I have over five years of experience in medical billing and coding, specializing in both inpatient and outpatient settings. I am proficient in using various billing software such as Epic and Cerner, and I stay updated with the latest coding guidelines and regulations. My experience includes handling claims, resolving billing issues, and ensuring compliance with insurance policies and government regulations.

I ensure accuracy by meticulously reviewing patient records, verifying diagnoses and procedures against coding guidelines, and cross-checking with insurance policies. I also conduct regular audits of claims to identify and rectify any discrepancies. By staying updated with the latest reimbursement policies and utilizing advanced billing software, I minimize errors and maximize claim approvals.

When facing denials, I first analyze the reason for the denial, whether it's a coding error, insufficient documentation, or policy non-compliance. I then work closely with the healthcare provider to gather additional information or correct any errors. For appeals, I prepare comprehensive appeal letters detailing the justification for reimbursement, supported by medical records and relevant policy information, to increase the chances of a successful appeal.

I stay updated by regularly attending webinars, workshops, and training sessions offered by professional organizations like AHIMA and AAPC. I also subscribe to industry newsletters and follow relevant blogs and forums. Additionally, I participate in online communities and discussion groups to exchange insights and stay informed about the latest policy changes and their implications on clinical reimbursement.

One challenging issue was a series of denials for a complex surgical procedure due to unclear documentation. I collaborated with the surgical team to clarify the procedure codes and ensure comprehensive documentation. I then prepared detailed appeal letters for each case, highlighting the medical necessity and supporting evidence. This resulted in a significant number of successful appeals and improved our overall reimbursement rate for similar procedures.