DENISE M. BODDEN
Concord
Summary
To obtain a professional position that offers the opportunity to utilize my years of knowledge, skills, and experience as a Coding Analyst, Medical Billing Specialist and Patient Account Representative
CCS-P-certified medical coder from AHIMA with four years of professional experience in application and evaluation of various code sets. In previous roles abstracted and assigned ICD and CPT codes to patient medical records, maintain 97% accuracy per 150 daily claims. Seeking to leverage coding guidelines knowledge and strong analytical skills to implement smooth coding services.
Overview
36
36
years of professional experience
Work History
Certified Professional Coder II
Novant Health
Charlotte
04.2023 - Current
- Ensures all technical aspects of the assignment of diagnostic and procedure coding is carried out in accordance with established standards and is in compliance with CMS, NCQA, third party payers and other regulatory agencies.
- Functions includes but are not limited to working charge review work queues for assigned non-surgical practices to ensure the completeness and accuracy of coding clinical diagnosis and procedures.
- With minimal supervision, review and codes work queues as assigned by applying coding principles for correct coding including sequencing.
- Query providers for clarification of incomplete or ambiguous documentation as appropriate and monitor for timely responses.
- Provides provider education and regular feedback on ICD-10 and correct coding issues.
- Evaluates and identifies frontend and back-end error trends for training needs and brings them to the attention of the coding manager.
- Communicates and participates in departmental meetings and initiatives involving coding and the revenue cycle enhancement process.
- Demonstrates a comprehensive knowledge of all procedures concerning the sequencing of diagnoses, procedures such as but not limited to those outlined in ICD-10-CM, CPT, HCPCS and CMS guidelines.
- Maintain adequate knowledge of coding, compliance and reimbursement procedures through review of information provided by RCS, payer policy updates and coding manuals.
- Provides coding assistance through interpretation of guidelines and communication to practitioner.
- Must be accurate in coding of diagnostic and procedure services in accordance with national coding guidelines and appropriate information reimbursement requirements.
- Responsible for responding to coding, billing, and collection inquiries.
- Coding and abstracting acute/chronic high-risk ICD-10-CM diagnoses for risk adjustment purposes that mapped for HCC/RxHCC value.
- Coding and abstracting of inpatient and outpatient medical records for risk adjustment purposes.
Coding Audit Response Specialist, Ambulatory
Novant Health
Charlotte
04.2022 - 04.2023
- Performs post and pre-bill audits as dictated by Corporate Coding Leadership, Compliance, or other Novant Health Leadership.
- Responds to coder comments regarding audit results.
- Identifies trends and risks regarding needed coder education and documentation improvement.
- Researches and corrects post-bill denials to ensure accurately billing.
- Coordinates with CBO and other departments to resolve denials.
- Identifies trends and risks regarding documentation and coding to ensure generation of more accurate claims.
- Identifies chargemaster issues related to billing error.
- Performs DRG/APC reviews for commercial and or CMS denials as assigned by Corporate Coding Audit Response Lead, Coding Supervisor, and Coding Manager.
- Writes appeal letters to commercial payers for applicable accounts to support coding.
- Answers coding related questions from other facility departmental personnel which are sent to coding review work queues.
- Answers questions from production coding staff as related to audits results.
- Initiates any necessary account rebills to ensure accurate billing and reimbursements.
Radiation Oncology Claims/Coding Analyst
Onslow Memorial Hospital
Jacksonville
10.2020 - 03.2022
- Abstract orders, charges, and related diagnoses codes from radiation oncology records to ensure services billed are consistent with the record documentation.
- Coordinate compliance with all billing and coding regulations.
- Input CPT codes for radiation therapy procedures.
- Post insurance and patient payments.
- Submit claim remission for payments.
- Review denials and claim rejections for possible appeals or resubmission.
- Input modifiers, work CCI edits, and MUE edits.
Coding Analyst, Edits Team: Promotion
Vidant Medical Center
Greenville
04.2016 - 10.2020
- Performed data quality reviews on outpatient encounters to facilitate clean claim submissions by using independent judgement.
- Preformed data quality claim edits.
- Use knowledge of coding and Medicare regulations to resolve coding issues identified by central billing office claim scrubber.
