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Thank you,
Kathy Cronkhite
[email protected]
Thank you,
Teri Peniston, CPC
Teri Peniston
CPC
AAPC License 01436954
[email protected]
(760) 707-4662
Summary
Dependable, hardworking professional
Bilingual in English and Spanish
Positive interactions with clients and staff
Detailed and analytical approach
Training in Office Procedures
ICD-10, DSM-IV, CPT coding
Adhere to HIPAA standards
Experience
Claims Compliance Analyst
September 2017 present
Research and resolve claims issues
Adjust any improper denials
Verify member eligibility and provider coverage
Ensure that ICD-10 and CPT codes are valid
Coordinate benefits
Prepare audits of provider-selected claims
Assist with special projects as needed
Claims Examiner III at American Specialty Health
December 2013 September 2017
Processed medical claims for chiropractic, acupuncture and physical therapy
Interpreted Explanation of Benefits and coordinated primary/secondary insurance
Consistently met quantitative and qualitative production standards
Verified personal health information and eligibility requirements
Sales Associate at Ross Stores, Inc.
June 2011 – August 2014
Cashier: Handled cash/credit card transactions
Fitting Room Attendant: Enforced loss prevention procedures
Sales Floor: Merchandised items, organized store
Case Manager at Palomar Counseling Services
September 2006 – April 2008
Provided short-term therapy to children, youth and families, including intakes and psychosocial assessments and psycho-educational groups. Completed medical documentation, with appropriate DSM-IV diagnoses and CPT/HCPCS codes, with monthly and annual updates
Provided community resources to families
Educated parents in behavioral interventions
Conducted psycho-educational groups for teen recovery program
Skills & Expertise
Knowledge of medical terminology
Familiarity with several commercial insurance companies and Medicare
Experience interpreting CMS-1500 forms
CPT and ICD-10 coding
Coordination of benefits
Customer Service
Computer applications: Word, Excel, Outlook, 10-key
Education
Mira Costa College
Certificate in Insurance Coding and Billing, Medical Administrative Professional, 2010 – 2012
San Diego State University-California State University
Master’s degree, Social Work, 2004 2006
AAPC
Practicode July 2017 May 2018
Operation Samahan Inc. (OSI) is a federally qualified community health center that emerged over forty years ago. The agency serves low-income families and individuals in the County of San Diego in two (2) strategic areas with a high-density population of Filipinos/Asian and other low-income, uninsured individuals National City (Southern San Diego County) and Mira Mesa (North Central San Diego).
JOB PURPOSE
Under the supervision of the Billing Manager the Certified Medical Coder is responsible for a variety of billing and coding functions. Identifies needs for provider education. Ensuring proper and compliant coding and billing.
ESSENTIAL DUTIES AND RESPONSBILITIES
Support and Administration:
Receive and review patient charts and documentation for accuracy
Ensure that all codes are current and active
Report missing or incomplete documentation
Meet daily coding production
Update and maintain document list
Ensure proper coding on provider documentation
Services as resource regarding insurance resolutions and coding questions
Follows coding guidelines and legal requirements to ensure compliance with federal and state regulations.
Performs additional duties assigned by Billing Manger as needed.
Education and Experience:
Strong knowledge of FQHC business
Minimum 5 years experience in a medical office or community clinic.
Current Medical Coding Certification (AAPC, AHIMA or PACHS [Family Practice Specialty])
Understanding of medical terminology, anatomy and physiology
Strong computer skills, eClinical Works software preferred.
Send resume or apply online at www.operationsamahan.org
Thank you for your consideration,
Teri Peniston