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ROBERT CASSELS, CPC
5526 N. Tramway Point Hernando, FL 34442 C: (407) 221-0800 bcassels5526@gmail.com
Professional Profile
Certified Professional Medical Coder/Medical Records Technician with over 9 years’ experience including 7-year background with Veterans Affairs Medical Centers. Specialized 3+ years’ experience in Outpatient Surgical Coding as well as managing broad range of outpatient and inpatient medical encounters. Advanced skill locating, reviewing, interpreting and abstracting medical information and notes to verify documentary evidence of diagnosis, treatments and services. Detail oriented, verifying and interpreting pertinent medical information and dates of record to determine primary diagnosis, proper sequencing, global periods, and surgery-related complications and comorbid conditions. In-depth knowledge of medical terminology, anatomy, physiology, pathophysiology, pharmacology and medications, disease and disease processes, diagnostics testing, medical procedures, treatment modalities, VA service connected status; ICD-10-CM, CPT, and HCPCS Level II coding guidelines, processes and requirements to ensure legal and accurate billing processes. Strong communication skills demonstrated through professional email and phone contacts with service providers. Documented success reviewing and correcting processing errors to resolve $90,000 in aging denials and accounts receivable.
Certification
Certified Professional Coder (CPC), American Academy of Professional Coders, 10/2008
Professional Experience
Veterans Affairs 04/2011 – Present
Medical Records Technician (Medical Coder) GS-0675-08 (01/2013 – Present)
Medical Records Technician (Medical Coder) GS-0675-7 (04/2012 – 01/2013)
Medical Records Technician (Medical Coder) GS-0675-6 (04/2011 – 04/2012)
Malcolm Randall Veterans Affairs Medical Center (VAMC) 02/2015 – Present
1601 SW Archer Rd, Gainesville, FL 32608 40 hrs/wk
Supervisor: Angelica Hudson, 352-376-1611, ext, 6070, may contact
Medical Records Technician (Medical Coder) / Assistant Lead; GS-0675-08
As Assistant Lead, assign cases to appropriately skilled coders. Establish and maintain suspense tracking and current case file management systems with deficiency tracking. Create and manage Excel spreadsheets of open case files, documentation deliverables, dates of first and subsequent requests for corrections or information. Monitor deadlines and progress; research any uncoded cases to ensure timely completion. Provide support to coders and provider groups to resolve any outpatient surgery coding issues. Complete DSS List of incompletely loaded cases in VISTA.
As Coder, access, review, analyze, extract, compile and abstract information from patient medical records, physician and other medical provider notes via VistA, Compliant Coding Module (CCM) and Computerized Patient Record System (CPRS) to locate documentary evidence of diagnosis, treatments and services, with primary focus on outpatient surgical procedures including OR, Non-OR and duplicate cases.
(Malcolm Randall VAMC continued)
Average 120% productivity with an accuracy rate of 93% to protect VA Reimbursements (VERA) and Centers for Medicare and Medicaid (CMS) reimbursements; complete all case coding for approximately 30 complex cases daily, all within 7 days of procedure per Joint commission standards. Consistently work ahead of schedule enabling support through short staffing due to illness or leave of other coders.
♦ Apply in-depth knowledge of medical terminology, anatomy, physiology, pathophysiology, pharmacology and medications, disease and disease processes, diagnostics testing, medical procedures, treatment modalities, VA service connected status and primary diagnosis to interpret records and notes and evaluate adequacy of documentation.
♦ Work on-site and remotely. Conduct quality assurance steps including processing through edits and Clintegrity for accuracy, compatibility and identification and incorporation of appropriate modifiers. Generate recode/reject list daily and address any discrepancies. Research and resolve issues related to “No Time Out,” “Incomplete/Undictated Cases,” and incorrect modifiers. Sequence poisonings, adverse effects, and underdosing diagnoses in correct order.
♦ Process daily list through CCM; research surgical notes in CPRS and imaging for PX and DX. Manage list groupings by alphabetization, OR/Non-OR, insured and Pathology. Track aging pathologies and undictated surgical notes. Code HCPS Level II codes for non-physician services, anesthesia profees, pathologies, radiology procedures, other diagnostic procedures and supplies. Apply ICD-10 (since 10/2015), CPT-4, Coder MD Evaluation and Management (E&M), and Gainesville local guidelines.
♦ Research unusual or complex cases to ensure sufficient documentation and accurate coding. Research technical resources including Toula’s Tips, VISN8 Coding Tips, Quantum VHA Coding Guidelines, Cleveland Clinic, Nuance Coding Procedures Manual, VHA Coding Library and Mayo Clinic and National Institutes of Health guides. Continually maintain knowledge of coding changes through AAPC and VA training classes.
♦ Generate copious CC notes regarding Path Pending, Undictated, SC Determination Need, Duplicate, and Date of Injury to ensure follow through and accuracy.
♦ Verify accuracy of dates, inclusion of electronic signature, physician and nursing notes for confirmation of administration of prescribed procedure/treatment. Cross check medical information across multiple records to verify consistency. Adapt to varied notation and documentation styles of doctors to interpret and apply codes. Notify providers of missing or insufficient documentation to prompt timely corrections and updates using Physician Query Tracking (PQT). Provide screenshots to support correction.
♦ Use F6 to interpret and verify global periods relative to diagnoses, treatments and surgeries across various practices including neurology, orthopedic, cardiology, ophthalmology, podiatry and others.
♦ Apply HIPAA privacy protections to protect patient privacy and confidential information; lock workstation and protect password to protect against unauthorized view.
Routine cases include Biopsies, Incisions, Excisions, Debridements, Grafts, I&Ds, Destructions, MANIPULATIONS, CATARACTS, HERNIA REPAIRS, COLONOSCOPIES, EGDS, ESOPHAGOSCOPIES, EUA, Hemmorhoidectomies, Stent Placements, Drug Instillations, Cystoururethroscopies, Calculus Lithrotripsies, TURPs, TUIBNCs, Circumcisions, Thyroidectomies, Dental Excisions Using “D” Codes, ECTs.
