Michael A. Taylor (CPC-A)
HIGH-CALIBER AAPC-CERTIFIED MEDICAL CODER
100 Carter Sells Rd., #12, Johnson City, TN 37604 email@example.com (423) 444-9945
Efficient | Organized | Reliable | Results-Oriented | Detail-Focused | Self-Motivated
Medical Coding Specialist with 10+ years healthcare industry expertise primed to successfully perform accurate
analysis of data records for coding compliance through skilled application of training and experienced clinical coding background. Committed to timely job completion via stellar performance. Eager to excel within a growth-oriented role.
Profile of KEY Qualifications
Ø Customer Service and Support
Ø Organization / Filing Systems
Ø Collaborative Team-Player
Ø Medical Terminology / Office Setting
Ø HIPAA / Data Security and Management
Ø High-Level Integrity / Professionalism
Ø Interpersonal Skills
Ø Articulate Communicator
Ø Stellar Time Management
Technical Proficiency in: Microsoft Office (Word / Excel) | Electronic Medical Record (EMR) Systems | Epic
NextGen | Foundation Systems | Legacy | SBA Tool | WMS | 10-Key By Touch | Keyboarding 50 WPM
Areas of Training and Applied Experience
Ø ICD9, ICD10-CM, ICD10-PCS and CPT Coding
Ø Coding Compliance and Clinical Guidelines
Ø Medicaid Billing / Medical Payment Practices
Ø Election Form Processing (PEP) / Enrollment
Ø Confidential Records and Document Management
Ø Fast. Accurate, Error-Free Data Entry
Ø Data Collection / Research and Analysis
Ø Insurance Eligibility (Blue Cross, Medicaid / Medicare) / Explanation Insurance Benefits (EIB)
Ø Charge Entry / Appeals / Denial Resolution
PROFESSIONAL DEVELOPMENT / EDUCATION / certifications
Bachelor of Science (B.S.), Healthcare Management, pending completion 2024
Southern New Hampshire University (SNHU) – Online
(Active Member: Health Information Management Student Association)
Certification: Certified Professional Coder (CPC-A), pending completion 07/2020
American Academy of Professional Coding (AAPC)
Diploma, Medical Billing and Coding Specialist, Everest College – Tacoma, WA
§ Detail-focused coding specialist with sound judgment and decisive decision-making to review cases and determine clinical documentation needs by leveraging deep knowledge of Medical Coding Rules, Regulations, and Guidelines.
o Garnered in-depth knowledge of coding, classification / reimbursement structures, applicable coding edits, and coverage decisions for accurate coding and billing.
o Fostered trust to establish positive rapport for strong working relationships across all organizational levels.
o Promoted knowledge-sharing to collaboratively create value-add service to team members and customers.
§ Demonstrated excellence in impeccable service delivery and accountability for consistent goal achievement.
o Advanced career development via successful achievement of gold-standard in coding certification through diligence, dedication, and exceptional time management, prioritization, organization, and multi-tasking talents.
o Strong customer service background to promote a warm and welcoming environment. Adeptly handled challenging situations within dynamic environments while maintaining highest levels of integrity, accuracy, and confidentiality.
o Rapidly responded to customer queries for prompt resolution of claim disputes while promoted positive public relations between patients and clinics / facilities.
§ Strong analytical aptitude and insight to investigate complex issues and initiate solutions-oriented strategies.
o Optimized use of resources to determine complex code assignments and identify situations in need of query.
o Consistently adhered to standards, rules, and regulations to achieve targeted goals and business objectives.
MICHAEL a. TAYLOR – RELEVANT EXPERIENCE
Insurance Account Representative, State of Franklin Healthcare Associates – Johnson City, TN 2019 – Present
§ Access / review applicable medical records, reporting data, and other clinical record documentation to verify patient information and ensure interpretation for accurate insurance billing.
