James G Cole 805-304-5833 www.linkedin.com/in/jamescole1912 jamescole1912@yahoo.com

PROFESSIONAL PROFILEMedical billing professional with proven billing and coding skills; and solid education. ICD-9/ICD10 coding, and Medisoft Advanced proficient. Responsible, efficient self starter, with extensive PC skills and customer service experience. Effectively interfaces with associates and other individuals to perform duties as required.

Over 15 Years of Customer Service Experience Excellent Communication & Administrative Skills Effectively Balances Team & Individual Responsibilities

In-Depth Knowledge of Medical Billing Techniques Proficient in Microsoft Office and Medisoft Software

AREAS OF EXPERTISEPaperless File Maintenance

Intermediate PC & Microsoft Office software

Accustomed to fast paced, priority changing environment

General AccountingDetail Oriented

Data EntryCall Center EnvironmentPositive Rapport Building

Life Cycle of an Insurance Claim

ICD-9 & 10 Coding Knowledge

Medical TerminologyPayment Posting & Medical

BillingMedisoft Software Skills

EDUCATION & PROFESSIONAL DEVELOPMENTLaurus College – Santa Maria, CA

Certificate of Medical Billing & Coding, 2014Occupational Associate’s Degree - Medical Billing & Coding, 2016

KEY PROFICIENCIES Efficient & Accurate Customer Service Training and Managerial skills Microsoft Excel and Word Medical coding ICD-9 & 10 Type 55 wpm/10-key Outlook/Lotus Notes

Electronic Health Records (EHR) Electronic Medical Records (EMR) HIPAA Compliance CMS certifications Medical Terminology Patient Processing and Accessing Dedicated to assignments

Administrative Assisting Medisoft Advanced Medical Billing Records Management Self Starter Fast Learner Adapts to change

EMPLOYMENT HISTORYAnthem 10/2014 – 6/2016Claims associateAudited claim submissions for payment or denialAudited re-billing to identify appeals for routing to medical review, member forms routed to Customer Service, and provider forms to their perspective queuesReviewed re-billing denial or payments to ensure accuracyReviewed claims and re-billing for proper coding conventions including modifiers, HCPCS, and grouping of codes such as for injections (90460, 90461)Calculated/re-verified claims and re-billing to ensure DME and supply pricing was HIPAA coordinator - Maintained 98% accuracy of claim reviews and 100% in financialsAudited at least 115% of the claims quota required daily

Anthem (via Kelly Services)

7/2014 – 10/2014Support staffCorresponded and built relationships with sales agents to support their efforts selling Medicare and other insurance prod-uctsAssisted agents with website navigation and login resetsAdvised agents on “Ready to Sell” requirements, “agent of record” changes Provided contact information for commission inquiriesMaintained HIPAA when agents requested information regarding the patient’s health or their claim status

Bank of America (via Randstad USA)5/2013 – 6/2014Fraud division associateAssembled electronic information and evidence into cases for fraud investigators

Countrywide 7/2001 – 11/2011Operations technology specialistMonitor, analyze, and communicate analyses of image transmission issues to IT, Disbursing, and Operations departmentCoordinated with internal departments to minimize impact to our external clients when the imaging system had issuesReviewed documents ensuring compliance with mortgage fee disclosure laws and Regulation “Z”Researched procedure notes for reviewing equity loan submissions, and created training programTrained new associates with newly approved training materialsParticipated in monthly quality checks of new program releases, beta testing the system prior to release

Achievements

Promoted nine times over the course of 10 years at Countrywide. Created a new training program as a Senior Suspense Coordinator; promoted to Training Senior Suspense Coor-

dinator for Equity Department at Countrywide Home Loans. Created and implemented a training curriculum for equity loan reviews to be utilized by all associates; managed

the training program and materials; trained all new associates. In total, trained roughly four monthly classes with approximately 15 students in each.

Spearheaded and helped create audit review process; ran a mail merge in Excel and Word to create letters for customers. 300 to 400 checks were sent each week, which were tracked on UPS.com to ensure delivery. Initial file count of reviews was between 1,000 to 3,000 per week.

Managed contact list in Excel; re-formatted for over 600 companies and individual contacts. Resolved between 400 to 500 issues daily, when necessary contacted the company who submitted for next steps.