Seeking Remote Prof Coding Mgmt Revenue Cycle Position

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Rosalyn C. Paisley, BA,CPC,NRCCS,CBCS, AAPC ICD-10 Certified
* Raleigh, NC * * rosalynpaisley321@gmail.com

SKILLS PROFILE
• Bachelors in Journalism ( impeccable written and verbal communication skills) double major
• Political Science (analytical, articulate, diplomatic and effective team-builder & conflict resolution specialist able to manage expectations for a workable solution)
• Certified Professional Coder (CPC) American Academy of Professional Coders
• Nationally Registered Certified Coding Specialist (NRCCS) National Assc for Health Professionals
• Technical Expert in Medicare, Managed Care, Private and Third-Party reimbursement policies/contracts
• Broad and comprehensive understanding of US health care system
• Proficient Coding and Billing expert on EPIC/IDX/Medisoft/Claimsgear/ Billing Systems
• 10+ years direct experience with proven management and organizational leadership skills
• Critical thinking skills, problem solving skills, follow-through skills, and the ability to see "the big picture" and prowess managing multiple projects with competing priorities
• Superior medical terminology, anatomy and physiology discipline
• Ability to manage a prodigious workload.

PROFESSIONAL EXPERIENCE
• Coding Supervisor Duke Raleigh OR Surgical Dpt. 05- 2011- 07-2013
and Duke North Emergency Dpt & Duke Raleigh Emergency Dpt
Medical Coder II DUHS (multi-specialties) 07-2013-Present
• Managed staff work volume and productivity. Oversaw the coding operations staff for quality and surgical abstraction/ ED chart abstract coding. Responsible for the leadership/day-to-day operations for all coding functions as well as abstract ED codes. Performed audits & worked with the quality auditing team for surgical and ED abstract coding cases to ensure adherence to coding guidelines and to maintain coding accuracy. Worked with a variety of multidisciplinary teams/ED Chiefs/Revenue Managers & Senior level management across the healthcare system. Responsible for on-boarding newly hired staff, responsible for hiring & terminating staff, scheduling, approving vacations, maintained FMLA and payroll/API approval. Validate staffing needs/ensure work flow and reconcile all budget and attainment of revenue goals.
• Review medical records to assure specificity of diagnoses, procedures and appropriate/optimal reimbursement for professional charges. Abstract information from medical records for hematology/oncology/psych/BMT/primary care & family medicine. Review documentation of services, coding rules, and use coding tools to resolve edits. Resolve coding denials via Epic work queues (follow-up), and process charge corrections based on established protocols. Review the complex problematic coding that needs research and reference checking for compliance/ payer verification and CCI edit reconciliation. Accurately code from medical records primary/secondary diagnoses and assign correct CPT code (s) using ICD-10CM and CPT coding conventions. Resolve denials for all commercial payers/BCBSNC/AETNA//traditional Medicare/Medicare Advantage/Medicaid/Wellpath Coventry/PPO and POS plans. Ensures adherence to coding guidelines, company policies, procedures, and related government regulations for pre/post coding denial claims.
• Regional Reimbursement Manager 05-2009- 04-2011 TranS1, Inc. Wilmington, NC
• Reported directly to the Director of Reimbursement to track and report trends within assigned geographic region. Abstract coded for Neurosurgeons utilizing the lumbar interbody fusion techniques for spinal surgery. Ensured proper code assignments for maximum reimbursement. Trouble shooter on key strategic initiatives. Effectively managed territory and area of responsibility with Area Directors, Clinical Sales Managers to provide coding and consultative reimbursement support.
• Medical Insurance Coding Instructor 06-2005 to 05-2009 Everest College Houston, TX
Motivated Educator performed daily onsite abstract coding from medical records and patient charts. Coded anesthesia/E&M as well as surgical cases. Taught hundreds of tomorrow’s coders to expertly and accurately assign and sequence ICD-9 diagnostic and CPT abstract procedural CPT codes. Empower and motivate students. Excellent conflict resolution management skills of divergent personalities. Authoritative/ informative training techniques employed. Educated students on HIPPA compliance. Taught commercial/managed care, Medicare and Medicaid policy guidelines.
• Benefit Specialist Supervisor 05-2003 to 06-2005 RSI Securities Houston, TX
Implemented company quality assurance procedures to assess and audit Health & Welfare employee benefit plan contracts to assure compliance with policy coverage. Interpreted complex or unusual policies to determine whether claims submitted to third-party carriers warranted escalating attention. Trained new employees. Assigned work to be accomplished by subordinate staff members. Helped staff with appeals/grievances.
• Claims Operation Manager 03-2001 to- 05-2003 Administaff Houston, TX
Managed physician payment policy and contracts for two major health plans. Ensured claims were paid or denied in compliance with physician contracts. Authorized payments within the scope of my authority for incorrectly adjudicated claims. Set and adjust short-term priorities, prepared work schedules, assigned work-load to subordinates, developed performance standards and evaluated work performance of subordinates. Gave instruction to employees on both work and administrative matters. Interviewed job candidates. Analyzed claims activities, prepared and presented reports to CEO. Liaised closely with Texas Department of Insurance preparing and presenting reports on corporate compliance.
• Medical Coder & Billing Rep 01-2000 to 03-2001 HCA Houston, TX
Reconciled billing and coding errors. Abstract coded and assigned ICD-9 & CPT & DRG codes in accordance with regulatory hospital standards positively impacting reimbursement. Responsible for audit control of incorrectly billed or coded claims. Collected outstanding revenue from fiscal intermediaries for 15 major hospitals thereby contributing to corporate bottom line and earning merit bonuses for technical expertise in the evaluation of claims billed against payment received.
• Internal Audit Manager 06-1997 to 01-2000 National Marketing & Administration TPA Houston, TX

 Performed operational and internal procedural audits of adjudicated claims in compliance with compensation and quality regulatory standards. Trained staff on claims operations and coding measures. Primary liaise between CEO and Senior Law Council to support administration of quality payment reimbursement. Provided constructive feedback to claims department staff. Investigated medical claim data in conjunction with insurance contracts to identify billing, coding or payment errors against medical documentation.
• Proficient with MS Word, Excel, Power-Point and Internet-based applications.

• Bachelor of Arts Broadcast Journalism & Political Science- Indiana University
• Member of American Academy of Professional Coders
• Member of National Sorority : Delta Sigma Theta
• Awarded Instructor of the Quarter
 
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