Experienced Physician Coder/Educator looking for full time position in Twin Cities area of MN. Looking for full-time position that will utilize my skills and talents. Currently unemployed and available to start work immediately. Resume attached below:

Susan Adams, CCS-P, CPC-P
2713 132nd Lane NW,
Coon Rapids, MN 55448
763-754-3403 or 612-280-8777 cell phone

North Suburban Eye Specialists – Ophthalmologist Coder
January 2010 – July 2011

Paper based record coding for 4 Ophthalmologists, one specializing in corneal diseases, 3 Optometrists and some Optical items that were reimbursable by insurance. Data entry of charges that were coded into” Mediformatix” practice management system. Research and resolution of claims not paid by insurance companies in a timely manner. Auditing physician documentation every 6 months to educate on any reoccurring deficiencies.

The clinic does approximately 1 million plus in claims per year. When I started working with the older claims in February 2010 they were 15+% of the total balance due from insurance companies. Of that amount 5% was 120+ days of age. Currently the 120+days claims are 1.78% of the outstanding insurance monies due to the practice. Lead person for soft collections of past due balances on customer accounts that are approx. 3 months or more past due. Follow-up on payment arrangements that have not been kept and then finally turning the accounts over for collections on the unpaid balances.

Medica – Coding Administrator
September 2007 – January 2010

In charge of coordination of system setup for new codes that are released on a quarterly schedule from CMS/AMA for Medica’s claim payment system. Documentation of companywide decisions for code implementation across all insurance products and the subsequent preparation of system setup documents to ensure that codes are setup for claims adjudication based on these decisions. Updating quarterly any CPT, HCPCS and/or ICD-9 code changes into the system to ensure seamless payment of members claims. Auditing/troubleshooting system implementation to see if an error may have occurred during the setup process to cause claims payment issues. Answering provider questions from the call center in regards to specific denial issues.

Manual review of NCD’s/LCD’s and Lab NCD’s for the states in the Medica service area for implementation on the affected Medica Medicare replacement products. Completion of internal set-up documents that are forwarded for software customization based on current information from those national websites. Running reports and sending claims to Field service for adjustment/payment based on the changes in CPT, HCPCS and/or ICD-9 codes for Medica’s affected Medicare replacement products when the criteria changed on the websites.

Representing the coding department on the Policy Creation Committee for implementation of drug crossover strategies to ensure implementation of committee’s decisions via system setup documents. Also on the DME committee and Reimbursement committee to provide coding information on policies and completion of system setup documents. Finally I am on the Benefit Interpretation Committee (BIC) to implement decisions for procedure/technology reviewed by Medical Technology Assessment Committee and complete the system implementation paperwork for those policies. Writing of new internal policy and procedures to cover manual review of claims for Epogen, and IVIG.

Auditing of medical records for the “Special Investigations Unit” to verify documentation supplied meets the standards for codes that were billed. Working with the Medical Director and MTAC members to ensure that medical coverage policies published on the Medica.com website were current with coding information for providers to reference for coverage information.

Traveling with Provider College to present coding educational materials to Medica’s service areas. Creation of Medicare website training materials to familiarize attendees with WPS, Noridian and CMS websites. Provide all internal training information for Provider Service Center quality assistants on a monthly basis. Writing a reference manual for new employees to familiarize them with the coding department functions within Medica. Training and mentoring new employees in the department. Serve as SME – subject matter expert in the coding department. Miscellaneous projects as requested by other operations department personnel.

Aspen Medical Group – Coder/Coding & Reimbursement Educator
December 2006 – September 2007

Manual coding of 6 clinics multi-specialty surgeries and alloffice charge tickets. Review of tickets that were pulled from the mainstream by data entry operators for modifiers and errors. Working denials on a daily basis that were received from the payment posting area.

Promoted to educator in February when the previous two educators left simultaneously. Updating and re-writing of Coding Policies and Procedures that had not been addressed since 2004 or earlier. Reviewing and updating all charge tickets and lab orders to correct common billing errors (i.e. outdated CPT and/or diagnosis codes.) Creating current cheat sheets for coders to have information at the fingertips (drug unit conversion sheets for calculating billable units, common supply items HCPCS codes, roster of physicians and their billing locations). Auditing and scoring of charts every 6 months for educational opportunities with the individual providers and or departments.

Creation and implementation of “Treatment Room/Nurse Visit” charge ticket to capture billable nurse “Incident To” visits. Education of RN’s and other staff in the correct way to document the billable services to ensure compliance with Medicare requirements. Creation of individual shingles with their documentation requirements for both Chronic Wound Care management and Sore Throat/Strep Test to comply with current billing guidelines. Bring issues to the weekly coding team meeting that impact the coding of tickets/surgeries. Complete revision of Well Child shingle to comply with DHS documentation requirements.

