Sara Culbertson, CPC
Cabot
Summary
Experienced coder with comprehensive understanding of the appeals process from both provider and insurance perspectives. Possesses extensive knowledge of reimbursement policies and guidelines. Recognized as a subject matter expert in laboratory coding, specifically in molecular pathology, cytogenetics, flow cytometry, staining, syndromic panel infectious disease, and drug testing.
Overview
15
15
years of professional experience
Work History
Recovery Resolution Analyst, Senior
Optum, UnitedHealth Group
05.2021 - Current
- Reviewed medical record appeal requests for medicare, medicaid, and commercial insurance plans.
- Issued payment or denial detailing the rationale and source of truth for nonpayment.
- Specialization in laboratory claim reviews including genetic testing (PLA, GSP, MAAA, unlisted) and serving as the point of contact for laboratory queries from teams.
- Provided detailed feedback on audits to share knowledge and best practices for increased accuracy and consistency throughout teams.
- Conducted root cause analyses to identify inconsistencies within reviews and provide actionable recommendations for resolution.
Coder II
UPMC
07.2019 - 05.2021
- Increased revenue recovery through diligent follow-up on outstanding claims and appeals.
- Reduced claim denials by identifying and addressing common errors in the coding process.
- Contributed to quality improvement initiatives by identifying areas for potential enhancement within the medical coding department.
- Communicated with insurance companies to research and resolved coding discrepancies.
Certified Specialty Coder
UPMC
05.2016 - 10.2018
- Reviewed medical records and applied appropriate CPT codes, ICD-10 codes, and modifiers.
- Reduced claim denials by applying knowledge of payer-specific coding requirements when coding procedure and appending modifiers for claim submission.
- Conducted ongoing self-audits to identify areas requiring additional education or resources in order to maintain a high level of coding accuracy and proficiency.
Business Representative
Butler Health System
05.2014 - 05.2016
- Correctly coded and billed medical claims for various professional specialty groups.
- Posted insurance and patient payments regularly to maintain accurate account status.
- Resolved patient billing inquires promptly and professionally.
Office Manager and Patient Billing Coordinator
Panther Physical Therapy
09.2013 - 06.2014
- Prepared and mailed monthly statements to patients and assisted with related requests for information and clarification.
- Handled account payments and provided information regarding outstanding balances.
- Reconciled accounts receivable to general ledger.
Phlebotomist
Butler Health System
10.2012 - 10.2013
Phlebotomist
UPMC
07.2012 - 10.2012
Certified Nursing Assistant
Sunnyview Nursing and Rehabilitation Center
03.2011 - 05.2012
Certified Nursing Assistant
St. John's Specialty Senior Care
05.2010 - 03.2011
Education
Associate of Applied Science - Office Administration - Medical
Butler County Community College
Butler, PA05.2013
Certificate - Medical Coding And Billing
Butler County Community College
Butler, PA08-2013
Certificate - Phlebotomy
The Phlebotomy Training Center
Pittsburgh, Pennsylvania05.2012
Skills
- 100% quality and accuracy for ~ 4 years
- Proficiency with Microsoft Office suite
- Experience with many EHR systems
- Proficiency with encoder
- Strong professional and interpersonal communication
- Ability to problem solve
Timeline
Recovery Resolution Analyst, Senior
Optum, UnitedHealth Group
05.2021 - Current
Coder II
UPMC
07.2019 - 05.2021
Certified Specialty Coder
UPMC
05.2016 - 10.2018
Business Representative
Butler Health System
05.2014 - 05.2016
Office Manager and Patient Billing Coordinator
Panther Physical Therapy
09.2013 - 06.2014
Phlebotomist
Butler Health System
10.2012 - 10.2013
Phlebotomist
UPMC
07.2012 - 10.2012
Certified Nursing Assistant
Sunnyview Nursing and Rehabilitation Center
03.2011 - 05.2012
Certified Nursing Assistant
St. John's Specialty Senior Care
05.2010 - 03.2011
Certificate - Phlebotomy
The Phlebotomy Training Center
Associate of Applied Science - Office Administration - Medical
Butler County Community College
Certificate - Medical Coding And Billing
Butler County Community College
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