Clinical Coding Specialist03/2011 to 07/2015United Health ServicesJohnson City, NYSpecialty coding for OB/GYN. Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered. Consistently ensured proper coding, sequencing of diagnoses and procedures. Accurately entered procedure codes, diagnosis codes and patient information into billing software. Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature. Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes. Analyzed and interpreted patient medical and surgical records to determine billable services. Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses. Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.
Reimbursement Educator Specialist10/2008 to 03/2011United Health ServicesJohnson City, NYConsistently ensured proper coding, sequencing of diagnoses and procedures. Audited physicians on their documentation and proper code selection for both CPT codes and ICD-9 codes. Trained incoming coders on documentation guidelines, proper CPT code selection and ICD-9 code selection as well as maintained audits on incoming coders for accuracy. Worked with IM Residents and educated them on the billing guidelines within a Residency Program. Reviewed denied claims for accuracy of denial and resubmitted based on documentation.
CDI Specialist06/2006 to 10/2008United Health ServicesJohnson City, NYCarefully reviewed medical records for accuracy and completion as required by insurance companies. Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses. Queried physicians for more specific diagnoses when documentation was nonspecific.