Group presentations to Pediatric providers on how to bill correctly for initial fracture care, Internal Medicine workshop on “The difference between a Pre-OP and a Preventive Exam” along with “When does a Preventive Exam become a problem oriented visit and not a preventive service?”. How to appropriately split bill a preventive exam and a minor problem that is addressed in the same visit. Initiated educational materials on ABN’s and how to correctly use them in the clinic setting.

Assisted with the assimilation of an outside Orthopedics practice into Aspen Medical Group. Created a hybrid office charge ticket from their practice and the existing one in house. In addition, since these providers read their own x-rays, a new radiology ticket had to be created with dummy codes that would crosswalk to the technical and professional components since the system is hard coded for only the technical.

Allina - Midwest Surgery & Urology Associates & Infectious Diseases
October 2005 to November 28, 2006 (20 hrs/wk)

Coding of all patient charge tickets as well as all out-patient surgeries performed by the group of 5 General Surgeons, 2 Urologists and 1 Infectious Disease physician. Our office recently converted from a paper based record to an EHR, all office transactions are now reviewed on the computer via the new “Epic Care” system. Hospital out-patient surgery tickets are still done on paper. Manual tracking of hospital tickets to ensure all surgeries performed are billed. Review of trends/errors made by physicians in assigning level of service or ICD-9 codes to their electronic office transactions. Providing education resources for the group practice as coding trends change and affect their work. Since May I have assisted several Family Practice clinics within the Allina system with their coding backlog to fill approximately 15 - 20 hours per week. Data entry of charges in order to meet end of month deadlines

St. Francis Medical Clinic
Position - Medical Coder/Medical Billing Specialist, November 2004 – June 2005

Duties: Coding of all patient charge tickets for two PA-C's and one MD. Entering of charges from the charge tickets and subsequent electronic or paper filing of all claims. Post all payments received by insurance companies, make notations of incorrect payment and research for appeal. Bill patients on a weekly basis the section of the alphabet that was due for statements, i.e.: (A-F, G-M, N-R, and S-Z). Answer patient billing questions, within limitations that were set by the clinic CEO. (Any disputes in charges or patient bills needed to be cleared up with the CEO, prior to writing items off or bill reductions.) Basic computer maintenance and trouble shooting on office PC’s and server. Contact outside IT consultant with permission of CEO when I was not able to solve the computer issues alone. Training of new front desk personnel and documentation of procedures to ensure correct entry of insurance information. Manually increase all prices for CPT codes and input them in the Medisoft program along with Medicare reimbursement amounts. Run reports for management to show progress in Accounts Receivable in 3 different date ranges. Train newly hired part-time billing person to run software system and then delegate accounts past a 45 day turnaround time for her to follow-up on. Delegate tasks to other office staff as their schedules permit, i.e.; (copy primary EOB’s for resubmission of unpaid secondary claims, sorting charge tickets by date and provider, pulling charts for incomplete charge tickets etc.)

I worked this job while attending school fulltime and carrying 13 credits. Most of my classes were on-line and the one class that I needed to be in school for was only 4 hours on Thursday mornings for fall semester. Since the clinic was open from 8 am until 7 pm I was able to maintain my 40 hours per week and keep excellent grades.

Metropolitan Hand Surgery – Temporary Employee thru DS & B Personnel Services
Position – Business Office Insurance Specialist, March 2004 – May 2004

Duties: This assignment was to assist office personnel using Disc/Med Anywhere as their computer system, with the backlog of unpaid or underpaid claims and unresolved patient balances. Working their unpaid claims reports for all insurance companies and appealing any claims that were paid at less than the contracted guidelines. Claims that were set aside for me to work on were from 60 days to over 2+ years old. Many items were past the timeframe allotted by the specific insurance
companies to appeal and I wrote journal entries to write off the charges. Items of correspondence on the claims were copied, and then given to the appropriate customer service representative for
information and to follow-up on in the future. After that project was completed, I began researching all of the credit balances on the accounts receivable reports and processing the paperwork to send refunds to either the insurance company or the patient that overpaid on
the account.