Complex cases include:
♦ Skin: repairs including adjacent tissue transfer, FTSG, split skin grafts, BREAST reconstruction, mastectomies.
♦ Musculoskeletal System: Osteotomies, Fracture and Dislocation Repairs, Repair, Revision, Reconstruction, Arthrodesis, Amputations, Spinal Instrumentation.
♦ Respiratory: Nose Repairs, Incision and Excision of Accessory Sinuses, Lung Removal, Lung Removal by VATS.
(Malcolm Randall VAMC continued)
♦ Cardiovascular System: TAVR, CABG, Embolectomies/Thrombectomies, AAA Repairs-Basic and Fenestrated, Bypass Grafts, Dialysis Circuit Creation, Endovascular Revascularization, Ballooning, Stenting, Angiographies, TEE/DCCV.
♦ Digestive System: Sialolithotomies, ERCPs, Enterectomies, Colectomies, Colostomies, Pancreatectomies.
♦ Urinary System: Nephrolithotomies, Insertion Penile Prosthesis.
♦ Female: Hysterectomies, Oophrectomies.
♦ Nervous System: Reservoir/Pump Implantation, Spinal Laminectomies, Crainectomies, Crainetomies, Percutaneous Implantation of Neurostimulator Electrodes, Chemodenervations, Neuroplasties.
♦ Eye: Keratoplasties, Shunts, Grafts, Drainage Devices, Trabeculectomies, Tarsorrhaphies, Conjunctoplasties.
Orlando Veterans Administration Medical Center (VAMC) 04/2011 – 02/2015
2500 South Lakemont Avenue; Orlando, FL 32814 40 hrs/wk
Supervisor: Scorro Ramos, (407) 629-1599, ext.6753, may contact
Medical Records Technician (Medical Coder); GS-0675-8, (01/2013 – 02/2015)
GS-0675-7 (04/2012 – 01/2013); GS-0675-6 (04/2011 – 04/2012)
Accessed, reviewed, analyzed, extracted, compiled and abstracted information from patient medical records, physician and other medical provider notes via VistA, QuadraMed’s Compliant Coding Module (CCM) and Computerized Patient Record System (CPRS) to locate documentary evidence of diagnosis, treatments and services. Applied in-depth knowledge of medical terminology, anatomy, physiology, pathophysiology, pharmacology and medications, disease and disease processes, diagnostics testing, medical procedures, treatment modalities, VA service connected status and primary diagnosis to interpret records and notes and evaluate adequacy of documentation.
• Verified accuracy of dates, inclusion of electronic signature, physician and nursing notes for confirmation of administration of prescribed procedure/treatment. Cross checked medical information across multiple records to verify consistency.
• Used F6 to interpret and verify global periods relative to diagnoses, treatments and surgeries across various practices including neurology, orthopedic, cardiology, ophthalmology, podiatry and others. Used F9 to assign accurate ICD-9-CM, CPT-4 and Healthcare Common Procedure Coding System (HCPCS) Level II codes, linking correct diagnoses to procedures. Used nCoderMD Evaluation and Management (E&M) calculator to verify correct level of service. Utilized SOP coder comments to include referring physician, duplicates, date of injury, date of onset, date of plan, date treatment started, date last seen by primary clinician, resident notes, global surgery, telephone encounters and Q modifiers as appropriate for reach case. Applied West Palm Beach Guidelines, Coding Roundtable, 1997 E&M Guidelines, and supervisory printed guidance to coding determinations.
• Assigned codes to full range of documented outpatient and inpatient care encounters (including inpatient discharges) provided by Orlando VAMC encompassing medical clinic, community nursing and rehabilitation program, long-term care and short-term rehabilitation community living center, and domiciliary care mental health rehabilitation and treatment center. Performed routine as well as complex and complicated coding encompassing E&M, cardiology, pacemaker checks, Holter monitoring, EKGs, radiology (x-ray/MRI/echocardiogram/ultrasound), nuclear stress tests/nuclear meds, PFT, sleep studies, cystoscopies, gynecology, women’s health, EEG/EMG, ophthalmology, psychiatry, psychology, audiology, home based care, pre-op, preventative, tele-health, physical therapy, podiatry, diabetic education, dermatology, wound care, excisions, destructions, closures, rearrangements, grafts reports labs, PAPs, pathology, bone and breast biopsies, infusions, injections, EGDs, colonoscopies, MACs, orthopedics, and PTF census VIP workplace for VERA dollars.
(Orlando VAMC continued)
• Adapted to varied notation and documentation styles of doctors, and unique documentation, reporting and processing requirements of VHA, VERA and Centers for Medicare and Medicaid Services (CMS) to support reimbursements.
• Maintained strict adherence to HIPAA privacy laws to protect patient private and confidential information. Applied JCAHO standards for ethics, honesty and competency in healthcare work. Reviewed and applied emerging CMS updates for documentation requirements.
• Used coding tools including Coding /Abstract CM and PCS, ENCODER ClintegrityReady, VIP Workplace, Quantum Coding, DRG Coding, Coding Roundtable and PTF Record. Locked workstation, protected password and prevented unauthorized view by others. Applied security protocols to document disposal.
• Carefully reviewed / proofread all documents and codes to protect integrity as a legal document, and ensure adequacy for continuity of care.
• Worked productively among coding group to support accuracy and productivity. Provided technical support and expertise in interpretation of terminology and documentation requirements in areas of dermatology, stress tests, nuclear medications and mathematical formula/issues for translating dosages of medication units for accurate coding.
