Lydia Jackson
Phoenix,AZ
Summary
Professional with significant experience in quality assessment and review processes, ensuring accuracy and compliance. Adept at collaborating with teams to drive high-impact results and adapt to changing priorities. Strong analytical skills, keen attention to detail, and excellent communication abilities valued by employers. Reliable and resourceful, excelling in environments that demand thorough evaluation and feedback.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Clinical Trials Charge Review Specialist
Banner Health Alzheimer's Institute
10.2024 - 05.2025
- Reviewed documentation for compliance with regulatory standards and guidelines.
- Collaborated with cross-functional teams to ensure alignment on review criteria and expectations.
- Monitored feedback trends to enhance quality assurance measures and support continuous improvement initiatives.
- Led initiatives to update review methodologies, integrating feedback from team reviews for enhanced accuracy.
- Daily reporting Clinical Conductor trial research, drug device data collection registry and observation
- Clinical Trial Facility and Office Billing & Coding Commercial Insurance ,Medicare and Advantage ,Medicaid all Variances
- Conducted root cause analysis on recurring issues encountered during reviews; proposed viable solutions that led to long-term improvements.
HIMS Coder
Banner Health
09.2016 - 10.2024
- Utilized coding software to assign appropriate codes for diagnoses and procedures.
- Reviewed medical documentation for completeness and compliance with coding guidelines.
- Analyzed discrepancies in coding to identify areas for improvement and accuracy.
- Assisted in training new coders on best practices and coding standards.
- Implemented feedback from audits to enhance coding practices and reduce errors.
- Maintained up-to-date knowledge of ICD-10, CPT, and HCPCS coding systems.
- Supported quality assurance initiatives by conducting regular audits of coded data.
- Maintained high coding standards by adhering to industry best practices and staying current with emerging technologies.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Correctly coded and billed medical claims for various hospital and Specialist offices
- Facilitated knowledge sharing within the team by conducting regular code reviews on relevant topics.
- Delivered consistent results under pressure by prioritizing tasks effectively during periods of high workload or tight deadlines.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Collaborated with Providers and office staff to ensure accurate coding of patient records.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Verified signatures and checked medical charts for accuracy and completion.
- Monitored changes in coding regulations to provide recommendations for compliance.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Verified accuracy of patient information in medical records.
Pediatric Charge Specialist Physician Practice
Banner Health Pediatrics
11.2011 - 09.2016
- Collaborated with cross-functional teams to streamline workflows and improve communication.
- Implemented process improvements that increased efficiency in daily operations.
- Trained new employees on standard operating procedures and best practices for role execution.
- Gathered feedback from stakeholders to refine processes and enhance service delivery outcomes.
- Followed all company policies and procedures to deliver quality work.
- Proactive problem-solving and efficient complaint resolution missing charges and procedures trends and Insurance denials
- Conducted regular reviews of operations and identified areas for improvement.
- Devised and implemented processes and procedures to streamline operations.
- Educated staff on organizational mission and goals to help employees achieve success.
- Cultivated positive relationships with all Providers to deliver timely and cost-effective charge review
- Receivable workstations assigned to audit and handle insurance follow up and resolve accounts to zero or patient.
- Review appropriate accounts for rebills and correspondence. Bill Physician and Hospital Claims, appeal letters, review and research denials. Track and communicate trends to different cross functions
Senior Patient Financial Representative
Banner Occupational Health
06.2008 - 01.2011
- Collaborated with healthcare providers to resolve patient billing inquiries efficiently.
- Processed patient payments and set up payment plans according to established guidelines.
- Maintained detailed records of patient interactions and transactions for compliance purposes.
- Reviewed and updated patient account information for accuracy and completeness.
- Coordinated with internal departments to streamline billing operations and enhance service delivery.
- Enhanced revenue collection by diligently following up on unpaid claims and negotiating payment plans with patients.
- Ensured patient privacy by adhering to all HIPAA regulations during daily tasks and interactions.
- Served as a liaison between patients, providers, and insurance companies, facilitating communication around financial matters.
- Described general insurance regulations and practice insurance contracts to clients.
- Developed a comprehensive understanding of various payer requirements and policies, resulting in fewer denied claims due to insufficient documentation or coding errors.
- Efficiently posted payments and adjustments in accounting system.
- Accurately reviewed and updated patient and financial information.
- Contacted guarantors to collect payments for past due accounts.
- Analyzed claims data to identify trends and ensure compliance with regulations.
- Assisted in developing strategies to reduce claim disputes and improve resolution timelines.
- Educated employees on workers' compensation procedures and best practices for reporting incidents.
- Implemented process improvements that enhanced efficiency of claims management workflows.
- Worked well in a team setting, providing support and guidance.
- Passionate about learning and committed to continual improvement.
- Excellent communication skills, both verbal and written.
- Skilled at working independently and collaboratively in a team environment.
- Worked effectively in fast-paced environments.
- Self-motivated, with a strong sense of personal responsibility.
- Paid attention to detail while completing assignments.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
Medical Billing Coding
Internal Medicine Specialist, PC
06.2004 - 01.2005
- Check in patients, collect co-pays, verifies insurance, Code Procedures. Submit electronic Medicare claims and prepare/review coding and errors, accounts receivable, bank deposits.
Referral Coordinator
Barrows Neurological Group
01.2001 - 01.2002
Education
Certificate of Technical Studies - Medical Billing/Physician Coding
Everest College
Phoenix, ArizonaNo Degree - Health Core Curriculum
Maricopa Community College System
AZSkills
- 19 years Medical Coding
- Medical Billing Insurance Medicaid Medicare Commercial
- Proficient in AI-driven medical billing
- Audit communication effectiveness
- Regulatory compliance practices
- Compliance management skills
- CPT and HCPCS coding expertise
- Medical claims denial management
- Specialty practice experience
- Clinical trials evaluation
- Technical coding assistance
- MedSeries4,Cerner, NextGen, Word, Excel, Power Point, NextGen, EMR/EHR, RCx, n-Thrive,3M,Optum
Certification
Medical Insurance Billing and Coding
Timeline
Clinical Trials Charge Review Specialist
Banner Health Alzheimer's Institute
10.2024 - 05.2025
HIMS Coder
Banner Health
09.2016 - 10.2024
Pediatric Charge Specialist Physician Practice
Banner Health Pediatrics
11.2011 - 09.2016
Senior Patient Financial Representative
Banner Occupational Health
06.2008 - 01.2011
Medical Billing Coding
Internal Medicine Specialist, PC
06.2004 - 01.2005
Referral Coordinator
Barrows Neurological Group
01.2001 - 01.2002
Certificate of Technical Studies - Medical Billing/Physician Coding
Everest College
No Degree - Health Core Curriculum
Maricopa Community College System