PhaedrasGate@aol.com
Objective:
I am CPC Certified with over 11 years experience and seeking a full-time remote position as a Certified Professional Medical Coder or Auditor/Analyst, where I may utilize my skills, knowledge and experience while furthering the development of this company in reaching and maintaining its goals.
Relevant Experience:
Blue Cross Blue Shield of Michigan
600 E. Lafayette
Detroit, MI 48226
May 2013 to present
Decision Medical Coding Auditor
? Review, audit and make corrections to medical coding of physician diagnoses including HCC categories and highest specificity codes from outpatient and inpatient medical records (EMR, Hybrid, and Paper).
? Develop rapport through consultation, education and communication with physician and/or their office team in process and results of audit outcomes and procedures, to resolve situations where the recommended coded service is not supported in the health record documentation and/or not consistent with coding and regulatory guidelines, using CMS Guidelines and RADV process.
? Provide physicians and office team with error rate and education on areas in need of improvement.
? Perform clinical reviews with knowledge of body systems, anatomy and physiology.
? Provide leadership team with status of projects; issue, communicate and recommend policy decisions to achieve project objectives.
? Utilize and maintain available corporate production and reporting systems; produce routine and non-routine reports, presentations, letters, communications and graphics.
? Assist internal and external personnel by answering questions, supplying information and training.
? Develop and maintain an effective working relationship with providers.
? Utilized Web URSA, MS Word, MS Excel, MS Office and Optum EPro encoder software.
OptumInsight
12125 Technology Dr
Eden Prairie, MN 55344
952-833-7100
2012-2013
Remote Medicare Advantage Coder II (HCC) / Short-term contract work
? Thoroughly review and analyze EMR, Risk Adjustments and clinical documentation of ED, IP, OP, HOP and physician outpatient encounters to identify all appropriate coding based on CMS HCC categories at DOS, using the ICD-9 diagnosis codes.
? Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
? Complete Audit/Over Read worksheet updates per QA.
? Partake in continuing education per company coding guidelines, HIPPA laws, etc.
? Synergy software experience and also MS Word, MS Excel, MS Office and others.
? Maintained an accuracy of 98% - 99%.
Outcomes Health Information Solutions
13010 Morris Rd
Alpharetta, GA 30004
678-942-2200
2011-2012
Remote Clinical Reader (HCC) / Short-term contract work
? Thoroughly glean through EMR clinical documentation for ED, IP, OP, HOP and physician outpatient encounters to identify all appropriate coding based on CMS HCC categories at DOS, using the ICD-9 diagnosis codes.
? Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
? Maintained an accuracy of 98%
Creative Care Services
34360 Harper Ave
Clinton Township, MI 48035
586-792-1300
2008-2013
Lead Coder/Biller (Mental Health) / part-time
? Responsible for assigning medical codes to Medicaid healthcare services and billing to the local county Mental Health department.
? Manage and maintain billing records, books and authorizations of Medicaid consumers.
? Trouble shooting EOB rejections and correcting in an efficient manner.
? Utilizes MS Word, MS Excel, MS Office, MS Publisher and FOCUS software (Macomb County Mental Health Dept.)
Pointe Vision Care
19637 Mack Avenue
Grosse Pointe Woods, MI 48236
313-881-6622
2003-2006
Lead Coder/Biller
? Responsible for assigning medical codes (Ophthalmology) to various medical procedures and optical goods utilizing the ICD-9, CPT and HCPCS books.
? Researched and resolved incorrect payments, EOB rejections, and other issues with outstanding accounts in an efficient manner.
? Billed insurance claims using HCFA 1500 and UB-92 form.
? Utilized MS Word, MS Excel, MS Office and MYSIS medical software.
Key Strengths:
? Self-driven with ability to work independently as well as working as a team member, independent and focused.
? Investigative by nature, analytical with strong attention to detail, excellent trouble shooting skills and excellent time management skills (left-brain thinker).
? Ability to communicate clearly and concisely, verbally and written.
? Strong interpersonal skills, critical thinking skills, organizational skills and leadership skills with ability to multi-task.
? Ability to analyze and abstract codes from hand written and electronic medical records.
? Ability to work in a fast paced production environment while maintaining at least a minimum QA level of 95%accuracy.
? Working knowledge of the business use of computer hardware and software to ensure effectiveness and quality of the processing and security of the data.
? Skilled in the use of a wide variety of office equipment including: computer, routers, and other office equipment as required.
? Over 11 years experience in Medical Coding with a strong knowledge base of medical terminology, medical abbreviations, pharmacology and disease processes.
Education:
AAPC/Macomb Community College
? ICD-9 Coding
? CPT Coding
? ICD-9 Medical Terminology
? ICD-10-CM Anatomy/Pathophysiology Training
? ICD-10-CM Medical Terminology
? Attending CAHIIM/AHIMA approved college in Fall of 2014/HIT program/RHIT goal
? Future goal to obtain CPC-P and CPMA Certifications
Certifications:
American Academy of Professional Coders
? Certified Professional Coder-CPC
Objective:
I am CPC Certified with over 11 years experience and seeking a full-time remote position as a Certified Professional Medical Coder or Auditor/Analyst, where I may utilize my skills, knowledge and experience while furthering the development of this company in reaching and maintaining its goals.
