Vickie Mathis Email & Phone Number

Us

Us

Performs clinical review of CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment.Determines accuracy of medical coding/billing and payment recommendation for pre-payment claims.This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information.Determines appropriate level of service utilizing Evaluation and Management coding principles.Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance.Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review.Maintains and manages daily case review assignments, with accountability to quality, utilization and productivity standards.Provides clinical support and expertise to the other investigative and analytical areas.Participates in team and department meetings.Engages in a collaborative work environment when applicable but is also able to work independently.Serves as a clinical resource to other areas within the clinical investigative team.Work with applicable business partners to obtain additional information relevant to the clinical review.

Indianapolis, Indiana, Us

Dallas, Texas, Us

Dallas, Texas, Us

Radiology

Medical Coder | Grapevine Inpatient Care Unit 2016 – CurrentHospitalist Clinic with 26 providers and 3 APP’s. Abstract coding, manually posting to EPIC PB Resolute with a daily metrics of 150 charges for charge capture. Provider documentation audit to ensure all history and physicals (H&P) and discharge summary adhere to coding guidelines and compliance standards. Provider queries and feedback via Prover Query Forms to safeguard ethical coding standards. Responsible for resolving back-end coding denials with a goal of 45 accounts per day. Current on CEU’s.Accounts Receivables | Irving Inpatient Care Unit 2013 – 2016Prep billing sheets and enter charges for the Carrollton Inpatient Care Unit. Payor and patient contact to reconcile outstanding invoices. Claim edit, follow-up, and escalation work queue correct rejections, denials, and clearinghouse errors. Appeal and reconsideration submissions and invoice repost. Reviewed patient’s financial status for charity eligibility. Self-pay, payment plan negotiations. Physician’s Office Rep II | Irving Inpatient Care Unit 2010 – 2013Oversees and coordinates the daily activity of the clinic, assists with patient registration, and assist with physician/clinic services. Front office phone calls, patients, and other visitors; and interfaces with insurance. Code and enter encounter data. Analyze and verify insurance coverage and aging accounts. Assists with patient registration duties by collecting and verifying patient demographics and insurance information, entering changes into the system, and photocopying appropriate documentation.SEE FULL RESUME FOR BACKGROUND, SOFTWARE, SKILLS, KEYWORDS AND CONTACT