• Trusted to apply independent judgment to assign accurate codes including for complex and complicated encounters involving multiple diagnosis. Interpreted primary diagnosis and other “top 4” diagnoses” as appropriate, proper sequencing and pertinent related surgery complication and comorbidity diagnoses. Definitively determined global periods based on dates of consultations / treatments / procedures, and natures of referrals such as consultation versus procedures.
• Identified insufficient, incomplete documentation and generated notifications and requests for information or updates using Physician Query Tracking (PQT). Provided screenshot of case status to support immediate identification of items needing attention and timely rectification. Consistently achieved high return on PQTs.
• Established and maintained highly organized suspense tracking and current case file management systems with medical record/chart deficiency tracking to continually monitor and manage priorities and ensure timely follow-up of pending issues with documentation. Created and managed Excel spreadsheets to track open case files, documentation deliverables, dates of first and subsequent requests. Identified daily and weekly priorities, maintaining flexibility to adjust to emerging priorities. Monitored deadlines. Maintained goal focused work ethic, following through on pending incomplete casework to protect timely VERA and CMS reimbursements, and resulting funding supporting veterans’ health care services.
• Compiled and continually updated coding resources into specialty area binders for ease of reference. Binders included resources specific to E&M, ophthalmology, physical therapy and rehabilitation, dermatology, labs, injections, orthopedics, pathology, psychiatry, pulmonary function tests, radiology, use of V codes, nuclear medicine, vascular radiology, gastrointestinal, and MACs. Created and updated Excel spreadsheets of commonly used VA diagnosis and procedure codes by categories of musculoskeletal, cardiology, labs, ophthalmology, gastrointestinal, physical therapy/rehab, injections/infusion, audiology, home care and wound care, V codes and commonly used miscellaneous codes.
• Researched technical resources for unusual or complex cases to ensure sufficient documentation and accurate coding.
• Provided technical support to analysts. Tracked and communicated trends in documentation errors and issues to support analysts in training physicians to improve productivity in coding and reimbursement processing.
(Orlando VAMC continued)
• Ensured efficiency and productivity in workflow, completing codes for 75 very detailed cases per day. Maintained awareness of deadlines and pending cases to prompt timely input by customers for smooth processing. Consistently surpassed production goals and audit standards for accuracy and thoroughness.
• Continually broadened knowledge of medical practices, terminology and coding through ongoing review of industry and association publications and training through Nuance, TMS, MyVeHU Campus and classroom reviews. Achieved over 40 hours of training on ICD-10-CM an ICD-10-PCS to date.
ACCOMPLISHMENTS
Identified ineffective PQT request processes due to formatting of messages. Secured supervisory approval to redesign automated subject line enabling medical service providers to easily identify issue and nature of request. Adopted for use across coding group resulting in increased follow-through of medical providers in reviewing and correcting documentation to improve reimbursement rate.
Identified common coding errors by peers related to extended psychotherapy visits. Initiated research by management to compel correction across group.
Identified and initiated correction for group in coding related to skin tag removal and biopsy procedures.
Achieved “Outstanding” on last 2 performance evaluations, 2012 and 2013. Delivered 97% productivity.
Selected to particpate in VA PRIDE self-development program for technical and leadership skills.
Selected by name to provide evaluation of PRIDE program with recommendations to enhance quality.
Leavitt Management Group 03/2009 – 03/2011
2600 Lake Lucien Drive, Suite 180, Maitland, FL 32751 40 hrs/week
Supervisor: Sheila Cunningham, 407-875-2080 ext. 1197, may contact $29,120/annual salary
Coder/Medical Records Technician
Reviewed and analyzed patient records, test results, and doctors’ diagnosis and notes via Advanced Toolkit for accuracy and inclusiveness of evidentiary and documentary requirements. Supported 73 dermatology practices and over 100 doctors throughout country.
♦ Verified date stamps and consistency with related records. Reviewed global periods for each related claim as appropriate; ensured no indication of unbundling and adequacy of record for continuity of patient care. Generated Medical Requests via email to clinicians and administrative staff as necessary to gain additional information, clarified ambiguities and conflicting information, and prompted corrections to records to ensure accurate and legal billing processes.
♦ Assigned accurate International Classification of Diseases (ICD)-9-CM diagnosis codes, Current Procedural Terminology (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) Level II codes, 2-digit modifiers, primary/secondary diagnosis in Next Gen 5 billing system.
♦ Ensured justification supports medical necessity. Researched complex cases through hard copy and online technical resources including Ingenix Coding Procedures Manuals, and Mayo Clinic and National Health Institute guidelines.
♦ Proofread Next Gen 5 entries prior to submission and checked for any automated alerts of errors; maintained full responsibility for accuracy and integrity of record. Posted transactions and reviewed transmission reports to enable early identification and resolution of issues.
(Leavitt Management Group continued)
♦ Collaborated with other team members to resolve complex coding issues. Provided knowledge and expertise and leverage others’ experience to ensure accurate classifications and code assignments. Participated in team meetings, discussing recent issues and emerging precedents to maintain up-to-date knowledge and accurate interpretation.
♦ Processed Mohs, biopsies, breast reconstruction, excisions, destructions, closures, injections, rearrangements, grafts and pathology reports. Adapted to varied notation and documentation styles of doctors, and unique reporting and processing requirements of each insurance provider. Ensured efficiency and productivity in workflow, completing codes for 900 to 1000 pages of notes per day. Consistently achieved production goals and audit standards for accuracy and thoroughness.
♦ Continually broadened medical knowledge and terminology. Maintained awareness of deadlines and pending cases to prompt timely input by customers for smooth processing.
Med-Bill, Inc. 10/2009 – 12/2009
PO Box 520531; Longwood, FL 32752 & 09/2008 – 11/2008
Supervisor: Louie Hilal, 407-702-3549, permission to contact
Billing Assistant, Collections and Appeals, (10/2009 – 12/2009), 5 hours/week
Billing Assistant Intern, (09/2008 – 11/2008), 40 hours/week; Unpaid Internship
Reviewed and prioritized outstanding accounts receivable. Analyzed denied claims, generated medical requests via email and phone as appropriate to gastroenterologist service provider clinical and administrative staff.
