Antonia Edwards (757)-589-6239

antonia.edwards@yahoo.com

Objective:To secure a position that exemplifies my extensive and diversified work experience. Team player, seeking to be a part of a thriving team, all working toward common goals to maintain an effective and efficient work environment.

Education and Certification: Centura College, Virginia Beach, VA June 2016Associate of Occupational Science Degree Medical Billing and Coding

Norfolk State University, Norfolk VA Conferred May 2016CertificationParalegal

Roxbury Community College, Roxbury, MA Conferred January 2008Spanish Medical Interpretation Advanced Medical Billing/CodingMedical Coding Certification Work Related Experience: Anthem BCBS Charlotte, NC.HEDIS Researcher 7/2014 – 2/2015

Performs medical records abstraction in support of annual The Healthcare Effectiveness Data and Information Set (HEDIS)On an annual basis develops expertise in the requirements and parameters of mandated External Accountability Set (EAS) performance measures. Applies structured auditing criteria to medical records to determine compliance with standards of the EAS. Accurately enters the results of chart audits into a database. Monitors progress towards completion of the annual HEDIS chart abstraction process. Maintains a less than 2% error rate in record abstraction and data entry. Accurately and efficiently conduct medical record review services in a timely manner. Conduct medical record review according to the current NCQA HEDIS® Technical Specifications. Communicate effectively and professionally with practitioner offices, clinics, hospitals, other clinical facilities, and staff.

Identify and effectively communicate trends in medical record review to the HEDIS team. Attend weekly meetings and ad-hoc meetings and trainings as needed. Abide by all HIPAA and associated patient confidentiality requirements.

Anthem BCBS Charlotte, NC.Network Data Specialist II 7/2014 – 2/2015 Responsible for accurate, timely maintenance of complex provider information and synchronization of data Medicaid and Medicare Providers. Ensure the Provider Participation Status and Provider Demographics gathered from the Facets database as well as information provided directly by Providers is accurately portrayed in Performs validation, audits and corrects provider demographic data and provider participation status to ensure accuracy of data loaded Provider Finder with attention to detail and accuracy. Participate in problem identification, analysis and resolution for provider database issues. Participates in system testing and analysis in support of new functionality, new system processes, and business rules changes. Researches and coordinates with various functions within the company to ensure discrepancy in provider data is resolved in a timely manner. Other projects and duties as assigned.

Premier Healthcare Resources Charlotte, NC.Physician Service (Contract) 1/2011 –11/2014 Exclusively contracted for Novant Health at Presbyterian Hospital. Perform in positions not limited to and including Medical Records Specialist, Medical Billing/Coding Specialist, Referral Coordinator, and Front Desk Coordinator

Counsel for Children Rights Virginia Beach, VASpecial Education and Mental Illness Legal Advocate/Guardian 1/2011 –11/2014 Work as a court appointed advocate for children involved in custody disputes. Educate, provide, monitor and maintains services that are in the best interest the child. . Provide legal advocacy to parents with children with special needs and mental illness. Assist parents/ families in obtaining services from city, state and federal agencies. Assist parents/families with SSI and SSDI process. Coordinate, monitor, and maintain medical care/evaluations for the purposes of obtaining special needs services. Liaise with medical and service providers on behalf of child and parents. Interpret medical evaluations for parents and coordinate. Develop IEP with parent and educational team. Coordinate and attend mediation hearings.

Mary Washington Hospital Fredericksburg, VA.Patient Access ER (PRN) 1/2012 –03/2013 Responsible for patient registration for admission to hospital for emergency services and inpatient stay. Verification of insurance, co pay and co insurance benefits for billing correctness from all major insurance carriers for correctness of billing. Responsible for the coordinating inpatient admission for patients with the Attending Physicians, Admitting Department and the Triage Coordinators/Resource Nurses. Perform as a Unit Coordinator, liaised between doctors and all other departments (internal as well as external) on behalf of the ER. Serve as the liaison between patients and family members on behalf of the hospital, coordinating financial assistance. Posting of ER pharmaceutical and medical charges. Coding of medical records

Lash Group Healthcare Consultant Charlotte, NCInvestigation Coordinator 11/2006-07/2007 Liaison for major pharmaceutical companies that manufacture specialty medications. Coordinate with medical specialists and specialty facilities for the purpose of IV Infusion Therapy for patients with chronic and severe medical conditions. Responsible for verifying and preauthorization of medical insurance for medical benefits. Investigate primary, secondary and tertiary insurance coverage with all major commercial, federal/state funded and private carriers. Insure the accurate medical coding, diagnosis, dosage, and treatment plan captured to obtain approval of medical service for patient. Create a benefit profile for the patient, medical specialist, and pharmaceutical company that outlines reimburse, and patient's responsibility as per their medical insurance guidelines.

Saint Francis Hospital Harford, CTEmergency Room Admissions /Registration 02/2002-12/2004

Responsible for registering and admitting patients for emergency healthcare services. Verification of insurance, co pay and co insurance benefits for billing correctness to present to all major and commercial insurance carriers. Self-pay billing included. Coded Emergency Room medical records, posted medical pharmaceutical

charges. Serve as the liaison between patients and family members on behalf of the hospital.

Computer and Software Experience: Software Operating Systems: Windows 8.1 & Apple OS X Mavericks (Version 10.9) Can utilize with expert skill both software operating systems to complete daily reports; client and worker messaging; and Internet networking.Office Productivity: Proficient with word-processing, database and presentation software programs (including adobe, Photoshop, OPERA, CISCO and others) Microsoft Office of both Windows & Apple (Word, Power Point, Excel, Access, Publisher, One Note, & Outlook). Utilize with expert skill all Microsoft Office to complete manuscripts; reports; data spreadsheets; and various types of power points to describe client’s needs and assessment data. Data Analysis & Reporting: SPSS, GIS, HER, & SAS Medical Terminology, Medical Coding/Billing, ICD-9, ICD-10, CPT 4, Medical Records Abstraction, Facets, Amysis, 3M, EPIC, Encoder Pro, NASCO, Rapid Retrieval, VIIS, Blue Square Sorian, AIMS, TriMed, VA Mainframe, CA Mainframe, WGS, MMHP, CHIPS, Quality Reporter, WCF, AS400, Excel, SAP, Oracle, MediTech, IDX, SMS, Spanish Medical Interpretation, Legal Assistant Document Preparation, Custody Advocacy, Substance Abuse and Mental Health AdvocacyInterviewing & Networking: Skype, Face Time, Social Media & iChat Utilize with skill both Apple and Windows operated networking software to complete interviews and worker conference meetings. Possesses solid research, analytical and organizational skills Demonstrated problem solving, creative and critical thinking skills Training and educational skills, mentor and quick learner Excellent written communication, public speaking and public relations skills

Professional Affiliation and Training: Unit Secretary and Medical Coding Specialist- CPCC - Charlotte, NC (Graduation Date 05/20/13) CCPC Certification Exam Preparation- Norfolk State University 03/13 AHIMA CPC Certification with Exam Preparation NVCC-Manassas Campus 02/13 AAHAM CPAT Certification Exam 02/13