Ty Franklin

· Assigning accurate ICD 10, CPT, E/M, HCPCS, and procedure codes with proper sequencing using coding tools 3M, Encoder Pro Optum and Codify and entering charges in EPIC across multiple specialty workques including Radiology, Neurology, Primary, Urgent Care, Internal Medicine, Psychiatry, Plastic Surgery, Breast Surgery, Hematology/Oncology, Neurosurgery, Cardiology, IR, General Surgery, Pediatrics, Pediatric Surgery, Transplant Surgery, Vascular Surgery, Urology, Gastroenterology, Orthopedic Surgery, Alternative Medicine and more. Working in Outpatient, Inpatient and Critical care.

· Reconciling error corrections such as unbundled and bundling codes, meeting diagnosis code relationship criteria using LCD or NCD guidelines through CMS, assigning correct modifiers, meeting Medicare, Medi-Cal and Managed Medi-Cal Payors requirements, Billing department and Billing Specialty inconsistencies, processing repeat and duplicate procedures, correcting incorrect primary diagnosis and external cause codes, NCCI edits, charge reviews, RFI claim edit to correct denials and resubmissions, coding audits, follow up status of charges held for clearance, and working knowledge of the Charge router reconciliation reports and tx inquiry to research codes and charges.

· Apply knowledge of payer reimbursement guidelines to ensure proper reimbursement. Attend seminars for updates on new coding rules and regulations. Knowledge of APC, OPPS, and IPPS payment methodologies. Meets productivity and quality standards as designated by Coding Supervisor and Manager. Orient and train new employees.

· Scheduling Gastroenterology surgeries and procedures such as Colonoscopies, EGD’s, EUS’s, ERCP’s, Sigmoidoscopies, Bariatric surgeries, Gastrostomy tube placements, Colon and Rectal surgeries, Pancreatic surgeries, Hiatal Hernia Repairs, etc.

· Submitting and obtaining pre‐certifications and authorizations along with LOA's using ICD-10 and CPT coding for Gastroenterology procedures and surgeries based on physician documentation. Insurance verifications

· Pre-op and post-op scheduling of GI procedures and surgeries. Coordinating pre‐op and cardiac clearance visits and testing. Maintaining constant open communication with the OR, physicians, and numerous surgery centers. Providing patients with instructions for surgeries and procedures. Ensuring all documents needed for surgeries are sent electronically and faxed manually prior to procedures. Obtaining procedure notes and pathologies for results. Patient and physician messages and phone calls.

· Rooming patient’s, vitals, collecting health histories and performing hydrogen breath testing and EKGs in the office.

· Insurance eligibility, obtaining prior authorizations for office visits, procedures, medications and referrals using ICD-10 and CPT coding. Updating and requesting referrals, incomplete and ready to schedule referrals.

· MyChart messages and appointment requests. Patient calls, rx requests and responses. Handling calls from patients, physicians, or other physicians’ offices.

· Providing front desk support by patient check ins and appointment scheduling.

· OBGYN and Ophthalmology surgery scheduling.

· Surgery scheduling. Patient education and counseling on their type of surgeries or procedures they’ll be having. Counseling of coverage benefits and share of costs. Coordinating pre op procedures such as pcp/cardiac clearances, lab and radiology testing as well as covid testing prior. Coordinating physician surgery schedule available slots with scheduling with the hospital, securing preferred surgery rooms and time. Coordinate with an assisting physician if needed. Obtaining authorizations for surgeries using ICD-10 and CPT coding.

· Insurance eligibility. Checking in and out of patients. Collecting copays, deductibles, and deposits. Front office supervision. Handling high-volume calls from patients, pharmacies, insurance reps and other physician offices. Settling the copays, balances and deposits at the end of the day.

· Scheduling all gastro procedures such as colonoscopy's, upper endoscopy's, ercp's, flexible sigmoid, pill cam capsules and hemorrhoid banding for the surgery center and hospital. Preparation of ancillary services requisition forms, patient consenting and providing clear instructions on detailed procedure preparations. Patient education. Obtain prior authorizations and referrals for office visits, radiology studies, procedures, and infusion therapies. Insurance verifications and medical coding.

· Assists assigned physician and/or other healthcare professional. Performs routine vitals, injection, ekg's, ear lavages, urine dips, urine pregnancy tests, accu checks, rapid streps and flu, patient health history and electronic documenting. Appointment scheduling and patient calls. Patient room cleaning, setting up and stocking. Assisting physician with minor procedures such as biopsies.

Specialties’ included: Gastroenterology, Pulmonary, Oncology and Hematology, Rheumatology, Neurology, Nephrology and Endocrinology, Internal Medicine, Pediatrics, Urgent Care, Cardiology.

· Process transfers, admits, and discharges, answers and routes calls, orders materials and supplies for units, appointments, maintains unit equipment, maintains medical records, and provides staffing/nursing support.

· Registration, pre‐registration, insurance verification, Third Party Liability screening, Medi‐cal/Medicare eligibility and Workers Comp verification. Securing deposits, co‐pays, and deductibles. Financial counseling, account collections and accounts receivable. Patient admissions.

· Managing day to day operations. Physician and staff scheduling and payroll. Hiring and training of all new staff. Supply management and ordering. Quick books.

Implementing new policies and procedures. Tracking finances and financial reports.

Collections. Outside vendor relations.

· Insurance verifications, referrals, appointment and radiology procedure scheduling, patient registration, preparing patient packets and charts, determining deductibles, and collecting co‐pays, physician calendaring, physician calls. Billing and coding. Filing, faxing, scanning, copying and data entry. Ordering and maintaining clinical and medical supplies.

· Rooming patients for multiple physicians, vital signs, phlebotomy, injections, EKG's, lab ordering/ processing/pipetting and urinalysis. Prescription refills. Manage data collection for various studies, telephone screening, coordinate appointments and procedures for studies, maintain study filling system, processing of research labs and data entry.

• Assisted healthcare providers with patient examinations and procedures to ensure quality care delivery.
• Managed patient records using electronic health record systems, ensuring accuracy and compliance with regulations.
• Coordinated appointment scheduling and follow-ups, enhancing patient access to services and reducing wait times.
• Administered medications and vaccinations under physician supervision, adhering to safety protocols and best practices.

• Managed office communications and schedules to enhance operational efficiency.
• Organized and maintained filing systems, ensuring easy access to information.
• Coordinated meetings, prepared agendas, and recorded minutes for accurate documentation.
• Assisted in budget tracking and expense reporting to streamline financial processes.
• Insurance eligibility, obtaining prior authorizations for office visits, procedures, medications and referrals using ICD-10 and CPT coding. Updating and requesting referrals, incomplete and ready to schedule referrals.