♦ Researched paper and electronic medical records to locate, verify or clarify information. Accessed and updated AdvancedMD and AltaPoint Medical Practice.
♦ Wrote letters of appeal to insurance coverage providers citing CPT guidelines to resolve reporting issues and gain payment for medical services.
♦ Communicated by email and phone with insurance providers to prompt timely approval and payments.
♦ Edited superbills and processed CMS-1500 forms for submission to insurance companies.
♦ Verified insurance eligibility information, referrals, authorization numbers and payment histories.
Accomplishments
♦ Successfully collected over $90,000 in aging accounts receivable.
♦ Worked with owner to implement online Medicare claim system, significantly reducing time for processing and expediting payments to customers.
Other Experience
Alarm Products Distributors 04/1996 – 10/2007
No longer in business 40 hours/week
Winter Park, FL 32789 $45,000/annual salary
Supervisor: Thomas D. Lehrer, 407-342-8609, permission to contact
Administrative and Sales Manager
Hired, trained and supervised 5-12 Sales, Marketing and Administrative staff to secure and service over 1000 commercial client accounts generating $7.2 million annually in specialized alarm and security products. Taught product knowledge, sales techniques and customer service standards.
(Alarm Products Distributors continued)
♦ Established sales goals and monitored progress. Oversaw staff in lead generation, development and presentation of sales calls to customers, and service delivery. Provided feedback to continually refine skills.
♦ Delegated tasks, clearly communicating expectations and timelines for accomplishment. Assigned new hire orientation and training responsibilities. Aligned mentoring relationships.
♦ Continually developed technical and functional skills of team through whole group training, one-to-one mentoring and coaching.
♦ Applied human resources best practices to recruit, screen and select candidates representing best technical and functional fit to organization and position.
♦ Utilized inclusive management techniques, recognizing individual contributions and professional growth, and celebrating team accomplishments to build strong ownership of mission. Solicited input of ideas from staff and developed highly productive team focused on excellent client satisfaction.
♦ Member of start-up team and key contributor to company growth throughout tenure.
♦ Restructured, cataloged, updated and managed technical resource library encompassing product and parts descriptions, manufacturer manuals and sales literature.
Education/Training
Herzing College, Winter Park, FL
Associate of Science in Medical Billing and Insurance Coding with Honors, 09/2008
American Health Information Management Association (AHIMA) accredited
Dean’s List Summer 2008, Summer 2004, Fall 2004; GPA: 3.87/4.0
Herzing Academic Award, Fall 2004
Relevant Coursework includes: Medical Office Administration I and II including Health Information Portability and Accountability Act (HIPAA); Introduction to Health Care including Joint Commission on Accredited Health Care (JCAHO) requirements and activities; Anatomy and Physiology I and II; Medical Billing and Insurance Procedures; Basic ICD Coding; Basic CPT/HCPCS Coding; Intermediate CPT/HCPCS Coding; Computers and Application Software; Pathophysiology and Pharmacology; Basic Diagnosis Coding; Keyboarding; Medical Terminology; Intermediate Diagnosis Coding including introduction to ICD-10-CM and ICD-10-PCS with study of upcoming changes and impacts on practices.
Department of Veterans Affairs HIPAA Training, 6 hours, 07/2008
Department of VA Orientation to Medical Billing Coding and Processing, 24 hours, 07/2008
Intern, Orlando Veterans Affairs Medical Billing and Coding Department, 07/2008 – 08/2008
Batched and filed hard copy medical charts and travel vouchers, ensuring accurate placement and indexing. Applied HIPAA regulations through all activities.
Bachelor of Arts in History, Vanderbilt University, Nashville, TN, 1979
High School Diploma, Druid Hills High School, Atlanta, GA, 1973
Professional Development
Participated in VA PRIDE Program for self-development of technical and leadership skills, 01/2013
PTF Census VIP Workplace Coding, Quarterly Updates
Attended VA CREW Training for development of productive, positive working relationships, 10/2011
Achieved over 40 hours of training on ICD-10-CM an ICD-10-PCS through ongoing review of industry and association publications and training through Nuance, TMS, MyVeHU Campus and classroom reviews.
Professional Publication
Cassels, R. H. and S. C. Safian, “Coding Pathological Testing on Bone Marrow.” AAPC Healthcare Business Monthly, October 2014, pp.22-24.
Contributed research to “Use Templates with Caution,” article written by Peggy Stilley. Published in Coding Edge Magazine, May 2011, pp. 18-20.
