1. Antonia Edwards
(757)-589-6239
antonia.edwards@yahoo.com
Objective:
To secure a position that exemplifies my extensive and diversified workexperience. Team player,
seeking to be a part of a thriving team, all workingtoward common goals to maintain an effective
and efficientworkenvironment.
Educationand Certification:
Centura College, Virginia Beach, VA June 2016
Associate of OccupationalScience Degree
Medical Billing and Coding
Norfolk StateUniversity, Norfolk VA Conferred May 2016
Certification
Paralegal
Roxbury Community College, Roxbury, MA Conferred January 2008
Spanish Medical Interpretation
Advanced Medical Billing/Coding
Medical Coding Certification
Work RelatedExperience:
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 tomedical 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 HEDISchart abstraction process.
 Maintains a less than 2% error rate in record abstraction and data entry.
 Accurately and efficiently conductmedical record review services in a timely manner.
 Conduct medical recordreview according to the current NCQA HEDIS® Technical
Specifications. Communicate effectively andprofessionally with practitioner offices,clinics,
hospitals, other clinical facilities, and staff.
 Identify and effectively communicatetrends in medical record review to the HEDISteam.
 Attend weekly meetings and ad-hoc meetings and trainings as needed.
 Abide by all HIPAAand associated patient confidentiality requirements.

2. Anthem BCBS Charlotte, NC.
Network Data Specialist II 7/2014 – 2/2015
 Responsible foraccurate, timely maintenance of complex provider information and
synchronization of data Medicaid and Medicare Providers.
 Ensure the ProviderParticipation Status and ProviderDemographics gathered from the
Facets database as well as information provided directly by Providers is accurately
portrayed in Performsvalidation, audits and corrects provider demographic data and
provider participation status to ensure accuracy of data loaded
 ProviderFinder 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 contractedfor NovantHealth at Presbyterian Hospital.
 Performin 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, VA
Special Educationand Mental Illness Legal Advocate/Guardian 1/2011 –11/2014
 Workas a court appointed advocate forchildren involved in custody disputes.
 Educate, provide, monitor and maintains services that are in the best interest the child. .
 Providelegal advocacy toparents with children withspecial 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 forparents and coordinate.
 Develop IEP withparent and educational team.
 Coordinate and attend mediation hearings.
Mary Washington Hospital Fredericksburg, VA.
Patient Access ER (PRN) 1/2012 –03/2013
 Responsible forpatient registration for admission to hospital for emergency services and
inpatient stay.
 Verification of insurance, copay and co insurance benefits for billing correctness fromall
major insurance carriers forcorrectness of billing.
 Responsible forthe coordinating inpatient admission forpatients with the Attending
Physicians, Admitting Department and the Triage Coordinators/Resource Nurses.
 Performas a Unit Coordinator, liaised between doctors and all other departments (internal
as wellas external) on behalf of the ER.

3.  Serve as the liaison between patients and family members on behalf of the hospital,
coordinating financial assistance.
 Posting of ERpharmaceutical and medical charges.
 Coding of medical records
Lash Group Healthcare Consultant Charlotte, NC
Investigation Coordinator 11/2006-07/2007
 Liaison formajor pharmaceutical companies that manufacture specialty medications.
 Coordinate with medical specialists and specialty facilities for the purpose of IVInfusion
Therapy forpatients with chronic and severe medical conditions.
 Responsible for verifyingand preauthorization of medical insurance for medical benefits.
 Investigate primary, secondary and tertiary insurance coveragewith all major commercial,
federal/state funded and privatecarriers.
 Insure the accuratemedical coding, diagnosis, dosage, and treatment plan captured to
obtain approval of medical service forpatient.
 Create a benefit profile forthe patient, medical specialist, and pharmaceutical company that
outlines reimburse, and patient's responsibility as per their medical insurance guidelines.
Saint Francis Hospital Harford, CT
Emergency Room Admissions /Registration 02/2002-12/2004
 Responsible for registering and admitting patients for emergency healthcare services.
 Verification of insurance, copay and co insurance benefits for billing correctness topresent
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.
ComputerandSoftwareExperience:
SoftwareOperating 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 workermessaging; and Internet networking.
OfficeProductivity:Proficientwithword-processing, database and presentation softwareprograms
(including adobe, Photoshop, OPERA,CISCO and others) MicrosoftOfficeof both Windows& Apple
(Word, PowerPoint,Excel, Access, Publisher, One Note, & Outlook).
 Utilize withexpert skill all MicrosoftOfficetocomplete manuscripts; reports; data
spreadsheets; and various types of powerpoints 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,EncoderPro, 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 Advocacy
Interviewing & Networking: Skype, Face Time, Social Media & iChat

4.  Utilize withskill both Apple and Windows operated networking softwareto complete
interviews and workerconferencemeetings.
 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
ProfessionalAffiliationandTraining:
 Unit Secretary and Medical Coding Specialist- CPCC - Charlotte, NC (Graduation Date
05/20/13)
 CCPC Certification Exam Preparation- NorfolkState University 03/13
 AHIMA CPC Certification with Exam Preparation NVCC-Manassas Campus 02/13
 AAHAM CPATCertification Exam 02/13