I have over five years of experience in medical billing and coding, where I handled claims submission, payment posting, and denial management. I am proficient in using ICD-10, CPT, and HCPCS coding systems, and I have worked with various insurance payers, including Medicare and Medicaid. My role required meticulous attention to detail to ensure accurate coding and timely reimbursement, which significantly reduced claim denials and improved revenue cycle efficiency.

When a claim is denied, I first review the denial reason provided by the payer. I then verify the accuracy of the submitted information, including patient details, coding, and documentation. If errors are found, I correct them and resubmit the claim promptly. For more complex denials, I may contact the payer for clarification or escalate the issue to the appropriate department. My goal is to resolve denials efficiently to minimize delays in reimbursement and maintain a healthy cash flow for the organization.

To ensure compliance, I stay updated on the latest healthcare regulations, such as HIPAA, and payer-specific policies. I regularly attend training sessions and review updates from regulatory bodies. Additionally, I implement internal audits to verify that all billing and coding practices adhere to these standards. By maintaining accurate documentation and conducting routine checks, I help the organization avoid penalties and ensure that all claims are submitted in compliance with the necessary guidelines.

In a fast-paced environment, I prioritize tasks based on urgency and importance. I use organizational tools like task management software to track deadlines and set reminders. I also maintain open communication with my team to ensure that critical tasks are addressed promptly. By staying organized and adaptable, I can efficiently manage multiple responsibilities, such as processing claims, resolving denials, and responding to payer inquiries, without compromising accuracy or quality.

In my previous role, I identified a recurring issue with delayed reimbursements due to incomplete documentation. I implemented a pre-submission checklist to ensure all required information was included before claims were sent. This reduced claim rejections by 20% and improved the overall reimbursement timeline. Additionally, I conducted training sessions for staff to emphasize the importance of accurate documentation, which further enhanced the efficiency of the reimbursement process.