Wiki CPC, CPC-H in LA/OC


Culver City
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Seeking a per diem, part time or remote employment as a Medical Coder/Compliance Auditor where I may utilize my eight plus years of healthcare experience and maximize my potentials for growth in the medical field.


01/12-Present St. Jude Heritage Healthcare-SJHS Fullerton, CA
Coder/Physician Educator
 Routine compliance audits
 HCC Risk adjustment coding, reviews & provider education
 Educate physicians on coding & documentation guidelines
 Accurately code inpatient, outpatient, intensive care, trauma/general surgeries, transitional care and family practice cases using ICD-9-CM, CPT-4, HCPCS code sets and properly sequence diagnosis/procedures per patient EMR
 Ensure coded data accurately reflects service provided, based on documentation, guarding against fraud and abuse
 Review, audit, and submit charges from Touchworks to IDX system
 Resolve billing & coding discrepancies

09/09–12/11 Vantage Oncology, Inc. Manhattan Beach, CA
Patient Account Services Representative-Collector
 Medical records abstracting & review
 Review aging reports for all Government, HMO, PPO, CCS, Worker's Compensation and other Commercial insurances carriers
 Audit claims prior to submission to insurance carriers
 Research & Analysis of delinquent third party payers
 Follow up on insurance denials, requests, and notifications
 Determine reimbursement problems and resolve billing & collection discrepancies
 Redeterminations, appeals, peer to peer reviews, refunds, claim inquiries, TAR, CIF, and Administrative Law Judge hearing requests
 Adjusting and resubmitting claims: adding modifiers, units, and procedure codes
 Manage up to (4) facilities with a an average year to date collected amount of: $5,728,042.00

06/08-09/09 California Hospital Medical Center-CHW Los Angeles, CA
Health Information Management Clerk
 Analysis and assembly of in & out patient medical records
 MedWrite & EmergiSoft dictation review
 Data entry (AS400) system
 Assist physicians & other healthcare professionals on accessing medical records
 Collect and create patient charts as they are discharged from the hospital
 PHI release forms, answering phones, and filing

05/06-06/08 California Hospital Medical Center-CHW Los Angeles, CA
Surgery Attendant-Level II Trauma Center
 12 Lead EKG's and Blood withdrawals
 Set up anesthesia/surgical equipment before and after each procedure
 Assist surgical team on positioning patient prior to procedure
 Check patients glucose and temperature after surgery
 Pick up and transfer specimen, PRBC, Platelets, and Thawed FFP's for surgical patients
 Inform patient's relatives on status, length of stay and bed assignment
 Respond to patient's needs from neonatal to convalescent


2009 United Education Institute-College Huntington Park, CA
 Medical Billing & Insurance Coding Certified
2003 Youth Opportunities High School Los Angeles, CA
 High School Diploma


• Excellent ICD-9-CM, CPT-4, and HCPCS Level II Coding skills
• Excellent Coding, Billing, Collection, and Reimbursement skills
• MS-DRG, OPPS, DOFR & HIPAA Compliant
• Knowledge of Medicare billing, coding & documentation guidelines
• Strong knowledge of Medical Terminology, Physiology and advanced human Anatomy
• Knowledge of Third Party Payer: PPO, HMO, Medicare, Medi-Cal, Global Period/Case Rates, Technical and Professional Components
• Knowledge of the following softwares: IDX, Touchworks, Allscripts, Meditech, MediSoft, AS400, EmergiSoft, MedWrite, Enterprise Intergy, Microsoft Excel, Word, and PowerPoint
• CMS-1500, UB04, TAR, RTD, MCR Redetermination, MCAL CIF, and Explanation of Benefit (EOB) forms expert


CPC, CPC-H, Medical Billing/Insurance Coding Certificate


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