DIANELA LIZARRAGA

Reviewed, researched, and resolved clinical denials for professional claims, including CPT codes, modifier, place of service, and payer policy-related rejections. Prepared and submitted appeals based on payer-specific guidelines for moderate complexity coding denials.

Worked all facets of the accounts receivable management system including billing, claims correction/reconciliation, and follow-up. Consistently exceeded productivity standards of 60 accounts per day while reducing A/R over 90 and ensuring clean claims are submitted.

Managed the program for high-quality, timely coding of diagnoses and procedures for inpatient and outpatient accounts, using ICD-10, CPT-4, HCPCS coding and DRG classification systems. Audited clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.

Managed the program for high-quality, timely coding of diagnoses and procedures for inpatient and outpatient accounts, using ICD-10, CPT-4, HCPCS coding and DRG classification systems for house calls claims. Obtained referrals and pre-authorizations as required for procedures and checked eligibility and benefit verification.

Completed a program in Medical Coding and Billing, gaining expertise in healthcare coding, compliance regulations, and insurance protocols. Developed a comprehensive understanding of medical billing, claims processing, and accounts receivables.