Jessica Young
Mechanicsville,VA
Summary
Experienced with medical coding and regulatory compliance. Utilizes coding expertise to ensure accurate and efficient processing of medical records.
Offering 13 years of experience in related roles, I have significantly contributed to streamlining operations and ensuring HIPAA compliance, demonstrating a commitment to excellence and continuous improvement in healthcare administration ranging from clinical documentation improvement to accurately coding and billing insurance claims.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Senior Medical Coding Specialist
Dominion Women's Health
11.2019 - Current
- Review, analyze, and manage coding of diagnostic and treatment procedures contained in outpatient medical records.
- Interact with physicians and other healthcare staff to ask questions regarding patient services.
- Correctly code and bill medical claims for office and hospital services.
- Collaborated with healthcare providers to obtain clarifications on documentation, resulting in improved clinical data quality.
- Train and mentor junior coders to support growth and development and apply high-quality coding practices.
- Communicate with insurance companies to research and resolved coding discrepancies.
- Monitor changes in coding regulations to provide recommendations for compliance.
Billing Specialist
Upstream Care LLC
01.2023 - 09.2024
- Identify, research, and resolve billing variances to maintain system accuracy and currency.
- Prepare itemized statements, bills, or invoices and recorded amounts due for services rendered.
- Research and resolve billing discrepancies to enable accurate billing.
- Work with multiple departments to check proper billing information.
- Utilize various EMR systems for claims processing.
- Perform Clinical Chart Reviews to maintain accurate clinical documentation.
- Created a process for denials management to ensure timely response to discrepancies or billing errors.
Medical Office Specialist
Advanced Surgical Partners Of Virginia
03.2019 - 11.2019
- Received, recorded and filed medical payments by check, cash, and credit card.
- Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
- Utilized ECW to schedule appointments for doctor visits and procedures.
- Scheduled and organized monthly Bariatric Surgery Seminars for new patients.
- Reconciled daily payments received and prepared deposits for smooth office finances.
- Prepared patient charts by gathering and organizing medical records ahead of appointments.
- Provided prompt, polite and professional in-person and telephone customer service.
Inventory Specialist
Alpha Automation LLC
02.2018 - 03.2019
- Completed physical inventory counts each month.
- Performed data entry and completed proper paperwork.
- Inspected products received for customer orders to ensure accuracy.
- Sorted and delivered materials to different work areas and staff.
- Requisitioned new supplies and maintained storage areas for smooth department operations.
- Inspected incoming and outgoing shipments to identify discrepancies with records.
Clinical Pharmacy Technician
Magellan Health
03.2017 - 02.2018
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Researched, resolved and documented prior authorization outcomes.
- Communicated prior authorization criteria, benefit coverage and formulary alternatives to physicians, physician office staff, medical management staff and/or pharmacists.
- Escalated requests to Pharmacist when request required extensive clinical review or denial.
- Researched, resolved and documented physician or client inquiries and grievances and provided verbal or written results to client, prescriber, provider and/or management.
RX Shift Supervisor
CVS Pharmacy
07.2016 - 02.2018
- Trained new employees and delegated daily tasks and responsibilities.
- Maintained clean and well-organized production areas to avoid violations or unnecessary work delays due to hazards or inefficient layouts.
- Resolved customer complaints and issues and offered thoughtful solutions to maintain customer satisfaction.
- Processed product returns/credits.
- Streamlined operational efficiencies by supervising inventory cycle counting processes, including accounting and reporting of surplus, product returns and damages.
- Responsible for scheduling, auditing, and determining inventory needs for the entire store.
- Responsible for maintaining drug inventory.
Lead Pharmacy Technician
CVS Pharmacy
12.2011 - 07.2016
- Resolved non-routine issues like third-party billing, computer system, and customer service issues.
- Responsible for creating Pharmacy Schedule.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
- Maintained proper drug storage procedures, registries, and records for controlled drugs.
- Supervised pharmacy technicians and coordinated day-to-day assignments.
- Monitored ordering of pharmacy medication stock to maintain streamlined inventory and low overhead.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
Education
GED -
Franklin County High School
Rocky Mount07.2018
Skills
- Billing systems and software
- Clinical Documentation Improvement
- Denials Management
- Claim submission & processing
- Clinical Coding Knowledge
- Insurance Verification
- HIPAA Compliance
- Data entry proficiency
- Research and due diligence
- Medical terminology proficiency
- Continuous learning mindset
- Proficiency in multiple EMR systems including Greenway Intergy, Athena, ECW, Allscripts, Medpointe, Epic, PracticeFusion, & Kareo
- Quality Assurance
- Invoice Processing
Accomplishments
- Paragon Award Recipient 2016 - Recognizes the best of the best among CVS Health colleagues and are among the highest honors awarded by the company.
- Developed a pathway to assist Upstream team members with insurance denials – implemented a follow up process and manual on how to submit corrected claims and reconsiderations depending on the requirements for individual payers.
- Assisted in creating a database to house outstanding claims and provide updates and outcomes of follow up that resulted in an overall recoupment amount of $46,097.75 across all practices we submitted CCM claims for from January 2023 through May 2024.
- Increased billing accuracy rates by an average of 7% based on chart audit reviews.
Certification
- CPht - Certified Pharmacy Technician 2011-2024
- CPC - Certified Professional Coder 2018
- CDEO - Certified Documentation Expert Outpatient 2024
Timeline
Billing Specialist
Upstream Care LLC
01.2023 - 09.2024
Senior Medical Coding Specialist
Dominion Women's Health
11.2019 - Current
Medical Office Specialist
Advanced Surgical Partners Of Virginia
03.2019 - 11.2019
Inventory Specialist
Alpha Automation LLC
02.2018 - 03.2019
Clinical Pharmacy Technician
Magellan Health
03.2017 - 02.2018
RX Shift Supervisor
CVS Pharmacy
07.2016 - 02.2018
Lead Pharmacy Technician
CVS Pharmacy
12.2011 - 07.2016
GED -
Franklin County High School
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