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Click here or scroll down to respond to this candidateCandidate's Name PHONE NUMBER AVAILABLEKmastroStreet Address @gmailSkills Expert knowledge of MDaudit Software, Cerner, Athena/IDX. Team player. Proficient time management skills. Excellent oral, written, and communication skills. Experience with administrative operations and analytical tasks. Strong knowledge of CPT & ICD-10 codes, HCPCS, Modifiers, HEDIS, Medical Terminology, EMR Software and basic HIPAA principles.ExperienceSB CLINICAL PRACTICE MANAGEMENT PLAN INC8/22 PresentCompliance Medical Auditor CPMP Compliance Department Conduct medical record documentation and coding/billing audits assessing the accuracy of CPT codes, diagnoses, and modifier assignments billed by CPMP, UFPC, and MHL providers; determine compliance with appropriate policies, procedures, bylaws, clinical staff rules and regulations, and the timeliness of documentation. Monitoring to identify patterns, trends, and variances during and from audits. Communicate with providers via email about their results, providing feedback which can include remedial training and/or a re-audit. Conduct follow-up audits as indicated to appraise the adequacy of corrective actions and determine whether deficiencies are corrected. Assist the Billing Compliance Manager and the Associate Director of Compliance on projects, including updating material for our new provider education and training programs. Present documentation, coding, and billing compliance training for all new providers. Attend and participate in the departments quarterly Coding Compliance Collaborative, which explores current and new material in accordance with the Compliance Work Plan. Collaborate with the Billing Compliance Manager in researching relevant regulations and communicating the need for policies, procedures, and education to stakeholders. Sustaining a current knowledge of regulatory requirements associated with professional coding, billing, documentation, and reporting requirements in an academic medical center and in hospital clinics and physician offices. Pursuing ongoing training and development to gain additional expertise in fulfilling the elements of an effective Compliance Program. Maintaining professional skills and knowledge through attendance at relevant educational programs, participation in professional organizations and applicable webinars, and reviewing current literature.2CPMP/STAFFCO STONYBROOK UNIVERSITY HOSPITAL7/17 8/22Medical Coder Department of Pediatrics Worked in an offsite pediatric department of a busy, prestigious regional hospital as part of a coding and administrative team. Exercised proficiency in coding disciplines of emergency services, inpatient, outpatient, facility, and physician care in all specialties and primary care. Interpreted medical terminology and pharmacological information, translating information into a coding system. Verified accuracy of procedure codes, proper coding sequencing of diagnoses, as well as modifiers used on claims, ensuring proper reimbursement levels. Created detailed reports highlighting areas of improvement or potential risk associated with certain types of claims. Provided feedback to clinicians on best practice approaches for improving efficiency during the medical coding process and documentation requirements. Maintained current knowledge of coding changes, updates, and new rules. Fulfilled positive working relationships with fellow staff and management. Adhered to HIPAA guidelines ensuring patient safety. Streamlined day-to-day office processes meeting long-term goals. Applied coding rules established by the American Medical Association (AMA) and Centers for Medicaid Services (CMS) for the assignment of procedural codes. Performed quarterly audits to capture and ensure all billing and coding was processed in a timely manner. Attended and summarized monthly team meetings discussing coding accuracy, software updates, and department changes.LEISURE PHYSICAL THERAPY - RIDGE, NY1/14 7/17Medical Receptionist/ Medical Biller Scheduled appointments collected and posted patient copayments. Verified insurance eligibility and obtained authorizations for physical therapy. Interacted with referring doctor offices daily for patient status updates, prescription renewals, and Plan of Care signatures. Processed billing through MD Online Clearinghouse, posted payments from insurance EOBS and Medicare remittance advices. Reconciled outstanding patient and insurance claims from monthly aging reports. Insurance plan credentialing.BILLING SERVICES INC Ronkonkoma, NY11/11 12/14Medical Biller Responsible for charge posting for providers servicing the Hospital for Special Surgery in NY. Formulated and maintained client protocols. Interacted with clients on a daily to weekly basis, ensuring accuracy in superbill coding for proper insurance reimbursement. Supervised a team of five billers.3MEDICAL DATA RESOURCE PROVIDER Nesconset, NY3/06 11/11Medical Biller Prepared electronic claims for Medicare, Medicaid, and Commercial insurance patients. Fielded patient calls and resolved account discrepancies. ICD-9, CPT, and HCPCS coding for all outpatient hospital and office services. Verification of insurance eligibility. Recognition of Workmans Compensation and No-Fault claims in a timely manner. EducationHUNTER BUSINESS SCHOOLMedical Billing Specialist DiplomaGPA: 4.0/4.0May 2017LAGUARDIA COMMUNITY COLLEGEAssociate Degree in Veterinary ScienceGPA: 3.5/4.0August 1997CertificationsAMERICAN ACADEMY OF PROFESSIONAL CODERS (AAPC)Certified Professional Coder (CPC)October 2020*Currently attending a CPMA bootcamp through AAPC* |