§ Diligently follow up on various Medicaid claims for medical and dental benefits, as well as refunds to insurance payers.
§ Communicate well with diverse population of patients / families and insurance personnel by using active listening skills.
§ Maintain accountability for creating new customer files and accurately filing all customer billing and medical records.
§ Utilize database systems to document reportable activities while ensure safety, security, and integrity of data.
§ Display utmost respect and courtesy with staff / community while supporting organization’s goals, vision, and values.
Medical Billing and Follow-Up Representative, Various Agencies – Mason City, IA 2017 – 2019
Trinity Health (12/2017-03/2019) / Healthcare Support Services (09/2017-12/2017)
§ Reviewed, researched, and processed claims in accordance with contracts and policies to determine extent of liability and entitlement, as well as adjudicated claims as appropriate for various medical claims, including Iowa Medicaid.
§ Identified barriers to patient care via strong analysis / assessment of codes for regulatory and standards compliance.
§ Ensured delivery of accurate payments through adherence to processes, procedures, and established protocols.
§ Performed medical coding and claims form processing by leveraging skilled background to confirm proper codes, Medicaid regulations, and HCPS guidelines. Evaluated client data and forms for completeness and accuracy.
§ Accessed and translated data into information acceptable to claims processing system. Identified, researched, and resolved coordination of benefits, subrogation, and general inquiry issues.
§ Proactively detected negative deviations and communicated results. Promptly responded to provider appeals, as well followed up on suspended claims. Accurately prepared and recorded history reviews in timely manner.
Follow-Up Coordinator, UFHealth – Jacksonville, FL (8-months) 2016 – 2017
§ Maintained data security and confidential document and information management while obtaining appropriate demographic / financial data. Registered patients, revised patient histories, and completed necessary documentation.
§ Coded and keyed physicians’ charges into automated billing system program with speed and accuracy.
§ Actively researched and analyzed charges to discern carrier code and financial class for proper billing.
§ Clearly and concisely communicated with internal / external customers for swift resolution of outstanding balances.
§ Delivered reliable quality of service while exercised company policy for assigned payers in a timely, efficient manner.
Medicare Follow-Up Representative, Mountain States Health Alliance – Johnson City, TN 2015 – 2016
§ Determined claim status via tenacious follow-up on Corporate Business Office (CBO) Patient Accounts with payers.
§ Facilitated fast, efficient, and accurate data entry to document customer calls, account inquiries, and other critical data.
§ Applied sharp attention to detail to effectively schedule verified insurance benefits, handle collections, process contract adjustments, interpret remits / EOBs, and identify payments in non-compliance with managed care contract terms.
§ Utilized knowledge of contract management, billing, system support, filing, optical scanning, and cash management.
§ Accurately verified data and facilitated communications via computer interactive services, fax, phone, email.
§ Applied CMS guidelines, rules and regulations by verifying proper Medicaid coding with ICD-9 ,CPT, HCPCS codes.
Accounts Representative, Various Staffing Agencies – San Diego, CA 2013 – 2015
Rose International Staffing (08/2013-04/2014) / Kaiser Permanente Administrative (04/2014-09/2014)
§ Independently processed member election forms for group / individual enrollments while adhering to all CMS and state guidelines. Promptly contacted members regarding discrepancies and / or questions.
§ Accurately processed election forms by enrolling members in Medicare using Market Prominence.
§ Processed enrollment forms for small-business employees. Leveraged programs and systems to process COBRA enrollments, set up MRN correction tickets, create / close enrollment files, and submit documentation for missing data.
§ Consistently maintained HIPAA compliance while interacted with groups / brokers for data clarifications / corrections.
Customer Service Representative, Ophthalmology, SNI Companies – Jacksonville, FL
Southern New Hampshire UniversityJanuary 6, 2020B.S. Healthcare Managment
I am a online student
AAPCJanuary 6, 2020CPC-A
I will be taking my Certification exam in July
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