Professional Associations
Member, American Academy of Professional Coders (AAPC)
Member, Phi Theta Kappa International Honor Society
Awards / Recognition
Step increase from GS-08-02 to GS-08-03 date 01/2014
Achieved “Outstanding” performance rating on 2012 and 2013 evaluations
Consistently achieve over 97% productivity ratings
Community Service
Participant, Orlando VAMC Food Drive
Annual Donor, Combined Federal Campaign
Technical Skills
ICD-10-CM; ICD-10-PCS; ICD-9-CM; CPT-4; HCPCS Level II codes; CPRS; CCM; 1997 E&M Guidelines; Coding /Abstract CM and PCS; VistA; ENCODER ClintegrityReady; VIP Workplace; Quantum Coding; DRG Coding; Coding Roundtable; PTF Record; CMS-1500 forms; AdvancedMD; Medical Manager; Advanced Toolkit; Next Gen 5; AltaPoint Medical; Explanation of Benefits (EOB) and Remittance Advice (RA) analysis and interpretation; interpretation and application of Joint Commission (JCAHO) and HIPAA compliance guidelines; MS Word/Excel/Access/PowerPoint/Outlook; document scanners, printers, copiers, Fax machines; type wpm
5526 N. Tramway Point Hernando, FL 34442 C: (407) 221-0800 bcassels5526@gmail.com
Professional Profile
Certified Professional Medical Coder/Medical Records Technician with over 9 years’ experience including 7-year background with Veterans Affairs Medical Centers. Specialized 3+ years’ experience in Outpatient Surgical Coding as well as managing broad range of outpatient and inpatient medical encounters. Advanced skill locating, reviewing, interpreting and abstracting medical information and notes to verify documentary evidence of diagnosis, treatments and services. Detail oriented, verifying and interpreting pertinent medical information and dates of record to determine primary diagnosis, proper sequencing, global periods, and surgery-related complications and comorbid conditions. In-depth knowledge of medical terminology, anatomy, physiology, pathophysiology, pharmacology and medications, disease and disease processes, diagnostics testing, medical procedures, treatment modalities, VA service connected status; ICD-10-CM, CPT, and HCPCS Level II coding guidelines, processes and requirements to ensure legal and accurate billing processes. Strong communication skills demonstrated through professional email and phone contacts with service providers. Documented success reviewing and correcting processing errors to resolve $90,000 in aging denials and accounts receivable.
Certification
Certified Professional Coder (CPC), American Academy of Professional Coders, 10/2008
Professional Experience
Veterans Affairs 04/2011 – Present
Medical Records Technician (Medical Coder) GS-0675-08 (01/2013 – Present)
Medical Records Technician (Medical Coder) GS-0675-7 (04/2012 – 01/2013)
Medical Records Technician (Medical Coder) GS-0675-6 (04/2011 – 04/2012)
Malcolm Randall Veterans Affairs Medical Center (VAMC) 02/2015 – Present
1601 SW Archer Rd, Gainesville, FL 32608 40 hrs/wk
Supervisor: Angelica Hudson, 352-376-1611, ext, 6070, may contact
Medical Records Technician (Medical Coder) / Assistant Lead; GS-0675-08
As Assistant Lead, assign cases to appropriately skilled coders. Establish and maintain suspense tracking and current case file management systems with deficiency tracking. Create and manage Excel spreadsheets of open case files, documentation deliverables, dates of first and subsequent requests for corrections or information. Monitor deadlines and progress; research any uncoded cases to ensure timely completion. Provide support to coders and provider groups to resolve any outpatient surgery coding issues. Complete DSS List of incompletely loaded cases in VISTA.
As Coder, access, review, analyze, extract, compile and abstract information from patient medical records, physician and other medical provider notes via VistA, Compliant Coding Module (CCM) and Computerized Patient Record System (CPRS) to locate documentary evidence of diagnosis, treatments and services, with primary focus on outpatient surgical procedures including OR, Non-OR and duplicate cases.
(Malcolm Randall VAMC continued)
Average 120% productivity with an accuracy rate of 93% to protect VA Reimbursements (VERA) and Centers for Medicare and Medicaid (CMS) reimbursements; complete all case coding for approximately 30 complex cases daily, all within 7 days of procedure per Joint commission standards. Consistently work ahead of schedule enabling support through short staffing due to illness or leave of other coders.
♦ Apply in-depth knowledge of medical terminology, anatomy, physiology, pathophysiology, pharmacology and medications, disease and disease processes, diagnostics testing, medical procedures, treatment modalities, VA service connected status and primary diagnosis to interpret records and notes and evaluate adequacy of documentation.
♦ Work on-site and remotely. Conduct quality assurance steps including processing through edits and Clintegrity for accuracy, compatibility and identification and incorporation of appropriate modifiers. Generate recode/reject list daily and address any discrepancies. Research and resolve issues related to “No Time Out,” “Incomplete/Undictated Cases,” and incorrect modifiers. Sequence poisonings, adverse effects, and underdosing diagnoses in correct order.
♦ Process daily list through CCM; research surgical notes in CPRS and imaging for PX and DX. Manage list groupings by alphabetization, OR/Non-OR, insured and Pathology. Track aging pathologies and undictated surgical notes. Code HCPS Level II codes for non-physician services, anesthesia profees, pathologies, radiology procedures, other diagnostic procedures and supplies. Apply ICD-10 (since 10/2015), CPT-4, Coder MD Evaluation and Management (E&M), and Gainesville local guidelines.
♦ Research unusual or complex cases to ensure sufficient documentation and accurate coding. Research technical resources including Toula’s Tips, VISN8 Coding Tips, Quantum VHA Coding Guidelines, Cleveland Clinic, Nuance Coding Procedures Manual, VHA Coding Library and Mayo Clinic and National Institutes of Health guides. Continually maintain knowledge of coding changes through AAPC and VA training classes.
♦ Generate copious CC notes regarding Path Pending, Undictated, SC Determination Need, Duplicate, and Date of Injury to ensure follow through and accuracy.
♦ Verify accuracy of dates, inclusion of electronic signature, physician and nursing notes for confirmation of administration of prescribed procedure/treatment. Cross check medical information across multiple records to verify consistency. Adapt to varied notation and documentation styles of doctors to interpret and apply codes. Notify providers of missing or insufficient documentation to prompt timely corrections and updates using Physician Query Tracking (PQT). Provide screenshots to support correction.
♦ Use F6 to interpret and verify global periods relative to diagnoses, treatments and surgeries across various practices including neurology, orthopedic, cardiology, ophthalmology, podiatry and others.
♦ Apply HIPAA privacy protections to protect patient privacy and confidential information; lock workstation and protect password to protect against unauthorized view.
Routine cases include Biopsies, Incisions, Excisions, Debridements, Grafts, I&Ds, Destructions, MANIPULATIONS, CATARACTS, HERNIA REPAIRS, COLONOSCOPIES, EGDS, ESOPHAGOSCOPIES, EUA, Hemmorhoidectomies, Stent Placements, Drug Instillations, Cystoururethroscopies, Calculus Lithrotripsies, TURPs, TUIBNCs, Circumcisions, Thyroidectomies, Dental Excisions Using “D” Codes, ECTs.
