Responsible for auditing of the Cardiac & Vascular procedures performed in our 3 Cath labs and our Hybrid room. Ensuring that all items and procedures are correct and appropriately billed and coded.In-service the cardiac catheterization lab staff and physicians on new procedural codes and proper documentation, for prompt payment.Keep the Medical Records Department and Material Management updated on the new devices that are used in the cardiac catheterization lab.Keep the Case Management Department updated on procedures that may need mandatory authorizations for inpatient stays.Update Pro Fee’s on an annual basis for our non-invasive and interventional physician’s contracts.Review the documentation of the echocardiograms that are done prior to entering the charges into Invision for the Non-Invasive side of the cardiology service line.Handle denied claims from Business Services for the Cardiology Service Line.Responsible for CDM modifications and or additions for the new CDM’sResponsible for creating Lawson numbers for our devices**updating as needed.Maintaining POU and CHC regarding the Lawson numbers (devices) and procedure codes.Have submitted paperwork and successfully received payer credentialing for the NP for the CVSL with Medicare, Medicaid, and other commercial carriers. In this position, I work independently, as well as cohesively work with a diverse group of other departments at Beebe Medical Center.

Responsible for supervising the charge entry for five full-service emergency room sites for professional and facility nurses' charge entry.Verify coded entries in IDX are correctly entered and are based on the correct diagnosis and correlate to the information contained within the patient’s chart.Responsible for staff production, education, annual reviews, personal time, as well as staff discipline if necessary.Perform pre-employment job interviews and confer with Human Resources on choice of candidates and verify their skill sets. I finished LVPG’s coding education classes. In these classes we gained a better understanding of the fee abstractors’ piece. The classes were for approximately six months. It was a great learning tool. In my position as Supervisor of Charge Entry it was something that I used daily. These classes were a great addition to my already solid understanding of ICD-9 codes and CPT codes. It helps to know about all the pieces of the puzzle and how they all fit together to give you the whole picture.

Responsible for the reimbursement analysis of all 24 practices within the Division of Internal Medicine practices of LVPG. Confirm that the current reimbursement rates are the highest they can be. Review monthly reports for potential trends of under-reimbursed and non-reimbursed procedures to improve current reimbursement rates.Work directly with Accounts Receivable to verify each medical practice’s billing procedures and work with individual practice team leaders and managers to correct billing functions as necessary, including meeting with individual physicians as required.Follow-up directly with the various insurance companies as needed to confirm current reimbursement rates and requirements within each company’s contract are being met.Work within the insurance follow-up team, IDX Ops team, finance department, credentialing department, as well as coding and compliance to correct any issues that are discovered.Was on the A3 committee for Lehigh Neurology Practice. (This committee was devised for the purpose of process improvement and increasing revenue and reducing waste.)

Utilize IDX reports to work accounts receivable as well as denied claims. Review Timely Filing requirements along with each insurance carrier’s proper filing process.Work closely with all LVPG practices and insurance carriers to ensure proper payment for services rendered.Work closely with Highmark Blue Shield, Capital Blue Cross, Aetna, many managed care products, HMO’s as well as Medicare, Medicaid, and various commercial carriers.

Assisted patients, physicians, and other providers with medical coverage questions.Coordinated with Medicare and other insurance providers to verify coverage and individual benefits.Determine if physicians, hospitals, and patients’ benefits were paid correctly.Helped educated recent retirees as to their coverage within Aetna and Medicare.

Team Lead responsible for medical claims processing and customer service.Responsible for training all new customer service representatives hired within the Allentown office of Aetna Life and Casualty.Assisted patients, physicians, and other providers with medical coverage questions.Coordinated with Medicare and other insurance providers to verify coverage and individual benefits.Would review with patients their benefits as well as their spouse’s benefits within their Aetna insurance coverage. Review what would be their responsibility, how it would be paid, as well as the expected usual and customary fee.Determine if physicians, hospitals, and patient’s benefits were paid correctly.Helped educated recent retirees as to their coverage within Aetna and Medicare.