Summary
Overview
Work History
Education
Skills
Certification
Timeline
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Roselyn Clark

Roselyn Clark

Newport News

Summary

Dynamic Claims Resolution Specialist with proven expertise in ICD-10 coding and claims processing at TEKsystems. Recognized for enhancing claim accuracy and efficiency through meticulous documentation and critical thinking. Adept at collaborating with cross-functional teams to resolve discrepancies, fostering client trust while streamlining revenue cycle processes.

Overview

13
13
years of professional experience
1
1
Certificate

Work History

Claims Resolution Specialist

TEKsystems
07.2024 - Current
  • Resolved customer inquiries regarding claims processing and status updates.
  • Collaborated with cross-functional teams to gather necessary documentation for claims resolution.
  • Reviewed claim submissions for accuracy and completeness, ensuring compliance with company policies.
  • Utilized claims management software to track progress and facilitate communication with stakeholders.
  • Provided support in identifying discrepancies and recommending solutions to enhance claim processing efficiency.
  • Maintained organized records of claims files, facilitating easy access for audits and reviews.
  • Mitigated risk by identifying trends in claim patterns and recommending proactive prevention strategies to management.
  • Provided exceptional customer service throughout the resolution process, fostering client trust and loyalty.
  • Increased accuracy in claims assessment through meticulous record-keeping and organized documentation.

Outpatient Medical Coder

Riverside Regional Medical Center
06.2015 - 06.2024
  • Reviewed medical records for accurate coding in compliance with industry standards.
  • Utilized ICD-10 and CPT coding systems to ensure precise documentation of diagnoses and procedures.
  • Collaborated with healthcare professionals to clarify documentation discrepancies and enhance coding accuracy.
  • Assisted in maintaining updated knowledge of coding guidelines and regulations through ongoing education.
  • Conducted audits of coded data for consistency and completeness, identifying areas for improvement.
  • Supported billing processes by ensuring timely submission of coded claims to insurance providers.
  • Implemented feedback from coding reviews to refine practices and reduce errors in future submissions.
  • Adapted quickly to changes in coding requirements, demonstrating flexibility in a dynamic healthcare environment.
  • Time management skills were utilized effectively to balance competing priorities under tight deadlines.
  • Supported compliance initiatives through meticulous adherence to coding guidelines and regulations.
  • Streamlined revenue cycle processes for improved reimbursement rates and reduced denials.

Medical Biller and Coder

Bayview Physicians
02.2012 - 06.2015
  • Managed patient billing processes, ensuring accuracy and compliance with healthcare regulations.
  • Reviewed and coded medical records utilizing ICD-10, CPT, and HCPCS coding systems.
  • Collaborated with healthcare providers to resolve billing discrepancies and improve revenue cycle efficiency.
  • Trained junior staff on coding practices and billing software applications for enhanced team performance.
  • Correctly coded and billed medical claims for various hospital and nursing facilities.
  • Reduced claim denials through meticulous verification of patient eligibility and coverage benefits prior to claim submission.
  • Worked closely with physicians to accurately assign ICD-10 diagnostic codes for optimal reimbursement rates from insurance companies.

Education

No Degree - Nursing Science

Southern University And A&M College
Baton Rouge, LA

Coding Certificate - Medical Billing And Coding

Tidewater Community College
Norfolk, VA

Skills

  • ICD-10 coding expertise
  • CPT expertise
  • Experience with private payor systems
  • Comprehensive understanding of human anatomy
  • Skilled in Microsoft software
  • Certified professional by AAPC
  • Deadline-oriented multitasker
  • Epic proficiency
  • Experienced with 3M applications
  • Claims processing professional
  • Adjustments processing
  • Problem-solving
  • Time management
  • Critical thinking

Certification

AAPC#01138558CPC


Linkedin: www.linkedin.com/in/roselyn-clark-31a65567

Timeline

Claims Resolution Specialist

TEKsystems
07.2024 - Current

Outpatient Medical Coder

Riverside Regional Medical Center
06.2015 - 06.2024

Medical Biller and Coder

Bayview Physicians
02.2012 - 06.2015

No Degree - Nursing Science

Southern University And A&M College

Coding Certificate - Medical Billing And Coding

Tidewater Community College

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Roselyn Clark