Complex cases include:
♦ Skin: repairs including adjacent tissue transfer, FTSG, split skin grafts, BREAST reconstruction, mastectomies.
♦ Musculoskeletal System: Osteotomies, Fracture and Dislocation Repairs, Repair, Revision, Reconstruction, Arthrodesis, Amputations, Spinal Instrumentation.
♦ Respiratory: Nose Repairs, Incision and Excision of Accessory Sinuses, Lung Removal, Lung Removal by VATS.
(Malcolm Randall VAMC continued)
♦ Cardiovascular System: TAVR, CABG, Embolectomies/Thrombectomies, AAA Repairs-Basic and Fenestrated, Bypass Grafts, Dialysis Circuit Creation, Endovascular Revascularization, Ballooning, Stenting, Angiographies, TEE/DCCV.
♦ Digestive System: Sialolithotomies, ERCPs, Enterectomies, Colectomies, Colostomies, Pancreatectomies.
♦ Urinary System: Nephrolithotomies, Insertion Penile Prosthesis.
♦ Female: Hysterectomies, Oophrectomies.
♦ Nervous System: Reservoir/Pump Implantation, Spinal Laminectomies, Crainectomies, Crainetomies, Percutaneous Implantation of Neurostimulator Electrodes, Chemodenervations, Neuroplasties.
♦ Eye: Keratoplasties, Shunts, Grafts, Drainage Devices, Trabeculectomies, Tarsorrhaphies, Conjunctoplasties.
Orlando Veterans Administration Medical Center (VAMC) 04/2011 – 02/2015
2500 South Lakemont Avenue; Orlando, FL 32814 40 hrs/wk
Supervisor: Scorro Ramos, (407) 629-1599, ext.6753, may contact
Medical Records Technician (Medical Coder); GS-0675-8, (01/2013 – 02/2015)
GS-0675-7 (04/2012 – 01/2013); GS-0675-6 (04/2011 – 04/2012)
Accessed, reviewed, analyzed, extracted, compiled and abstracted information from patient medical records, physician and other medical provider notes via VistA, QuadraMed’s Compliant Coding Module (CCM) and Computerized Patient Record System (CPRS) to locate documentary evidence of diagnosis, treatments and services. Applied in-depth knowledge of medical terminology, anatomy, physiology, pathophysiology, pharmacology and medications, disease and disease processes, diagnostics testing, medical procedures, treatment modalities, VA service connected status and primary diagnosis to interpret records and notes and evaluate adequacy of documentation.
• Verified accuracy of dates, inclusion of electronic signature, physician and nursing notes for confirmation of administration of prescribed procedure/treatment. Cross checked medical information across multiple records to verify consistency.
• Used F6 to interpret and verify global periods relative to diagnoses, treatments and surgeries across various practices including neurology, orthopedic, cardiology, ophthalmology, podiatry and others. Used F9 to assign accurate ICD-9-CM, CPT-4 and Healthcare Common Procedure Coding System (HCPCS) Level II codes, linking correct diagnoses to procedures. Used nCoderMD Evaluation and Management (E&M) calculator to verify correct level of service. Utilized SOP coder comments to include referring physician, duplicates, date of injury, date of onset, date of plan, date treatment started, date last seen by primary clinician, resident notes, global surgery, telephone encounters and Q modifiers as appropriate for reach case. Applied West Palm Beach Guidelines, Coding Roundtable, 1997 E&M Guidelines, and supervisory printed guidance to coding determinations.
• Assigned codes to full range of documented outpatient and inpatient care encounters (including inpatient discharges) provided by Orlando VAMC encompassing medical clinic, community nursing and rehabilitation program, long-term care and short-term rehabilitation community living center, and domiciliary care mental health rehabilitation and treatment center. Performed routine as well as complex and complicated coding encompassing E&M, cardiology, pacemaker checks, Holter monitoring, EKGs, radiology (x-ray/MRI/echocardiogram/ultrasound), nuclear stress tests/nuclear meds, PFT, sleep studies, cystoscopies, gynecology, women’s health, EEG/EMG, ophthalmology, psychiatry, psychology, audiology, home based care, pre-op, preventative, tele-health, physical therapy, podiatry, diabetic education, dermatology, wound care, excisions, destructions, closures, rearrangements, grafts reports labs, PAPs, pathology, bone and breast biopsies, infusions, injections, EGDs, colonoscopies, MACs, orthopedics, and PTF census VIP workplace for VERA dollars.
(Orlando VAMC continued)
• Adapted to varied notation and documentation styles of doctors, and unique documentation, reporting and processing requirements of VHA, VERA and Centers for Medicare and Medicaid Services (CMS) to support reimbursements.
• Maintained strict adherence to HIPAA privacy laws to protect patient private and confidential information. Applied JCAHO standards for ethics, honesty and competency in healthcare work. Reviewed and applied emerging CMS updates for documentation requirements.
• Used coding tools including Coding /Abstract CM and PCS, ENCODER ClintegrityReady, VIP Workplace, Quantum Coding, DRG Coding, Coding Roundtable and PTF Record. Locked workstation, protected password and prevented unauthorized view by others. Applied security protocols to document disposal.
• Carefully reviewed / proofread all documents and codes to protect integrity as a legal document, and ensure adequacy for continuity of care.
• Worked productively among coding group to support accuracy and productivity. Provided technical support and expertise in interpretation of terminology and documentation requirements in areas of dermatology, stress tests, nuclear medications and mathematical formula/issues for translating dosages of medication units for accurate coding.