- Communicate corrections to the Central Billing Office in a timely and accurate manner so that billing edits remain at developed targets.
- Medical Record Documentation to ensure corrections are consistent with documentation.
- Trend OCE/CCI edits.
- Code by using governmental guidelines to optimize reimbursement.
- Accurately assigned ICD 10 and CPT codes to all surgical specialty areas.
- Reviewed patients charts and identified discrepancies in the medical documentation.
- Performed computer assisted coding using 3M and Knowledge source information systems.
- Communicate any identified patterns or trends in OCE/CCI edits.
- Assist with the resolution of identified patterns and trends.
- Assist with the monitoring of implemented resolutions.
- Knowledge of government and coding charges.
- Apply governmental and coding changes related to billing.
- Communicate any governmental or coding changes that may affect reimbursement.
- Resolve coding related denials.
- Reviewed medical records to validate charges.
- Meet productivity and accuracy standards for department.
- Maintained productivity standards as communicated by supervisor.
- Maintained 95% accuracy rate when assigning ICD and CPT codes.
Patient Access Representative
03.2013 - 04.2016
- Performed quality patient registration and pre-registrations.
- Completed patient registration functions.
- Obtained signatures for consent for treatment.
- Explained financial obligations including collections of co-pays, deductible and or co-insurance.
- Coordinates scheduling of patient procedures by working with physicians and physician’s office staff, clinical staff of various departments via telephone or faxes.
- Enters all information into computerized medical records and or patient care management applications as indicated for billing or UR follow-up.
- Coordinates printing and faxing of various schedules for use by designated staff.
- Verified insurance benefits using the electronic eligibility application (passport), internet application or telephone calls to insurance carriers.
- Created referrals into Prelude when authorizations are obtained.
- Provide insurance benefits interpretation and counseling based on the information provided through electronic eligibility functions.
- Scan all pertinent documents, including precertification documents, benefits information, and insurance card copies.
- Scheduled emergent, urgent, and elective surgical cases for a variety of surgical specialties in a fast-paced, high-stress environment.
- Coordinated the scheduling, various changes and cancellations of surgical cases with physicians and/or physician’s offices staff, surgical staff, appropriate inpatient units, and patients via telephone or faxes.
- Facilitated communication between patients, anesthesiologists, physicians, and surgical staff.
Commercial Medical Biller
Pediatrics Associates
Fayetteville
01.2012 - 02.2013
- Pull off all remits for BCBS, Aetna, Cigna, Tricare and Medicaid.
- A folder of mailed remits given weekly to post payments.
- Post all payment and work denials for all offices.
- Keep a spreadsheet of all payments that are given and pulled and posted.
- Work secondary claims.
- Keep up with over payments and come to management regarding all refunds and write offs.
- Work aging report.
- Keep track of recoupment’s.
- Work all commercial and government errors.
- Work rejection report.
- Work denials and follow up with insurance company on nonpayment claims.
- Writes appeals for denied claims & Analyzes patients’ accounts, performs reconciliation and refund activities and assists with inquiries regarding account activities including insurance and guarantor overpayment resolution.
Patient Account Representative
Fresenius Medical Care
Fayetteville
04.2010 - 12.2011
- Performed patient billing and account management utilizing Medical Manager billing software; enter payments, adjustments, refunds and credits.
- Review all batches received for completeness and accuracy prior to posting payments.
- Distribute payments to accounts per patient request when available.
- Provided accurate posting of insurance payments per Explanation of Benefits (EOB) s, calculate contractual allowances.
- Verify patient demographics, payment amount, reference numbers, pay code and contractual allowances.
- Identify duplicate payments, overpayment, and misdirected payments and prepare refunds and credits; accordingly, Pend and forward unidentifiable payments to Audit Specialists for investigation.
- Foster team cohesiveness to ensure timely completion of department responsibilities and goals.
Cash Posting Specialist
Memorial Sloan Kettering Cancer Center
New York
08.2004 - 12.2009
- Entered payments, adjustments, refunds and credits into IDX (healthcare management software); processed over 400 transactions daily.
- Reviewed batches received daily for completion and accuracy prior to posting payments.
