cehrs harvey l. johnson

Processed government(Medicare and Medicaid) and commercial medical insurance claims, both facility (UB92) and provider(HCFA 1500), for Chiropractor, and Physical Therapist, related to various accidents, and Third Party Liability. Provided expertise or general claims support to appropriate areas in reviewing, researching, investigating, negotiating, processing and adjusments of related claims. Reviewed, prepared and resolved EOB denials, and/or appeals, as well as patient account inquiries and collections. Conducted data entry and re-work; for follow-up with appointed carriers, involved parties, or representation. Analyzed, and identified trends and provided reports as deemed necessary to resolve relative issues.

Instructed assigned courses in accordance with Medical Billing and Coding guidelines, to include proficiency in ICD-9, CPT, HCPCS Coding, as well as Billing Techniques. Adequately prepare all course materials and lessons. Provide students with clear course expectations, evaluations and timelines through carefully written topical outlines and approved, standardized syllabus. Provide Interesting and relevant assignments for students that demonstrate learning outcomes in a real-life billing and/or coding setting. Suitably challenge, engage, serve and communicate with students to encourage their participation and learning while maintaining mutual value and respect. Complete grade books, final grade sheets, learning assessments and final exam assessments on a timely basis. Identify and refer at-risk students to specific academic support services. Ensure course and program learning outcomes are delivered as defined by the syllabus.

Trained students to become proficient in Medical Insurance Billing, ICD-9, CPT, HCPCS, and Dental Coding. Performed bi-monthly student progress evaluations. Managed instructional classroom setting with up to 25 adult students. Prepared students to take the Certified Professional Coder Examination. Generated monthly and end of term grades, and reports. Tutored students that had fallen below guideline standard, or with language barriers. Assisted in Medical Assistant labs when required. Various others duties as assigned.

Coached, counseled and evaluated team of Customer Service Representatives, in a call center environment. Set objectives, consistently measured and analyzed individual performance to meet specific standards. Reprocessed denied claims. Ensured accurate file compilation for proper processing of claims and contracted payments . Handled escalated and/or irate issues, requiring managerial decision. Claims Operative Report Coding Liaison. Detailed coding documentation of surgical procedures.

Managed daily accounts receivable transactions. Recorded and tracked monthly incoming revenues for each insurance carrier. Negotiated HMO, PPO, and other insurance contracts for participation. Monitored and communicated clearing house changes, for the effective transmission of electronic claim submittals. Maintained accurate claims and investigative reports, record keeping and the handling of all administrative responsibilities associated with the processing and payment of claims. Remained current on claim settlement process, processes and procedures. Ensured strict adherence of all company policies and practices, state and government regulations and/or statues. Facilitated informational presentations. Responsible for conducting Continuing Education Sessions.

Reviewed Emergency Room physician narratives, assigned appropriate ICD-9, CPT, and/or HCPCS codes as required, for future billing purposes, from patient’s triage to admission to ICU, CCU, Surgical Care, discharge, or appropriate disposition. Coded all major trauma charts to include: Gun-shot wounds, Motor Vehicle Accidents, Occupational Accidents, in addition to various other accidents. Utilized 3M Encoder. Charts included, multiple fractures, minor and major surgical procedures, IV medications and/or infusions. Abstraction of completed charts. Researched necessary information for adherence within regulatory compliance with CCI, and CMS guidelines. Performed onsite audits as deemed necessary. Provided comments on the overall encounter documentation for physicians and provided a report on procedures not documented adequately for code assignment.

Reviewed inpatient and outpatient radiology reports, selected appropriate ICD-9, CPT, and/or HCPCS code required for finalization of billing. Coded Interventional Radiology charts, as well as special fluoroscopy assisted procedures, to include Heart Catheterizations, Ablations, Stent placements and/or removals, and other Cardio-related procedures. Reviewed Medicare, Medicaid, and various Third-Party Administrator denials for reprocessing. Tracked on-line UPIN information, from various states for provider participation, and eligibility. Attended numerous seminars for Continuing Education Units.

Trained students in both technical (Patient care, Vitals, Phlebotomy, and Injections) and administrative (Front Office Procedures, Professional Development, Medical Terminology, Anatomy & Physiology, and Insurance Billing) aspects of becoming a Medical Assistant. Counseled and tutored students that fell below the required GPA of 2.0. Managed classroom setting for up to 35 adults, and maintained appropriate records for each student. Administered monthly evaluations, and maintained reports required by government standards.

Supervised and coordinated activities of employees engaged in the process of individual, and insurance company collections. Analyzed aging credit, and revenue reports monthly as well as other information received. Monitored credit/debit activity for bad debit reserve projections. Resolved escalated issues requiring managerial decision. Hired additional staff. Initiated any corrective action plans, deemed necessary. Processed claims for payment in accordance to written policies and procedures. Facilitated Procedural and Diagnosis Code Training Classes.

Managed medical insurance billing, and data entry department. Tracked Medicare, Medicaid, and private insurance changes, as well as contract statuses. Monitored claims processing, and follow-up progress. Monitored managed care contracts for accuracy. Reviewed insurance EOB denials. Delegated appropriate actions for resolution.. Evaluated employee progress and additional training requirements. Hiring, and maintaining of additional staff.

* Senior Membership and Billing Representative * Quality Assurance Supervisor * Senior Quality Assurance Analyst * Senior Case Management Analyst * Claims Specialist Team Leader * Claims Processor * Coordination of Benefits Analyst * Worker's Compensation Analyst * PIP Analyst * Medicare Secondary Payer Analyst * Subrogation Analyst * DME Prescription Reviewer * DME Medical Coding Review Specialist * DME Review and Reopen Analyst * Senior Customer Service Representative Medicare A & B * Medi-Gap Claims Specialist * Medicare Part B Correspondence Analyst

Reviewed Emergency Room physician narratives, assigned appropriate ICD-9, CPT, and/or HCPCS codes as required, for future billing purposes, from patient’s triage to admission to ICU, CCU, Surgical Care, discharge, or appropriate disposition. Coded all major trauma charts to include: Gun shot wounds, Motor Vehicle Accidents, Occupational Accidents, in addition to various other accidents. Charts included, multiple fractures, minor and major surgical procedures, IV medications and/or infusions. Researched necessary information for adherence within regulatory compliance with CCI, and CMS guidelines. Performed onsite audits as deemed necessary. Provided comments on the overall encounter documentation for physicians and provided a report on procedures not documented adequately for code assignment. Generated charge logs, evaluated practice management and administrative data, and reported codes to the billing system.