• Trusted to apply independent judgment to assign accurate codes including for complex and complicated encounters involving multiple diagnosis. Interpreted primary diagnosis and other “top 4” diagnoses” as appropriate, proper sequencing and pertinent related surgery complication and comorbidity diagnoses. Definitively determined global periods based on dates of consultations / treatments / procedures, and natures of referrals such as consultation versus procedures.
• Identified insufficient, incomplete documentation and generated notifications and requests for information or updates using Physician Query Tracking (PQT). Provided screenshot of case status to support immediate identification of items needing attention and timely rectification. Consistently achieved high return on PQTs.
• Established and maintained highly organized suspense tracking and current case file management systems with medical record/chart deficiency tracking to continually monitor and manage priorities and ensure timely follow-up of pending issues with documentation. Created and managed Excel spreadsheets to track open case files, documentation deliverables, dates of first and subsequent requests. Identified daily and weekly priorities, maintaining flexibility to adjust to emerging priorities. Monitored deadlines. Maintained goal focused work ethic, following through on pending incomplete casework to protect timely VERA and CMS reimbursements, and resulting funding supporting veterans’ health care services.
• Compiled and continually updated coding resources into specialty area binders for ease of reference. Binders included resources specific to E&M, ophthalmology, physical therapy and rehabilitation, dermatology, labs, injections, orthopedics, pathology, psychiatry, pulmonary function tests, radiology, use of V codes, nuclear medicine, vascular radiology, gastrointestinal, and MACs. Created and updated Excel spreadsheets of commonly used VA diagnosis and procedure codes by categories of musculoskeletal, cardiology, labs, ophthalmology, gastrointestinal, physical therapy/rehab, injections/infusion, audiology, home care and wound care, V codes and commonly used miscellaneous codes.
• Researched technical resources for unusual or complex cases to ensure sufficient documentation and accurate coding.
• Provided technical support to analysts. Tracked and communicated trends in documentation errors and issues to support analysts in training physicians to improve productivity in coding and reimbursement processing.
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• Ensured efficiency and productivity in workflow, completing codes for 75 very detailed cases per day. Maintained awareness of deadlines and pending cases to prompt timely input by customers for smooth processing. Consistently surpassed production goals and audit standards for accuracy and thoroughness.
• Continually broadened knowledge of medical practices, terminology and coding through ongoing review of industry and association publications and training through Nuance, TMS, MyVeHU Campus and classroom reviews. Achieved over 40 hours of training on ICD-10-CM an ICD-10-PCS to date.
ACCOMPLISHMENTS
Identified ineffective PQT request processes due to formatting of messages. Secured supervisory approval to redesign automated subject line enabling medical service providers to easily identify issue and nature of request. Adopted for use across coding group resulting in increased follow-through of medical providers in reviewing and correcting documentation to improve reimbursement rate.
Identified common coding errors by peers related to extended psychotherapy visits. Initiated research by management to compel correction across group.
Identified and initiated correction for group in coding related to skin tag removal and biopsy procedures.
Achieved “Outstanding” on last 2 performance evaluations, 2012 and 2013. Delivered 97% productivity.
Selected to particpate in VA PRIDE self-development program for technical and leadership skills.
Selected by name to provide evaluation of PRIDE program with recommendations to enhance quality.
Leavitt Management Group 03/2009 – 03/2011
2600 Lake Lucien Drive, Suite 180, Maitland, FL 32751 40 hrs/week
Supervisor: Sheila Cunningham, 407-875-2080 ext. 1197, may contact $29,120/annual salary
Coder/Medical Records Technician
Reviewed and analyzed patient records, test results, and doctors’ diagnosis and notes via Advanced Toolkit for accuracy and inclusiveness of evidentiary and documentary requirements. Supported 73 dermatology practices and over 100 doctors throughout country.
♦ Verified date stamps and consistency with related records. Reviewed global periods for each related claim as appropriate; ensured no indication of unbundling and adequacy of record for continuity of patient care. Generated Medical Requests via email to clinicians and administrative staff as necessary to gain additional information, clarified ambiguities and conflicting information, and prompted corrections to records to ensure accurate and legal billing processes.
♦ Assigned accurate International Classification of Diseases (ICD)-9-CM diagnosis codes, Current Procedural Terminology (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) Level II codes, 2-digit modifiers, primary/secondary diagnosis in Next Gen 5 billing system.
♦ Ensured justification supports medical necessity. Researched complex cases through hard copy and online technical resources including Ingenix Coding Procedures Manuals, and Mayo Clinic and National Health Institute guidelines.
♦ Proofread Next Gen 5 entries prior to submission and checked for any automated alerts of errors; maintained full responsibility for accuracy and integrity of record. Posted transactions and reviewed transmission reports to enable early identification and resolution of issues.
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♦ Collaborated with other team members to resolve complex coding issues. Provided knowledge and expertise and leverage others’ experience to ensure accurate classifications and code assignments. Participated in team meetings, discussing recent issues and emerging precedents to maintain up-to-date knowledge and accurate interpretation.
♦ Processed Mohs, biopsies, breast reconstruction, excisions, destructions, closures, injections, rearrangements, grafts and pathology reports. Adapted to varied notation and documentation styles of doctors, and unique reporting and processing requirements of each insurance provider. Ensured efficiency and productivity in workflow, completing codes for 900 to 1000 pages of notes per day. Consistently achieved production goals and audit standards for accuracy and thoroughness.
♦ Continually broadened medical knowledge and terminology. Maintained awareness of deadlines and pending cases to prompt timely input by customers for smooth processing.
Med-Bill, Inc. 10/2009 – 12/2009
PO Box 520531; Longwood, FL 32752 & 09/2008 – 11/2008
Supervisor: Louie Hilal, 407-702-3549, permission to contact
Billing Assistant, Collections and Appeals, (10/2009 – 12/2009), 5 hours/week
Billing Assistant Intern, (09/2008 – 11/2008), 40 hours/week; Unpaid Internship
Reviewed and prioritized outstanding accounts receivable. Analyzed denied claims, generated medical requests via email and phone as appropriate to gastroenterologist service provider clinical and administrative staff.
