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RN/CPC with 10+ years multi-specialty coding experience - seeking employment


Nashville, TN
Best answers
Len Hales, RN, BSN, CPC
1808 State Street, #207
Nashville, TN 37203 Cell: 615.403.4546

 Healthcare Management professional with a career path in healthcare administration and nursing.
 Certified coding and billing manager (CPC) with 10+ years of experience in high-volume physician office and outpatient settings. Consistently achieve record-high customer satisfaction rankings, improvements to the bottom line and turnaround of underpaid claims.
 Dedicated and patient-focused Registered Nurse with proven expertise in patient care, staff development, and family advocacy.
Areas of Expertise
Teambuilding & Training
Chemotherapy and other complex biological agents
Advanced ICD-9, CPT, HCPCS coding
Insurance audits (RAC, prospective and retrospective reviews, etc.)
Proficient in all areas of Electronic Health Records (EHR/EMR). Phlebotomy, Injections
Ability to maintain calm in stressful
working conditions
Cost-Reduction Strategies
Strong critical-thinking skills
Managing others while maintaining a positive working environment.
Preparing complex financial reports
Professional Experience
Coding & Billing Manager/RN
Selected Contributions:
 Manage all aspects of coding, billing, and cash applications.
 Dispense oral and injectable medications from in-office pharmacy.
 Accurately code and post daily office charges, including IV infusions, injections, hospital charges, home health care/hospice care plan oversight, bone marrow biopsies, and pathology.
 Post daily insurance payments utilizing Electronic Remittance Advices (ERA) and Electronic Funds Transfers (EFT).
 Obtain all prior-authorizations for chemotherapy, injectables, and oral medications while adhering to NCCN, ASCO, and clinical trial guidelines.
 Consistently research and implement updates from CMS, FDA, OIG/HIPAA, Coding newsletters, etc. in order to maintain current in all areas of coding, compliance, auditing, clinical issues, etc.
 Review physicians transcription on a daily basis to check for errors in clinical documentation; communicate findings and recommendations to physicians to ensure coding compliance.
 Stay abreast of and monitor practice performance in areas related to chart audits, coding accuracy, and billing.
 Key player in implementation and enhancement of EHR system (Aria), including developing templates, updating ICD-9 and CPT codes, and drug regimens.
 Guide practice in complex transition of practice management systems (Medical Manager > Centricity).
 Accurately obtain, document, and manage patient's medical history and medication history in EHR.
 Implement process, train staff, and ensure compliance with Medicare PQRI program.
 Create and administer staff training to physicians, practice administrator, clinical and clerical personnel in all areas of billing and coding.
 Serve as a resource and active patient advocate; strive to understand a patient's needs and concerns.
 Prepare and analyze all financial reports, including end of month activity reports, and quality review reports to maintain optimal reimbursement and ensure practice compliance with applicable laws/regulations.
 Significantly reduced outstanding accounts receivable and implemented policies to improve collections and increase cash flow.

Leonard Hales Page 2
Billing & Coding Supervisor, 7/06 to 7/07
Previous Position: Coding/Billing Representative, 1/05 to 7/06
Advanced to an increasingly responsible position, culminating in management role with oversight for a team of 48 billing/coding personnel. Directed employees in appropriate coding/reimbursement for multiple specialties, including: Pulmonology, Gastroenterology, Podiatry, Internal Medicine, Urgent Care, Pediatrics, Radiology, Pathology, and Cardiology.
Selected Contributions:
 Worked closely with physicians to educate them on proper documentation guidelines for E&M services as well as procedures, including: colonoscopies, bronchoscopies, thallium stress tests, cardiac tests, surgeries, etc.
 Performed performance evaluations, approved time-off requests, trained new employees, and handled personnel issues.
 Implemented a new work plan, redistributing tasks of all billing/coding representatives. This resulted in increased productivity and reimbursement.
 Followed up with insurance carriers and patients to expedite the recovery of payment obligations.
 Carefully researched and reviewed denied claims, exercising a strong working knowledge of major medical plans and leading healthcare networks.
 Facilitated monthly staff meetings.
COLIN L. HALES, M.D., P.A. — PORT ARTHUR, TX 7/1996-8/03
Billing/Compliance Manager and Medical Assistant
Selected Contributions:
 Efficiently managed the front desk and billing office in areas of computerized processes utilizing Medical Manager to handle scheduling, charge and payment entry, collections, medical records and insurance claims.
 Assisted physician and Nurse Practitioners with examinations, suturing, routine physical examinations, and pelvic examinations.
 Performed ear irrigations, pulmonary function testing, audiograms, vision screening, EKG's, and Holter monitors.
 Collected and processed blood for CBC's and prothrombin time testing, interpreted strepscreens, urinalysis and microalbumin testing in-office.
 Administered IM and SQ injections to patients and monitored for drug reaction.
 Maintained day-to-day office compliance with OSHA and CLIA.
 Obtained patient's vital signs and triaged to exam rooms; applied/changed dressings.
 Ensured open lines of communication and accurate charting procedures; updated computerized patient data.
 Managed all aspects of accounts receivable and billing operations.
 Developed and maintained practice clinical and billing procedure manual.
 Reviewed A/R reports continuously to evaluate and improve collection efforts.
 Prepared and deposited all payments daily.
 Greeted patients at front desk, checked patients in and out as needed.
 Prepared and analyzed end of month activity reports, and quality review reports.
Education and Training
American Academy of Professional Coders (AAPC) 5/07
Earned CPC certification – License # 01064375

Belmont University – Nashville, TN 8/03-12/06
Graduated with Bachelor of Science in Nursing, December 2006.
Passed NCLEX 3/07 - TN State License # RN0000158180

References available upon request.