volume of over
$1,300,000.00 per month. Responsible for work load of each employee, all accounts receivables for the client. Supervise and train new employees in my department. Conduct merit reviews monthly as well as annual reviews for all employees. Following up on all denials, rejections and appealing claims not paid correctly.
Conduct classes to keep current in all aspects of the billing business. Setting protocols and tracking trends for the client. Maintained credentialing status for all 62 physicians in the practice, updating as needed. Responsible for month end reporting to CFO and Physician administrator.
06/01 to 9/04 Jamie Kim, M.D. (Continuation from
previous employer)
Fountain Valley, CA
Coder/Biller/LVN/CPC
Accurately code all superbills, operative reports in accordance to ICD9
and CPT guidelines. Enter all patient demographics using Medisoft,
Ultramed or Medical Manager software, while adhering to the HIPAA
privacy rules. Billing all open insurance claims as well as billing all
patient statements. Tracking and working accounts receivable according
to each insurance contract. Educate physicians on proper coding for
optimal reimbursement. Conduct in-house audits quarterly for coding
reimbursement accuracy. Analyze each practice for productivity
based employees. Educate on HIPAA guidelines and procedures.
04/00 to 06/01 Doctors of Women Health Centers
Irvine, CA
Biller/Educator
managed the A/R for two offices. Reviewed contracts up for renewal
and/or new prospective insurance companies requesting provider status.
Responsible for setting up protocol and tracking all deposits and transfers
of both offices and balance to day sheets. Responsible for maintaining
correct codes in computer system annually. Educate physicians and staff
on any changes/updates in coding or insurance guidelines. Developed
protocols to increase revenue by auditing productivity losses. Report
directly to the physician partners monthly. Process all company mail.
08/98 to 05/00 Orange-Irvine Doctors of Kids and Teens
Orange, CA
Billing Supervisor
Supervise and train employees in billing office. Contract manager
for nine physicians to insurance companies and hospitals. Management of
practice revenue resulting from the processing of Third Party insurance
claims and patient billing statements. Collections of accounts >90 days in
accordance to the collection laws. Conducting quarterly meetings with the
physicians and financial officer. Developing educational bulletins relating
to changes/updates on coding or insurance carrier guidelines. Conducting
physician education meetings to keep the MD’s apprised of any changes
as needed. Conduct in house audits to assure policies and procedures are
followed. Responsible for direction of employees in billing department.
PROFESSIONAL LICENSE
Licensed Vocational Nurse VN140933
Certified in Phlebotomy
Certified Professional Coder CPC
EDUCATION
HIPAA education training
ICD9 , CPT, HCPCS coding
American Academy of Professional Coders member
Risk Adjustment trainer/educator
Hope to hear from some soon....
RESUME OF DEBRA BALES
507 S. Euclid Spc 82
Santa Ana, CA 92704
(714) 497-7938 (cell)
OBJECTIVE
Utilize my experience, education and clinical expertise to educate physicians and increase revenue due to inexperience or lack of billing /coding education.
JOB HISTORY
05/07 to present Bristol Park Medical Group
Tustin, CA
Coding Specialist/LVN
Auditing and coding from EMR ICD9, CPT and HCPCS codes according
to the contract at Bristol Park Medical group and CPT, ICD9 guidelines.
Working closely with the Director of Billing Services to capture lost
revenue based on audits done. Educating the clinical staff and physicians
on coding guidelines and risk adjustment coding for optimal
reimbursement. Extracting ICD9 codes for Risk Adjustment sweeps by
insurance plans. Conducting inservices for all accounts receivable and
data processing staff on billing issues, coding issues and updated coding
and billing guidelines as they become effective. Maintaining all Appeal
letters and collections guidelines in accordance to collections laws.
Assisting with projects from medical director on physician education for
proper coding. Member of the Risk Adjustment HCC task force.
01/06 to 09/06 Physician WebLink/ Monarch Healthcare
Irvine, CA
Risk Adjustment Specialist/CPC/LVN
Chart auditing of all senior members for HCC Codes. Abstracting ICD-9
codes for risk adjustment. Teach physicians and their staff the
importance of documentation. Full knowledge of the HCC risk
adjustment model through CMS. Teach the physicians and their staff in
proper documentation for patient encounters and to accurately code the
encounters. Conduct inservices to exclusive providers. Submit the
encounter data in a timely manner according to the sweep dates by CMS
and other insurance plans into a spreadsheet for future transmissions.
Monitor the physician offices risk scores and keeping them updated.
Conducting audits twice per year. Responsible for all 400 North County
Physician offices for Monarch HealthCare.
10/04 to 01/06 ArborMed Corp.
Orange, CA
Account Manager
Manage a team of six employees with a client charge volume of over
$1,300,000.00 per month. Responsible for work load of each employee, all accounts receivables for the client. Supervise and train new employees in my department. Conduct merit reviews monthly as well as annual reviews for all employees. Following up on all denials, rejections and appealing claims not paid correctly.
Conduct classes to keep current in all aspects of the billing business. Setting protocols and tracking trends for the client. Maintained credentialing status for all 62 physicians in the practice, updating as needed. Responsible for month end reporting to CFO and Physician administrator.
06/01 to 9/04 Jamie Kim, M.D. (Continuation from
previous employer)
Fountain Valley, CA
Coder/Biller/LVN/CPC
Accurately code all superbills, operative reports in accordance to ICD9
and CPT guidelines. Enter all patient demographics using Medisoft,
Ultramed or Medical Manager software, while adhering to the HIPAA
privacy rules. Billing all open insurance claims as well as billing all
patient statements. Tracking and working accounts receivable according
to each insurance contract. Educate physicians on proper coding for
optimal reimbursement. Conduct in-house audits quarterly for coding
reimbursement accuracy. Analyze each practice for productivity
based employees. Educate on HIPAA guidelines and procedures.
04/00 to 06/01 Doctors of Women Health Centers
Irvine, CA
Biller/Educator
managed the A/R for two offices. Reviewed contracts up for renewal
and/or new prospective insurance companies requesting provider status.
Responsible for setting up protocol and tracking all deposits and transfers
of both offices and balance to day sheets. Responsible for maintaining
correct codes in computer system annually. Educate physicians and staff
on any changes/updates in coding or insurance guidelines. Developed
protocols to increase revenue by auditing productivity losses. Report
directly to the physician partners monthly. Process all company mail.
08/98 to 05/00 Orange-Irvine Doctors of Kids and Teens
Orange, CA
Billing Supervisor
Supervise and train employees in billing office. Contract manager
for nine physicians to insurance companies and hospitals. Management of
practice revenue resulting from the processing of Third Party insurance
claims and patient billing statements. Collections of accounts >90 days in
accordance to the collection laws. Conducting quarterly meetings with the
physicians and financial officer. Developing educational bulletins relating
to changes/updates on coding or insurance carrier guidelines. Conducting
physician education meetings to keep the MD’s apprised of any changes
as needed. Conduct in house audits to assure policies and procedures are
followed. Responsible for direction of employees in billing department.
PROFESSIONAL LICENSE
Licensed Vocational Nurse VN140933
Certified in Phlebotomy
Certified Professional Coder CPC
EDUCATION
HIPAA education training
ICD9 , CPT, HCPCS coding
American Academy of Professional Coders member
Risk Adjustment trainer/educator
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