SUMMARY:

• CPC Certified Professional Coder (AAPC)
• ICD - 10 certified
• 14 years of successful professional experience in Medical Coding, Precertification, Insurance Verification and Customer Service
• Proficient in Medical Terminology, Anatomy & Physiology
• Inpatient, outpatient, home health and radiology coding
• 5 years HCC Coding
• Recipient of Cigna Champions Award 2010 and 2014
• Self-motivated and confident in working individually and /or part of a team
• Leadership, Communications, Multitasking, Customer Focus and Interpersonal Skills and overall resourcefulness
• Broad medical experience includes insurance verification, billing, reimbursement, HIPPA compliance and scheduling

TECHNICAL SKILLS:

• 3M Coding and Reimbursement System, EPIC, Quantim, CHC, CCMS, Trucare, Benefit Access
• Medical Record Management, Gemstone, IRR
• HCC Coding
• ICD-9, ICD-10, CPT & HCPCS Coding Guidelines
• Medical Billing, Medical Coding, Adjustment, Reconciliations and Reimbursement
• Medical Insurance verification
• Medical terminology, Anatomy & Physiology
• Microsoft Word, Access, Excel, Outlook and PowerPoint
• 2017 HIPPA and Medicare Guidelines and Compliance Training

PROFESSIONAL WORK HISTORY:

Remote Medical Case Associate

Confidential, Pittsburgh, PA

Responsibilities:

• Reviews medical record documentation to select and sequence the appropriate ICD-9-CM and ICD-10 diagnosis, CPT and HCPCS codes
• Knowledge of third party reimbursement regulations and billing practices ( CMS, HMO and other commercial payers)
• Applies all appropriate coding guidelines and criteria for code selections.
• Extensive use of 3M Coding and Reimbursement system
• Resourcefully used various coding books, procedure manuals and on-line encoders
• Actively maintained current working knowledge of DRG CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing
• Triage Faxes through Provider Link for inpatient admissions and outpatient services and procedures
• Routinely assign ICD-10, CPT and HCPCS codes using Winstrat and 3M Coding and Reimbursement System
• Conduct training, in-service and other education regarding diagnosis, procedure code assignment and regulatory requirements for compliance and data quality.
• Initiate physician to physician reviews on denied inpatient and outpatient services
• Reconcile clinical notes, patient encounter form, health information for compliance with HIPPA rules and JCAHO standards.
• Responsible for handling incoming calls in queue and assign cases for case management and nurse review.
• Successfully enter information in Utilization/Medical Management System to complete precertification
• Managed customer calls effectively and efficiently in a complex, fast-paced and challenging call center environment
• Precertification of medical and radiology procedures, surgeries and admissions
• Verify member eligibility and demographics

Remote HCC Risk Adjustment Coder/Temp

Confidential

• Review medical record information to identify, collect, assess, monitor and document encounter coding information as it pertains to Hierarchical Condition Categories (HCC)
• Review Comprehensive Annual Wellness Examination (CAPE) forms to abstract HCC codes the risk adjust per Medicaid guidelines
• Support and participate in process and quality improvement initiatives
• Weekly coding for IRR,SLR/Recode and UHC FTC
• Perform chart reviews which include coding, abstracting and analyzing outpatient medical records using ICD-10 coding guidelines and assign ICD-10 codes for all conditions addressed in the documentation for the encounter.

Remote Certified Medical Coder/Temp

Confidential

• Abstract pertinent information from patient medical records. Assign appropriate ICD-10-CM codes, creating HCC and/or RxHCC group assignments as applicable.
• Assign Confidential Flagged Event codes when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes.
• Check chart assignments every day and report accurately all hours worked on a weekly basis.
• Maintain the highest levels of accuracy and patient confidentiality
• Review   medical   records to assign diagnosis and procedure codes, creating APC, MS-DRG, or APR group assignments. 

Unit Clerk/Medical Coder

Confidential, Pittsburgh, PA

• Prepared billing sheets and dictation notes for physicians
• Performed inpatient hospital coding by assigning ICD-9 and CPT codes for inpatient admissions
• Answer multi-lined telephone and transfer calls
• Maintained and organized patient charts for new admissions, filed patient information, prepared discharge paperwork and ordered charts from medical records
• Arranged transportation and security for patient appointments
• Greet and grant visitors access on a secured units and perform security checks
• Performed clerical duties such as copying, faxing, and other general office work.
• Managed office supplies, vendors, organization and upkeep

Medical Records Clerk/ Coder

Confidential, Pittsburgh, PA

• Worked and resolved coding\billing account edits and/or denials
• Routinely scheduled appointments, filed patient charts, and handled copays
• Prepared patient charts for distribution
• Performed general office duties including serving as the receptionist and clerical staff
• Code inpatient and /or outpatient diagnoses and procedures using ICD, CPT & HCPCS codes and guidelines

Intern Medical Biller/Coder

Confidential, West Mifflin, PA

• Code inpatient and/or outpatient diagnoses and procedures using current ICD-9 CM, CPT-4 and/or HCPCS codes
• Worked and resolved coding\billing account edits and/or denials
• Applied learned knowledge of diagnostic and procedural terminology and coding in order to complete CMS-1500 billing sheets
• Performed coding procedures, successful management and execution of various medical insurance plans and programs
• Demonstrated the proper methods of obtaining patient information necessary for claims management
• Performed patient check-in, scheduled appointments, appointment confirmations and handled copayments
• Performed general office duties including serving as the receptionist answering phones, sending faxes and making copies
• Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy
• Resourcefully used various coding books, procedure manuals and on-line encoders.
• Posted and adjusted payments from insurance companies.
• Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
• Prepared patient charts, pre-admissions and consent forms as necessary