Debra Scholle

Background

About Debra Scholle

CPC Certified Medical Coder Code and bill Complex Trauma surgical cases, General Surgery, Ventriculoperitoneal shunts, as well as hospital evaluation and management services accurately and timely. Communicate timely with physicians on billing and documentation questions and issues, as needed. Provide coding assistance for surgery pre-certification. Work Lag Day reports and Missing Surgical Data reports. Provide coding assistance in order to secure payment of the claim. Contribute to team effort by performing other duties as assigned. Posses knowledge of ICD-9-CM, CPT-4, ICD-10-CM, and Medical Terminology. Work with Epic, Excel, Powerpoint, and Microsoft. Insurance Verification and Pre-Certification Utilize systems to ensure active patient coverage and efficiently document timely notification to insurance carriers of inpatient stays. Collaborate with internal and external resources regarding specific pre-certification scenarios. Use sound judgment to determine appropriate documentation to support notification and pre-certification. Contact insurance carriers and families for necessary information to begin notification and pre-certification process. Work with Utilization Review and other internal departments to ensure information needed for timely notification and pre-certification are available. Work with various reports within systems and utilize resources appropriately such as Internet, Insurance payor websites, and internal software associated the documentation of pre-authorization, notification and pre-certification. Understand and follow department policies or payor specific policies to complete notification process and being pre-certification and follow standards of documentation of all actions taken to assure information is available for others to understand and act upon. Remain current on notification and pre-certification protocols.