| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
Street Address Vineyard Ridge Dr.Griffin, GA Street Address
PHONE NUMBER AVAILABLE-Cell / PHONE NUMBER AVAILABLE-VMEMAIL AVAILABLEInteroStreet Address Feb 2023-PresentRemote Outpatient CoderResponsible for reviewing all post-billed denials (inclusive of coding-related denials) for coding accuracy and appealing them based upon coding expertise and coding judgment within the Hospital and/or Medical Group revenue operations ($3-5B NPR) of a Patient Business Services (PBS) center. Serves as part of a team of coding payment resolution colleagues at a PBS location responsible for identifying and determining root causes of denials. Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals as required by payers. in addition to promoting departmental awareness of coding best practices. This position reports directly to the Supervisor Clinical/Coding Payment Resolution.HMA Apr 2020-Jan 2023Remote Outpatient Coding & Auditing SpecialistThis position involved remote auditing and coding outpatient services ED Profee, Diagnostic, Ancillary, OBS, Family/Pediatrics/Wound Care/ utilizing software programs such as Epic, Cerner, Meditech, 3M, TruCode, etc. Experience in Microsoft office applications, such as PowerPoint, Word, Excel and Outlook a plus.UPS (United Parcel Service) Aug 2019 Nov 2022Part Time Hub SupervisorAs a Part-Time Hub Operations Supervisor my responsibilities include but were not limited to the following:Meet or exceed all established standards for accuracy and productivity. Management of department resources to ensure maximum output, accuracy, and efficiency always. Ensure that all department and/or corporate policies and procedures are communicated, understood, and adhered to. Establish and promote a positive, team-oriented work environment emphasizing employee involvement, pro-active communication, inter-departmental cooperation, and continual improvement on all levels. Implement employee personal development plans as required to ensure the continuing professional growth of department personnel.Ensure that all department employees receive specific and detailed orientation, skills and safety training, appropriate materials and information, regular evaluations, and pro-active coaching to support their continued development. Establish and maintain an aggressive cross-training program within the department to promote development, enhance flexibility, and ensure backup coverage of vital functions and processes. Function as an effective liaison and advocate on all levels to ensure that employee, department, and corporate needs are addressed in a timely and productive manner. Responsible for ensuring that all employees adhere to safety policies and procedures at all times by doing audits, operating in full compliance with department, station, corporate and OSHA requirements.FFAM360 Healthcare (Morehouse School of Medicine) Oct 2019-Mar 2020Certified Professional CoderReview, analyze, and code medical record documentation to include, but not limited to, medical, diagnostic, and procedural information for the correct ICD-9 and /or ICD-10 and/or CPT-4 HCPCS codes to the greatest specificity. Abstract demographic and coding information into the information system accurately and completely. Review documentation for medical necessity. Audit orders and claims before submission for entirety and accuracy and to minimize claim denials. Assess records and prepare reports. Develop effective working relationships with physicians and other stakeholders.Insight Global Apr 2019-Sep 2019Remote Outpatient Coder InterimCode all ED records for the professional/facility physicians including E/M leveling utilizing 1995 guidelines, also responsible for coding specialty clinics utilizing 1997 E/M guidelines. Reviewed all denial and edits and corrected on the backend and educated staff on trends. Also served as a coding resource for the dept. Provided weekly, monthly and year end reports of audit findings for the dept.STRIVANT HEALTH: July 2018-Mar 2019Outpatient Coding QA SpecialistConsult with internal leaders, staff on best practices, methodology, and tools for accurately coding Professional Fee services. Chart Analysis of professional fee (physician services) coding for E/M 1995 data auditing and validation. Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition. Adheres to Standards of Ethical Coding (AHIMA and AAPC). Reviews medical records to determine accurate required abstracting elements (facility/client/payer specific elements) Reviews medical records for the determination of accurate assignment of all documented ICD-10-CM codes for diagnoses and procedures. Ensures Coders are meeting IQR and MQR expectations of 95% accuracy Provides grading and educational feedback to coders who may not be achieving 95% accuracy Coding: Uses discretion and specialized coding training and experience to accurately assign ICD-10, CPT- 4 codes to patient medical records. Coding Quality: Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses and procedures. Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by SOW. CDI: Identifies and communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to appropriate personnel for follow-up and resolution. Professional Development: Stays current with AMA, AAPC and AHIMA official coding guidelines and with CMS and other agency directives for ICD-10-CM and CPT coding. Attends mandatory coding seminars on an annual basis (ICD-10-CM and CPT updates) for inpatient and outpatient coding. Attends Coding Update Meetings and all coding conference calls. Problem-solve insurance rejections and denial issues Uphold productivity standards / daily quota set by management Maintain company accuracy rate of 95% in monthly internal audits.Loma Linda University Medical Center Oct 2015-June 2018Remote Outpatient Coding SpecialistsCode all ED records for the professional physicians including E/M leveling utilizing 1995 guidelines, also responsible for coding specialty clinics utilizing 1997 E/M guidelines. Reviewed all denial and edits and corrected on the backend and educated staff on trends.Georgia Regional Hospital Nov 2013-Aug 2018Outpatient Coding LeadCode Inpatient/Outpatient records for Mental Health Hospital for state of GA, run the State monthly ORYX Error Report, code laboratory results on the HL7 Report bi-monthly, and code Medicare part B concurrent for long term patients. Informed the compliance dept of all in accurate coding and inappropriate documentation to leadership, including HIM staff, physicians, billing personnel, and ancillary departments, all the while teaching them the correct ways of documenting their work. Created a formalized review process that incorporates regular audits (coding/documentation accuracy) and coordinates ongoing monitoring.National Staffing Consulting June 2013-Oct 2013Outpatient Coding SpecialistsChart Auditing, Editing Denials, and Correcting Documentation also, helped with the backlog to get them caught up.On-Assignment (HIM) Tuba City Regional Hospital June 2012-Mar 2013Outpatient Facility/Pro Fee CoderCoded Outpatient Clinic Visits, SDS, Edits, EM Leveling, Physical Therapy/Occupational Therapy Medicine, Determined Principal Diagnosis and Procedure(s), utilizing updated Medicare coding guidelines and other references, Identified and coded all applicable invasive procedures utilizing the 3M Encoder, Entered diagnosis and procedure codes into the billing system on series accounts to generate a bill as appropriate, and Coded for the Pharmacy Dept.Crystal Mover Services Inc. (Desmear Services Inc.) Mar 2010-June 2012Shipping & Receiving/Parts & Storeroom ManagerI coordinated all shipping & receiving materials, plus all heavy equipment needed for some work orders. I then would input that data into MMIS for tracking of later usage: (Qty, Stock Number, Bin Location, Descriptionetc). If the parts coming in were new, I made labels, made a spot for them in the storeroom, and added this new product into MMIS. When techs needed parts, Id issue them out to a required work order, and if we didnt have it in the building, I would go out and purchase it from another vendor, by driving to other locations to pick up other deliveries that were urgently needed when under time restraintsBaptist Hospital Sep 2009-June 2012Remote Outpatient Facility Coder/Documentation SpecialistsCode Outpatient Clinic Visits, Same Day Surgery, EGDs, Emergency Department charts, Outpatient Diagnostics, Assign Facility/Professional Fees E/M, educate/audit at the same time.Med Assurant (Crownsville Hospital Ctr.) July 2008-July 2009Remote Chart Review Coordinator (HCC/RXHCC)Conduct chart reviews for purposes of identifying, confirming, and/or documenting appropriate medical coding. Perform quality control over-read reviews of previously completed record reviews to ensure accuracy, completeness, and overall high quality of Med Assurants record review processes, including: Electronically downloading completed, pre-filled record reviews to assigned computer system and DCT, Comparing pre-filled record review results contained in DCT application to the scanned support documentation resident within Med Assurants Site Review Support Application (SRSA), Correct the original, pre-filled review as necessary and note any discrepancies found, and Uploading completed quality control over-read reviews to Med Assurants centralized server system via the Internet, intranet, and associated web portal. Mentor/Maintain ongoing communication (verbal, email, updates and Stats) with supervisor. Assist in training processes associated with in-field and/or other medical chart code review staff. Record all time worked, performing record reviews and over-read reviews. Maintain compliance with Med Assurants policies, procedures and mission statement.Medpartners (Brookville Hospital) Aug 2007-Feb 2009HIM-Auditor/QA/Physician EducationAudited all remote coders and gave feedback on coding accuracy, my primary duties were to make sure all coders are at 95%. Other responsibilities included physician education, regarding proper documentation, physicians were given feedback on their documentation in all charts and coding. Perform numerous HCCs Project ICD-9 codes chart reviews.Piedmont Medical Center Sep 2002-Aug 2007Remote HIS CoderUtilized ICD-9-CM and CPT-4 for abstracting medical records for all specialties, for outpatient clinics and ER profee. Audited/Educated all remote coders within the dept, assist in other department functions per request of HIM Director. Cross-trained all new coders in the dept.TECHNICAL SKILLS / ADMINISTRATIVE SKILLSElectronic Medical RecordsSOFT-MED, CARE-MEDIC, CHART FACT, CONSORTIUM, HBOC, ALLSCRIPTS, AVATAR, EPIC, MEDITEC, MCKESSON, CHARTMAXX, CERNER, CENTRICITY, HPF, CITRIXEncoders:3M,3M 360 Quadramed, Optumn, Webstrat, Ingenix, Encoder Pro, TrucodeMicrosoft Applications:Microsoft Word/Powerpoint, Access/Excel |
