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Click here or scroll down to respond to this candidateCandidate's Name , CPC, CPMAREVENUE CIRCLE MANGER - COMPLIANCECONTACTPHONE:PHONE NUMBER AVAILABLEEMAIL:EMAIL AVAILABLEEDUCATIONKeiser University Bachelors3/2000 About to graduate spring/mid-summer.On Deans list with a 3.9 GPA.Everest University08/20/2020 10/12/2014I was on the honor roll and passed my CPC (Certified Professional Coder).2021 I obtained the CPMA Certified Professional Auditor.CERTIFICATIONSCertified Professional Coder (CPC) AAPCCertified Professional Medical Auditor (CPMA) AAPCGoogle Certification Course: Foundations of Business IntelligenceWORK EXPERIENCECentene Operational Coding Analytics Manager09/2020 - CurrentWork with or train various departments on the waste, abuse, and fraud prepay process to ensure all processes are compliant and efficient. Oversee quality claim audits to ensure guideline enforced including documentation. Develop and maintain all policies and procedures for new processes. Create various reports using EDW and/or IT reporting for monthly distribution to executives and the health plans. Review and approve monthly savings reports.Florida Orthopedic Institute Professional Coder and auditor03/19/20 09/20/2020Perform annual Medicare documentation audits for each provider (physicians, PA, ARNPs, Physical & Occupational therapists, Ortho techs) and ensure correct claim coding and documentation compliance. Met with each provider to discuss results of audits and answer any questions the providers may have. Perform onboarding training specific to coding claim documentation compliance for all new Fellows, Physicians, PA, and ARNPs and routinely discuss claim billing concerns with the business office to determine if additional training is needed. Assist with creating reference materials (cheat sheets) for providers to utilize in clinic specific to their specialty. First point of contact for all claim coding compliance questions. Provide coding and compliance updates to all staff.Revenue Cycle Manager (Coding Department)(12/17 to 03/19)Managing the Revenue Cycle Department (includes coding specialist and claim denial specialists) in various duties, such as front-end claim coding, account management, communications with insurance providers, collections, and claim billing. Managing staff performance by providing regular feedback, performance reviews, and one-on-one meetings. Overseeing the hiring and training of staff. Evaluate staff performance and initiate disciplinary actions, as necessary. Authorize overtime. Approve work and vacation schedules. Complete annual performance reviews for each department member no later than their anniversary date. Efficiently managing patient complaints in respect of claim billing and collections. Planning and structuring the department workflow and staffing. Compile statistics and prepare reports related to staffing, space and equipment needs, productivity, and expenditure. Correctly coding diagnoses and procedures on claims.SKILLS |