Northwest Eye Clinic – Temporary Employee thru DS & B Personnel Services
Position – Business Office Insurance Specialist, November 2003 – Feb

Duties: Daily posting of third party commercial insurance payment checks to patient accounts via Centricity computer system. Monitor accounts receivable information for the following payors: Workman’s Compensation carriers, Automobile Accident claims, and all non-PPO insurance carriers. Follow-up on any claims not paid within 45 days or more using provider websites, account representatives and other contacts. Appeal claims in writing using the chart notes, ICD-9 diagnosis codes and underlying medical conditions to correct payment by the insurance company on the patient’s behalf. Review accounts with credit balances and determine if the insurance company overpaid or if the patient overpaid. Two medical software systems were worked on at the same time, since they had done a major conversion from Disc to a windows based program called Centricity. Work with electronic insurance claim submissions. Correct errors in the various stages of the approval process prior to reaching the clearinghouse and making any corrections in the batch once they have gone to the clearinghouse. Audit daily deposit sheets from three clinic locations to ensure accuracy in posting co-payments and patient payments. Assist the business office supervisor with projects as time permits.

Allied Interstate – Temporary Employee, Brooklyn Center, MN
Position: Collections – Account Specialist, August 2003 – November 2003

Duties: Third party collection of consumer credit card debt, closed bank accounts and older uncollectible bank loans. Secure viable payment arrangement with consumers within the guidelines given by the specific creditor they owe. Recover any NSF payments received in prior monthly
payments. In a call center atmosphere a Smart Dial system was used with a recorded outbound only message to generate in-calls from people who may or may not know why we have called them. In addition, simultaneously work with the outbound dialer that calls phone numbers
at random from a pre-determined grouping of accounts set up by the production manager. When I started with Allied I received the Top Rookie Award for collecting over $2500 my first week on the floor, surpassing anyone in the history of that location. Also, I was the top production collector in my section for the Month of September and October.

All Pro Sewing Centers, Coon Rapids, MN
Position: Store Manager - Coon Rapids & Maplewood, Jan 2001 – August 2003

Duties: Ensure total customer satisfaction with purchases of Husqvarna Viking sewing machine purchase at either location. Organize, write, and illustrate each quarter for store newsletter and JoAnn Fabrics class schedule. Recruited new employees, instructors and special programs for
both stores. Schedule staff, verify hours worked, prepare payroll and non-employee instructor paychecks bi-weekly. Maintain inventory levels in each location via computerized “Profit Plus” program. Order stock for stores as inventory levels required; redistribute stock between
stores to maintain optimum inventory control levels. Host “Class Preview Day” quarterly on behalf of our store to help build brand recognition and overall goodwill with general public. Arrange displays of stock and class projects to keep customers interest and highlight new items in store. Fill in hours or class instruction when regularly scheduled employees are unable. Train employees on all aspects of machine operation and the latest in software advancement for the sewing
machines. On-call at any time when the store owner was not able to be reached to resolve any issues that may arise.

Glen Oaks Dental, Circle Pines, MN
Position: Office Manager, October 1999 – May 2000

Duties: Maintain all Accounts Receivable information for the office via the Soft Dent Computer System. Issue monthly statements for all accounts and entry of all checks for the office into the system. Prepare daily bank deposits and verify amounts via bank records and Day Sheets in office. Collection of all co-pays and patient balance due at the time of appointments and/or make financial arrangements for larger patient portions. Documentation of all financial arrangements in writing for future follow-up and timely collection of payments by office personnel. Review all accounts overdue more than 90 days to determine if referral to collection agency was necessary. Work on all insurance claims more than 45 days past due to resolve problems with the insurance companies. Run profit and loss information for dentists as requested. Make sure that dentist and hygienist’s schedules were filled to ensure timely recall intervals for patients. Write new and update existing office policy manual and employee benefits information. Assign projects to office personnel as their schedule permitted. Backup at front desk positions as needed.

Park Dental, Roseville, MN
Position: Dental Scheduling Manager, January 1999 – October 1999

Duties: Scheduling of patients for a dentist that operates a fourhanded chair, his 3 hygienists and the dental resident on my schedule. Daily reviews of accounts for co-pays that are due on the day of service as well as any previous financial arrangements that have been made.
Answering 3 incoming phone lines, handling patient charts and filing insurance claims. Resolution of patient billing questions and insurance problems. Greet patients at time of check-in and make sure new patients to the practice have all their paperwork filled out correctly. Confirm
appointments for all providers on my schedule. Hold pre and post schedule meetings to inform staff of patients that need to schedule future treatment appointments, check for lab cases, patient comments, emergency time slots and review of patient care calls. Handle referrals of patients to specialty offices as necessary. Work 60 – 70 day old reports to resolve patient accounts that are in arrears and take necessary action on those accounts deemed uncollectible by the practice. Investigate problems on 45-day-old report of unpaid insurance claims. Refile claims if needed; supply additional information or x-rays to assist in claims being processed at the insurance company. Review weekly credit balance report to determine if refunds are due and
then process paperwork for patient refund or inform insurance company of overpayment. Assist the office manager and practice manager with special projects as requested.