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08-09-2012, 11:54 AM
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KY CPC with Anesthesia/Pain Management/Claims Processing Experience
Patricia A. McLean, CPC
704 Gatehouse Place Lexington, KY 40505 859-552-9194/859-536-4760 pamclean1@gmail.com PROFESSIONAL STRENGTHS * ICD-9 and CPT Coding * Chart Review/Audits * EOB Comprehension * Medicare * EOB follow-up * Denial/Appeals Processes * Private collection patient accounts * Commercial Insurance * Workman’s Comp * Medicaid EDUCATION Kentucky Community Technical College Medical Terminology Course – Completed 2007. Soterion Medical Services Prep Course for CPC Exam – Certificate of Completion – 2007--Exam Successfully Passed 12/2007. EMPLOYMENT EXPERIENCE ACS/Gold Coast Health Plan: Medical Claims Billing (06/2011 – 10/2011): Responsible for reviewing medial claims information for inconsistencies/corrections. Responsible for reviewing/removing when possible, ‘error’ codes that prevent claims from moving through the system in a timely manner. Responsible for understanding and following work flow instructions correctly to ensure proper processing of claims. Pain Management Medicine: Physician Billing (2/2011 – 06/2011- Responsible for reviewing documentation of office visits and procedures to determine correct, current assignment of CPT and ICD-9 codes. Responsible for denial follow-ups and appeals. Humana, Inc.; MRA Operations Analyst/Field Coder (6/2009 – 1/2010): Responsible for contacting physician’s offices to schedule chart reviews for Medicare Risk Adjustment. Responsible for conducting chart reviews and bringing records back to the office to be uploaded into system. Submitted risk adjusted codes and uploaded them into system. University of Kentucky—Dept. of Anesthesiology; 6/2007 – 2/2009): Health Data Analyst Senior: Responsible for overseeing the billing/coding for the OR, the Acute Pain Service, and Critical Care. Responsible for the start-up of a Pre-Op Clinic and for the training of the Attending Physicians and Residents in correct coding concepts for this specialty. Responsible for reviewing all documentation to ensure that it met all industry standards. Responsible for correct batch processing on a weekly basis. Health Data Analyst: Responsible for assisting with OR billing, Acute Pain, and Critical Care divisions. Responsible for reducing the number of department edits. Patient Relations Assistant: Responsible for overseeing/implementing start-up of new Pain Management practice. Responsible for multi-line phones, records review, filing, verifying insurance coverage/benefits, obtaining pre-certification for visits and procedures. Responsible for arranging/scheduling of procedures and admissions to hospital. 
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