Relevant Experience:
Blue Cross Blue Shield of Michigan
600 E. Lafayette
Detroit, MI 48226
May 2013 to present
Decision Medical Coding Auditor
? Review, audit and make corrections to medical coding of physician diagnoses including HCC categories and highest specificity codes from outpatient and inpatient medical records (EMR, Hybrid, and Paper).
? Develop rapport through consultation, education and communication with physician and/or their office team in process and results of audit outcomes and procedures, to resolve situations where the recommended coded service is not supported in the health record documentation and/or not consistent with coding and regulatory guidelines, using CMS Guidelines and RADV process.
? Provide physicians and office team with error rate and education on areas in need of improvement.
? Perform clinical reviews with knowledge of body systems, anatomy and physiology.
? Provide leadership team with status of projects; issue, communicate and recommend policy decisions to achieve project objectives.
? Utilize and maintain available corporate production and reporting systems; produce routine and non-routine reports, presentations, letters, communications and graphics.
? Assist internal and external personnel by answering questions, supplying information and training.
? Develop and maintain an effective working relationship with providers.
? Utilized Web URSA, MS Word, MS Excel, MS Office and Optum EPro encoder software.
OptumInsight
12125 Technology Dr
Eden Prairie, MN 55344
952-833-7100
2012-2013
Remote Medicare Advantage Coder II (HCC) / Short-term contract work
? Thoroughly review and analyze EMR, Risk Adjustments and clinical documentation of ED, IP, OP, HOP and physician outpatient encounters to identify all appropriate coding based on CMS HCC categories at DOS, using the ICD-9 diagnosis codes.
? Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
? Complete Audit/Over Read worksheet updates per QA.
? Partake in continuing education per company coding guidelines, HIPPA laws, etc.
? Synergy software experience and also MS Word, MS Excel, MS Office and others.
? Maintained an accuracy of 98% - 99%.
Outcomes Health Information Solutions
13010 Morris Rd
Alpharetta, GA 30004
678-942-2200
2011-2012
Remote Clinical Reader (HCC) / Short-term contract work
? Thoroughly glean through EMR clinical documentation for ED, IP, OP, HOP and physician outpatient encounters to identify all appropriate coding based on CMS HCC categories at DOS, using the ICD-9 diagnosis codes.
? Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
? Maintained an accuracy of 98%
Creative Care Services
34360 Harper Ave
Clinton Township, MI 48035
586-792-1300
2008-2013
Lead Coder/Biller (Mental Health) / part-time
? Responsible for assigning medical codes to Medicaid healthcare services and billing to the local county Mental Health department.
? Manage and maintain billing records, books and authorizations of Medicaid consumers.
? Trouble shooting EOB rejections and correcting in an efficient manner.
? Utilizes MS Word, MS Excel, MS Office, MS Publisher and FOCUS software (Macomb County Mental Health Dept.)
Pointe Vision Care
19637 Mack Avenue
Grosse Pointe Woods, MI 48236
313-881-6622
2003-2006
Lead Coder/Biller
? Responsible for assigning medical codes (Ophthalmology) to various medical procedures and optical goods utilizing the ICD-9, CPT and HCPCS books.
? Researched and resolved incorrect payments, EOB rejections, and other issues with outstanding accounts in an efficient manner.
? Billed insurance claims using HCFA 1500 and UB-92 form.
? Utilized MS Word, MS Excel, MS Office and MYSIS medical software.
Key Strengths:
? Self-driven with ability to work independently as well as working as a team member, independent and focused.
? Investigative by nature, analytical with strong attention to detail, excellent trouble shooting skills and excellent time management skills (left-brain thinker).
? Ability to communicate clearly and concisely, verbally and written.
? Strong interpersonal skills, critical thinking skills, organizational skills and leadership skills with ability to multi-task.
? Ability to analyze and abstract codes from hand written and electronic medical records.
? Ability to work in a fast paced production environment while maintaining at least a minimum QA level of 95%accuracy.
? Working knowledge of the business use of computer hardware and software to ensure effectiveness and quality of the processing and security of the data.
? Skilled in the use of a wide variety of office equipment including: computer, routers, and other office equipment as required.
? Over 11 years experience in Medical Coding with a strong knowledge base of medical terminology, medical abbreviations, pharmacology and disease processes.
Education:
AAPC/Macomb Community College
? ICD-9 Coding
? CPT Coding
? ICD-9 Medical Terminology
? ICD-10-CM Anatomy/Pathophysiology Training
? ICD-10-CM Medical Terminology
? Attending CAHIIM/AHIMA approved college in Fall of 2014/HIT program/RHIT goal
? Future goal to obtain CPC-P and CPMA Certifications
Certifications:
American Academy of Professional Coders
? Certified Professional Coder-CPC