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Search 2 million Resumes Keywords: City or Zip:	Related Resumes Medical Coder Coding Ellicott City, MD Outpatient Coder Part-Time Baltimore, MD Information Security It Auditor Woodbridge, VA It Auditor Compliance Analyst Baltimore, MD Material Handler Internal Auditor Lake Ridge, VA Accountant, Auditor, Financial Manager Washington, DC IT Auditor Washington, DC

Candidate's Name , CPC, CPMAWoodbridge, Virginia  EMAIL AVAILABLE  PHONE NUMBER AVAILABLELINKEDIN LINK AVAILABLEPROFESSIONAL AFFILIATIONS and CERTIFICATIONSU.S. Government Secret Security ClearanceAmerican Association of Medical Coding Professionals (AAOMCP), Member in good standingAmerican Academy of Professional Coders (AAPC), Member in good standingCertified Professional Coder, CPCCertified Professional Medical Auditor, CPMAAttended the AAPC Regional Conference in Washington, DC, 2023Regularly attend local AAPC chapter meetings to remain current with coding changesEDUCATIONAAPCCurrently enrolled in the AI in Medical Coding and Billing courseCertification Coaching Org (CCO)Certificate of Completion, Certified Risk Adjustment Coder Course, 2022Certificate of Completion, Inpatient Medical Coding Course, 2021, 2022Prince Georges Community CollegeAssociate Degree, General Studies, 2015RELEVANT SKILLS and TRAININGCPT ICD-9/10-CM HCPCSDRG Standards Medical Terminology Anatomy & PhysiologyCoding Guidelines HIPAA Policies ModifiersCoding Payment Policies NCD and LCD Edits NCCI EditsDocumentation Guidelines Medical Chart Reviews Coding EducatorCompliance Fraud/Waste/Abuse Resolution Microsoft Office SuiteEHR and CODING SYSTEM PROFICIENCIES3M AHLTA AllscriptsCCE Cerner CHCSEPIC NextGen OptumComputer Assisted Coding (CAC)HCC CODING and AUDITING EXPERTISEHHS Risk Adjustment HIX Risk Adjustment HCC ModelsHCC Coding Processes Data Validation Audits (RADV) Data MiningHEDIS Abstraction Clinical Risk Groups (CRG)OUTPATIENT CODING and AUDITING EXPERTISEAmbulatory Patient Visits (APV) Evaluation and Management (E/M) DentalEmergency Department (ED) Gastroenterology (GI) General SurgeryInjections/Infusions Internal Medicine NephrologyOB/GYN Orthopedics Otolaryngology (ENT)Pediatrics UrologyPROFESSIONAL EXPERIENCEAuditor, Visual Connections, 0/12019-05/2019Facilitated second-look Risk Adjustment Data Validation (RADV) audits, confirming the completeness and validity of the selected ICD codes mapping to HCC classificationsInitiated audits of random encounters for Centers for Medicare and Medicaid Services (CMS)Examined records, reports, operating practices, and documentation, confirming compliance with established internal control proceduresCoder II, Fresenius Medical Center, 07/2018-10/2018Coded and audited medical records for the complete and correct assignment of CPT, ICD, and HCPCS codes, following strict guidelines for Nephrology and dialysis codingQueried providers to obtain information and patient data to ensure compliant and complete patient documentation and medical recordsInvestigated and corrected billing edits to ensure clean claim submission, guided by extensive knowledge of Medicaid, Medicare and commercial insuranceHEDIS Reviewer, Equity Staffing, 01/2018-05/2018Conducted on-site Healthcare Effectiveness and Data Information Set (HEDIS) audits, driving the overall direction, coordination, and implementation of provider medical record reviews for HEDIS and HEDIS-like measuresCompleted quality control checks of charts coded by HEDIS abstractors, utilizing expertise in HEDIS Rules of Abstraction to verify data accuracy, document errors, and confirm guideline complianceMet with provider offices, medical groups, and staff members of other clinical facilities to support team operations with benchmarking and improving qualityInpatient Auditor, TeAM, Inc., 07/2016-12/2018Inspected coded charts for Inpatient and Outpatient encounters, confirming the application of the correct DRGs, Evaluation and Management codes, and procedure codes while under contract with the Department of Defense (DOD)Served as an interim supervisor, directing the teams daily workflow to achieve optimal production and auditing quality, and providing coder educationAdvised providers regarding opportunities for documentation improvement, sharing educational resources to ensure compliance, correct documentation, and maximum reimbursementRemote HCC Coder, Inovalon, 01/2016-07/2016Reviewed provider documentation to abstract and confirm all diagnosis codes mapping to Hierarchical Condition Category (HCC) conditions, initiating prospective coding and complete code capture across health assessments on geriatric patientsPerformed overreads of previously coded charts and efficiently abstracted unknown HCCs for Medicaid, Medicare (CRG), and commercial insurance (HIX) payorsMaintained quality accuracy rate of 95% and greater while meeting and exceeding production goalsOutpatient Coder, Diamond Solutions Inc., 04/2015-12/2015Abstracted and applied CPT and ICD codes to medical records for Ambulatory Patient Visits (APV) and Emergency Department (ED) encounters for U.S. Navy Hospital, Okinawa, Japan, adhering to DOD contract requirementsInitiated queries to providers regarding missing and conflicting documentation, obtaining all necessary information for clinical documentation code abstractionMedical Coder, Complex Care Solutions, 10/2013-04/2015Retrospective HCC abstraction specific to the geriatric populationTransitioned to Lead CoderContract Coder, Maxim Healthcare, 06/2012-11/2013, 2016Cleared a six-month coding back log in 2 months, allowing for on-time coding and prompt reimbursement going forwardHCC abstractionCoded Emergency Department encounters assigning all ICD, CPT and HCPCS codesContract Remote Coder, Coding IQ, 10/2012-03/2013Audited new coders and overseas coders on HCC projects for various insurance companiesContract Remote Coder, KForce 06/2011-09/2013Coded and audited multiple specialty outpatient clinics for various healthcare systems and facilitiesProvided education to providers on a weekly basisMedical Coder, Altegra Health, 08/2010-09/2012Audited documentation for HCC/Risk adjustment reviewsProvided feedback to insurance plansMedical Coder, Wright Solutions Inc., 04/2008-02/2010DOD contract in which I managed auditing and coding for 3 assigned outpatient clinicsCleared a 3 month backlog in 7 weeks for Walter Reed Army Medical CenterIdentified coding trends and improper documentationProvided feedback and reports to supervisor and Command. Conducted monthly meeting to my clinicsAssisted in coding other outpatient clinics which included IBWA, and inpatient visits during downtimeContract Coder, KForce, 07/2007-03/2008Travel assignment to Kaiser in Colorado conducting outpatient auditingManaged 6 clinics throughout the state providing education and documentation requirements to staffContract Coder, DOD, 06/2006-06/2007DOD contract. Coded and audited outpatient clinicsProvided reports of coding errors and trendsMedical Coder, Kaiser Permanente, 01/2006-05/2006Assisted the Tumor Registrar with backlogged claimsAudited OB/GYN clinic encountersMedical Coder/Biller, Capital Home Health Care, 06/2003-02/2006Managed Company 2 accounts with over 500 claim submissionsSetup and established billing protocols