♦ Researched paper and electronic medical records to locate, verify or clarify information. Accessed and updated AdvancedMD and AltaPoint Medical Practice.
♦ Wrote letters of appeal to insurance coverage providers citing CPT guidelines to resolve reporting issues and gain payment for medical services.
♦ Communicated by email and phone with insurance providers to prompt timely approval and payments.
♦ Edited superbills and processed CMS-1500 forms for submission to insurance companies.
♦ Verified insurance eligibility information, referrals, authorization numbers and payment histories.
Accomplishments
♦ Successfully collected over $90,000 in aging accounts receivable.
♦ Worked with owner to implement online Medicare claim system, significantly reducing time for processing and expediting payments to customers.
Other Experience
Alarm Products Distributors 04/1996 – 10/2007
No longer in business 40 hours/week
Winter Park, FL 32789 $45,000/annual salary
Supervisor: Thomas D. Lehrer, 407-342-8609, permission to contact
Administrative and Sales Manager
Hired, trained and supervised 5-12 Sales, Marketing and Administrative staff to secure and service over 1000 commercial client accounts generating $7.2 million annually in specialized alarm and security products. Taught product knowledge, sales techniques and customer service standards.
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♦ Established sales goals and monitored progress. Oversaw staff in lead generation, development and presentation of sales calls to customers, and service delivery. Provided feedback to continually refine skills.
♦ Delegated tasks, clearly communicating expectations and timelines for accomplishment. Assigned new hire orientation and training responsibilities. Aligned mentoring relationships.
♦ Continually developed technical and functional skills of team through whole group training, one-to-one mentoring and coaching.
♦ Applied human resources best practices to recruit, screen and select candidates representing best technical and functional fit to organization and position.
♦ Utilized inclusive management techniques, recognizing individual contributions and professional growth, and celebrating team accomplishments to build strong ownership of mission. Solicited input of ideas from staff and developed highly productive team focused on excellent client satisfaction.
♦ Member of start-up team and key contributor to company growth throughout tenure.
♦ Restructured, cataloged, updated and managed technical resource library encompassing product and parts descriptions, manufacturer manuals and sales literature.
Education/Training
Herzing College, Winter Park, FL
Associate of Science in Medical Billing and Insurance Coding with Honors, 09/2008
American Health Information Management Association (AHIMA) accredited
Dean’s List Summer 2008, Summer 2004, Fall 2004; GPA: 3.87/4.0
Herzing Academic Award, Fall 2004
Relevant Coursework includes: Medical Office Administration I and II including Health Information Portability and Accountability Act (HIPAA); Introduction to Health Care including Joint Commission on Accredited Health Care (JCAHO) requirements and activities; Anatomy and Physiology I and II; Medical Billing and Insurance Procedures; Basic ICD Coding; Basic CPT/HCPCS Coding; Intermediate CPT/HCPCS Coding; Computers and Application Software; Pathophysiology and Pharmacology; Basic Diagnosis Coding; Keyboarding; Medical Terminology; Intermediate Diagnosis Coding including introduction to ICD-10-CM and ICD-10-PCS with study of upcoming changes and impacts on practices.
Department of Veterans Affairs HIPAA Training, 6 hours, 07/2008
Department of VA Orientation to Medical Billing Coding and Processing, 24 hours, 07/2008
Intern, Orlando Veterans Affairs Medical Billing and Coding Department, 07/2008 – 08/2008
Batched and filed hard copy medical charts and travel vouchers, ensuring accurate placement and indexing. Applied HIPAA regulations through all activities.
Bachelor of Arts in History, Vanderbilt University, Nashville, TN, 1979
High School Diploma, Druid Hills High School, Atlanta, GA, 1973
Professional Development
Participated in VA PRIDE Program for self-development of technical and leadership skills, 01/2013
PTF Census VIP Workplace Coding, Quarterly Updates
Attended VA CREW Training for development of productive, positive working relationships, 10/2011
Achieved over 40 hours of training on ICD-10-CM an ICD-10-PCS through ongoing review of industry and association publications and training through Nuance, TMS, MyVeHU Campus and classroom reviews.
Professional Publication
Cassels, R. H. and S. C. Safian, “Coding Pathological Testing on Bone Marrow.” AAPC Healthcare Business Monthly, October 2014, pp.22-24.
Contributed research to “Use Templates with Caution,” article written by Peggy Stilley. Published in Coding Edge Magazine, May 2011, pp. 18-20.
Professional Associations
Member, American Academy of Professional Coders (AAPC)
Member, Phi Theta Kappa International Honor Society
Awards / Recognition
Step increase from GS-08-02 to GS-08-03 date 01/2014
Achieved “Outstanding” performance rating on 2012 and 2013 evaluations
Consistently achieve over 97% productivity ratings
Community Service
Participant, Orlando VAMC Food Drive
Annual Donor, Combined Federal Campaign
Technical Skills
ICD-10-CM; ICD-10-PCS; ICD-9-CM; CPT-4; HCPCS Level II codes; CPRS; CCM; 1997 E&M Guidelines; Coding /Abstract CM and PCS; VistA; ENCODER ClintegrityReady; VIP Workplace; Quantum Coding; DRG Coding; Coding Roundtable; PTF Record; CMS-1500 forms; AdvancedMD; Medical Manager; Advanced Toolkit; Next Gen 5; AltaPoint Medical; Explanation of Benefits (EOB) and Remittance Advice (RA) analysis and interpretation; interpretation and application of Joint Commission (JCAHO) and HIPAA compliance guidelines; MS Word/Excel/Access/PowerPoint/Outlook; document scanners, printers, copiers, Fax machines; type wpm