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Click here or scroll down to respond to this candidateCandidate's Name , CPC, CRCRPowhatan, VA Street Address
PHONE NUMBER AVAILABLE - EMAIL AVAILABLEWebsite, Portfolio, ProfilesLINKEDIN LINK AVAILABLEProfessional SummaryCompetent Revenue Cycle Analyst and Medical Coder with over 10 years of experience in handling wide variety of medical coding and billing tasks looking for part-time data entry/customer service work. Sophisticated and hardworking individual with excellent analytical and multitasking abilities. Coordinates with insurance companies and expedites claims processes. Expertise in accurately inputting procedure and diagnosis codes into billing software to generate invoices. Adaptable and driven with strong work ethic and ability to thrive in a team-based or individually motivated settings. Portrays excellent analytical and multitasking abilities. Frequently praised as hard-working by peers and can be relied upon to help the Revenue Integrity department achieve its goals.SkillsAuditDiscrepancy ResolutionData Analysis and OrganizationProcess MonitoringMedical Billing ProcessingCertified Professional CoderEpic SystemsICD-9/ICD-10 and CPT CodingCoding Error ResolutionHIPAAWork History12/2020 to CurrentRevenue Integrity AnalystEnsemble Health Partners Richmond, VADaily review of charge items and Revenue Integrity work queuesAnalyzes billed charges and medical records to look for missing, incorrect or late chargesEvaluates charge capture practices to ensure accuracy and completeness of charge captureMaintains working knowledge of CPT and HCPCs coding as well as billing, CCI, MUEs, and other relevant coding and billing guidelinesPerforms database editing and auditing functions to maintain and/or improve data qualityPerforms account reconciliations and resolves variancesReports trends, findings, and opportunities for improvement to managementProvides recommendations based on findings to improve charge capture workflows and to standardize charge capture processesAssists in training of work processes to fellow employeesPromoted consistent accuracy of billing information by reconciling 1,000 accounts monthly.Trained and mentored team members and managers on new work processes and policies to build cohesive groups and promote operational performance.11/2012 to 12/2020Claims Coder IIVCU Health Systems Richmond, VAConducted and oversaw review of hospital claims to ensure compliance with all applicable federal, state, local and payor specific requirementsReconciled billing sheets with patient procedure record to ensure proper procedure billing and timely filing of claimsUtilized GE/IDX and Cerner to manage and confirm patient data, such as insurance, demographic and medical history informationDrove LCD Denial Report and Claims Submission operational improvements that resulted in significant savings and improved profit marginsInitiated audit process to evaluate thoroughness of documentation and maintenance of facility standardsPerformed account reconciliations and resolved variancesGuarded against fraud and abuse by verifying coded data accurately reflected services provided.Reviewed outpatient diagnostic Radiology records and interpreted documentation to identify diagnoses and procedures.Interacted with physicians and other healthcare staff to ask questions regarding patient services.Accurately selected proper descriptive code when more than one anatomical location was indicated.Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.Performed billing and coding procedures for diagnostic radiology and cardiology services.Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.Verified signatures and checked medical charts for accuracy and completion.Reviewed patient charts to better understand health histories, diagnoses and treatments.Applied charges and updated patient records by using Cerner and GE/IDX.Resourcefully used various coding books, procedure manuals and on-line encoders.09/2012 to 02/2013HCC Remote Coding SpecialistVerisk Analytics Inc Richmond, VACode hospital and multi-specialty outpatient charts for HCC risk adjustment and HEDISConsistently met productivity standards of coding 10 charts per hour with 95% accuracy.Guarded against fraud and abuse by verifying coded data accurately reflected services provided.Reviewed outpatient records and interpreted documentation to identify HCC diagnoses.Verified signatures and checked medical charts for accuracy and completion.Accurately selected proper descriptive code when more than one anatomical location was indicated.Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.Correctly coded and billed medical claims for various hospital and nursing facilities.Reviewed patient charts to better understand health histories, diagnoses and treatments.EducationExpected in 12/2022Bachelor of Science: Healthcare AdministrationLiberty University - Lynchburg, VAGPA: 3.77Dean's List Fall 2019 Fall 2021Member of Sigma Beta Delta Honor Society05/2009Health Records Coding Technician Health Records CodingJ Sargeant Reynolds Community College - Richmond, VAGPA: 4.0CertificationsCertified Professional Coder (CPC) 01211090Certified Revenue Cycle Representative (CRCR)AffiliationsAmerican Academy of Professional CodersHealthcare Financial Management Association |
