SUMMARY:

Objective Experienced coder with an inpatient coding accuracy rate of 94 percent per 13 charts per hour and outpatient coding accuracy of 94 percent per 18 charts per hour seeks employment in a fast paced HIM department. Skills

• HCFA and UB-04 data entry revising
• Billing and collection procedures expert
• Records management professional
• Inpatient and Outpatient records coding proficiency
• Records maintenance professional
• Patient chart auditing ability
• MS-DRG and PC grouping
• Understands insurance benefits
• Records maintenance professional
• Coding Guidelines
• Uniform Hospital Discharge Data Set UHDDS Guidelines
• NCCI Coding Edits
• Patient chart auditing ability
• Insurance and collections procedures
• OASIS Documentation billing and coding
• Research and data abstracter
• Posting and Reviewing Payments
• Outpatient surgery coding specialist
• Familiar with commercial and private insurance carriers
• Research and data abstracter
• Office support phones, faxing, filing
• American Academy of Professional Coders AAPC member

Software Technology

• Medisoft, Medisoft Pro Encoder, Kareo, Sonosoft, AdvancedMD, Cintrix, Strataware
• Microsoft: Outlook, Word, Excel, Access, Powerpoint
• Quickbooks

Relevant Experience

Confidential

Medical Coder Provider Appeal Analyst

• Performed a detail review of previously submitted medical, hospital, and durable medical equipment, pharmacy, home health claims with accompanying reports/information for accuracy and to determine and generate medical appropriateness.
• Used multiple screens on Strata Care Claim Calculator system to generate pricing
• Reviewed scanned medical reports to determine that services on claim were actually performed and coded to reflect the services that were actually provided.
• Compared bill and rates with appropriate fee schedules, clinical edits, and Medicare, National Correct Coding Initiative NCCI , and PPO contracts to determine whether additional payment is due or recovery of overpayment is necessary.
• Compiled all medical claims to determine if there is overlap or duplication of any services
• Applied payment policies to medical supplies, drugs/medicine.
• Accurately made payments to medical providers based on the analysis of each medical claim

Confidential

Medical Records Coding and

Duties/Tasks

• Assisted in the maintenance of medical charts and/or electronic medical record filing, Op IP Reports, test results, home care forms .
• Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
• Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
• Resourcefully used various coding books, procedure manuals and on-line encoders.
• Processed a minimum 150 medical claims and charts daily while ensuring processing time not exceed 3 hours
• Correctly coded and billed medical claims for various hospital and nursing facilities.
• Verified patients' eligibility and claims status with insurance agencies.
• Diligently filed and followed up on third party claims.
• Prepared patient charts, pre-admissions and consent forms as necessary.
• Determined prior authorizations for medication and outpatient procedures.
• Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.
• Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
• Managed collections claims for unpaid bills against the estates of debtors
• Accurately posted and sent out all medical claims.
• Submitted electronic/paper claims documentation for timely filing.
• Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services.
• Responded to correspondence from insurance companies
• Posted and adjusted payments from insurance companies.
• Identified and resolved patient billing and payment issues.
• Maintained and updated collections tracking spreadsheet to help organize payment information.
• Investigated, researched, reconciled denial issues by reviewing EOB rejections.
• Confidently and adeptly handled claim denials and/or appeals.
• Evaluated patients' financial status and established appropriate payment plans.
• Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.
• Updated patient financial information to guarantee accuracy.
• Compiled and tracked outstanding balances owed to medical facilities.
• Accurately posted surgeries, hospital visits and payments for assigned carriers.
• Printed and reviewed monthly patient aging report and solicited overdue payments.
• Prepared billing correspondence and maintained database to organize billing information.
• Professionally and courteously verified appointment times with patients.
• Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge.

Confidential

Medical Records Coding Specialist

Duties/Tasks

• Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
• Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.
• Accurately selected the proper descriptive code when more than one anatomical location was indicated.
• Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories.
• Assigned icd-9-cm codes to physicians diagnosis and ensures accurate e/m services and procedural codes are captured
• Prepared patient charts accurately and neatly for the clinic.
• Scheduled appointments, registered patients and confirmed appointments daily.
• Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations.
• Verified abstracts data from medical record Assessed medical record documentation for accuracy and completeness
• Coordinated luncheons with Pharmaceutical Representatives.
• Resourcefully used various coding books, procedure manuals and on-line encoders.
• Assigned icd-9-cm codes to physicians diagnosis and ensures accurate e/m services and procedural codes are captured
• Treated all patients, their families, visitors, peers, staff and providers in a pleasant and courteous manner.
• Investigated, researched, reconciled denial issues by reviewing EOB rejections.

Confidential

Medical Coder Provider Appeal Analyst

• Performed a detail review of previously submitted medical, hospital, and durable medical equipment, pharmacy, home health claims with accompanying reports/information for accuracy and to determine and generate medical appropriateness.
• Used multiple screens on Strata Care Claim Calculator system to generate pricing
• Reviewed scanned medical reports to determine that services on claim were actually performed and coded to reflect the services that were actually provided.
• Compared bill and rates with appropriate fee schedules, clinical edits, Medicare, National Correct Coding Initiative NCCI , and PPO contracts to determine whether additional payment is due or recovery of overpayment is necessary.
• Compiled all medical claims to determine if there is overlap or duplication of any services
• Applied payment policies to medical supplies, drugs/medicine.
• Accurately made payments to medical providers based on the analysis of each medical claim