- Posted payments per patient’s instructions via Chase on-line/or Chase CD; entered insurance payments per EOBs and calculated contractual allowances; verified patient information and payment codes, amounts, and postings.
- Identified duplicate payments, overpayments, and misdirected payments.
- Reviewed and processed Medicare Electronic Data Interchange (EDI) assigned for that day to include loading, load edits, manual, interests and offsets payments.
- Prepared and printed all reports for EDI processing.
Audit & Control Specialist
Memorial Sloan Kettering Cancer Center
New York
08.2004 - 12.2009
- Resolved credit balances in a timely and accurate manner; ensured all charge corrections were processed and credit balances were resolved in a timely manner.
- Investigated and resolved patient account discrepancies as needed in accordance with Departmental Adjustments Policy and Procedure.
- Communicated with insurance carriers to determine the necessary information to secure payment; recommend posting to unmatched and miscellaneous accounts for follow-up after month end closing.
- Processed all voided refunds and assisted with various special projects and account audits.
Patient Registrar Clerk – Admitting and Emergency Departments (2nd Job)
New York-Presbyterians, Cornell Weil Center
New York
08.2008 - 11.2009
- Provided outstanding customer service and care while collecting accurate detailed demographic, financial, and clinical information to perform admissions and registrations for the Admitting and Emergency Departments.
- Converted Ambulatory and Emergency admissions to Inpatient admissions.
- Obtained pre-certification and authorization for patients to ensure payments from a third-party payer.
Data Entry & Billing Clerk
12.1989 - 07.2008
- Keyed and verified appropriate alphabetical and numeric data in accordance with established procedure codes; ensured the accuracy and confidentiality of patient information.
- Rejected source document when information inaccurate; maintained current personal data entry documentation file; posted charges for surgical cases and supplies utilizing Surgery Server Software, TPX Eagle Software and Picis (Medical Systems Manager) Software.
- Processed charge corrections for any discrepancies with credits and debits as well as adjustments of charges posted for both inpatients and outpatients.
Education
AAS Degree - Medical Coding and Billing
Grantham University
AS Degree - Computer Science; Emphasis in Computerized Billing
Monroe Community College
Awards
Medical Group Management Association- Certificate of Superior Performance in Medical Billing
References
Personal and professional references available
Licensures
CCS-P-Certified Coding Specialist-Physician Based (AHIMA awarded 2018)
Computer Software
- Siemens Pharmacy Software
- Pysis Connect
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Medical Manager
- Picis Medical Systems Manager
- EMR-Electronic Medical Records
- Allegiance Medical billing software
- Surgery Server Software
- Signature Gold Software
- IDX systems
- ICD10/ICD9/CPT4 coding
- Health Quest
- Eagle TPX Software
- Eagle Gold
- CPM Ormis 735
- EHR-Electronic Health Record
- Health Span
- Epic
- RealView
- Soft med
- Optime2014
- ImageNow
- 3M Coding
- Knowledge source
- Aria/Variance
- Centricity G4 12.3
Timeline
Certified Professional Coder II
Novant Health
04.2023 - Current
Coding Audit Response Specialist, Ambulatory
Novant Health
04.2022 - 04.2023
Radiation Oncology Claims/Coding Analyst
Onslow Memorial Hospital
10.2020 - 03.2022
Coding Analyst, Edits Team: Promotion
Vidant Medical Center
04.2016 - 10.2020
Patient Access Representative
03.2013 - 04.2016
Commercial Medical Biller
Pediatrics Associates
01.2012 - 02.2013
Patient Account Representative
Fresenius Medical Care
04.2010 - 12.2011
Patient Registrar Clerk – Admitting and Emergency Departments (2nd Job)
New York-Presbyterians, Cornell Weil Center
08.2008 - 11.2009
Cash Posting Specialist
Memorial Sloan Kettering Cancer Center
08.2004 - 12.2009
Audit & Control Specialist
Memorial Sloan Kettering Cancer Center
08.2004 - 12.2009
Data Entry & Billing Clerk
12.1989 - 07.2008
AAS Degree - Medical Coding and Billing
Grantham University
AS Degree - Computer Science; Emphasis in Computerized Billing
Monroe Community College