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CMS / HHCS/ HEDIS/Coding/ data analyst and quality coordinator Resume Example

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CMS / HHCS/ HEDIS/CODING/ DATA ANALYST AND QUALITY COORDINATOR
Professional Background
Certified Coding Specialists (CCS) with E/M, outpatient, in patient/ER admits, diagnostic, procedural /pro fee Coding, CMS-DRG, VBP, CPT II codes, HEDIS, HCC, RAF, data analyst and quality auditing in health management programs, ICD 10 Certified.  5 Years experience in Administration/ Office management and as Coding/billing manager. Licensed EMT-I since 2002. 10+ years' experience in billing and 6 years coding experience, 3rd Party insurance follow up which include commercial, work comp, VA, Medicare, Medicaid, appeals, insurance verification, authorizations. 5+ years Clinical as a Medical Assistant, phone triage, in office surgical procedures. I have a total of 18 years working in the medical field and VERY customer service oriented. Knowledgeable with various different EMR, EHR systems, Cerner, Centricity, Athena, Allmeds to name a few. Excel, Word, Outlook,Salesforce. I have two secret Government clearances given 1985 still active thru the Department of Defense so all my background checks run smoothly and pass with flying colors.
Skill Highlights
  • CCS
  • Attestations
  • SDS 
  • HEDIS/Quality measures 
  • HCC
  • CMS-DRG
  • Out patinet
  • Skilled nursing
  • Home health
  • RAF
  • VBP
  • CPT II codes
  • ICD- 10 
  • EPRG
  • Sales force
  • Word
  • Excel
  • Outlook
  • 10 Key by touch
  • 62 WMP typing
  • Epic
  • Pulse
  • encoder
  • Cerner
  • Allmeds
  • EMR/EHR

Professional Experience
CMS / HHCS/ HEDIS/Coding/ data analyst and quality coordinator07/2016 to CurrentAltiumLa Jolla , CA

 Review, obtain data extracted remotely and on site physician medical records to analyze quality and outcome of health management programs, quality, pharmacy, Financial, claims, coding, helping to locate where providers need to close gaps, information missing to maintain highest ratings and help with SDS/attestation submission. Knowledgeable with many different EMR systems, HHCS, RAF, HEDIS, CMS DRG CPT II, Coding guidelines. Our goal is to see that the physician receives any and all monies available to them and to help them provide the best possible healthcare to our members. We provide training to the offices where they may need help in closing these gaps

Coder/Billing Manager05/2015 to 01/2016Dr MT Pally MD CardiologistCity , STATE

Performed daily charge entry, review and obtained codes using MS-DRG, VBP, HCC, RAF, HEDIS quality auditing/guidelines, Coding for all office visit, inpatient hospital visits, tests, ER admits, Echo's/Vascular, Nuclear stress Testing, PET Scan and all nursing home, home health visits. Query physician and tech for any missing or incomplete documentation, maintaining a high productivity standard with 95%+ accuracy, working denials, letters of appeals. Assisting the front desk whenever needed, answering phones, scheduling appointments, verifying insurance's, obtaining authorizations.  Ali 239 303 9550

Coder/Front Office Coordinator/coder09/2014 to 04/2015Tenet Health Catawba Cariothoracic SurgeonsCity , STATE

Check in/check out, scheduling, phone triage, insurance verification, insurance authorizations, Medical assisting, room patients, obtain vitals, chart documentation, Reviewed and code entry using MS-DRG, VBP, HCC, RAF, HEDIS quality/guidelines, answering high volume calls, data entryin Nex Gen *EMR, managing medical records, surgical boarding, collecting copays, deposits and provide quality customer service.

 800 367 2884 Ann Marie.

Coder/Insurance verification specialists08/2013 to 09/2014HMA/Physicans Regional HosptialCity , STATE

Reviewed and corrected Coding using the MS-DRG, VBP, HEDIS quality auditing/ guidelines for all the high cost surgical procedures, verified and authorized insurance, quote patient pricing, answer any patient questions regarding insurance, pricing or procedure, data entry in EMR system, team player and provide excellent customer service. Stacy 704-660-4584.

Coder/Patient Account Representative08/2010 to 02/2013Centura Health SystemsCity , STATE

Answered high volume patient's questions, insurance verification, data entry in Meditech, work insurance collections, 3rd party follow up, query physicians and tech for missing or clarification of documentation, corrected coding issues, performed paper and electronic billing, correct ICD-9 CPT coding using MS-DRG, VBP, HCC, RAF, HEDIS quality auditing/guidelines for accounts receivables, and provide excellent customer service.

Was a rehire Tawyna Scott 303-715 7000.

Medical Assistant/EMT at Hand Surgery Associates at10/2009 to 06/2010The Swedish HospitalCity , STATE

Triage and room patients, provided assessment of injury/wounds, removed sutures, dressings, applied casts and splints, assisted with surgical procedures, and performed data entry in EMR and provide excellent customer service.

Kim Beard 303 744 7078.

Medical Assistant/EMT at Associates of Otolaryngology05/2008 to 07/2009Associates Of OtolaryngologyCity , STATE

High volume phone triage, greet and room patients, obtained vitals, performed data entry in EMR system, in room scribe, assisted with office surgical procedures, ICD-9, CPT coding, transcription, injections, biopsies, cultures, lab and radiology orders, Team player and performed excellent customer service.

Diana Mcleron 303 744 1961

Office Manager01/2005 to 01/2008Press O Matic Keyless LocksCity , STATEManage front office, answered phones, assist with phone sales and walk in sales, invoicing, shipping and receiving, A/R, A/P, quick books, handled monthly inventory, ordering, restocking, some assembly of production line when needed, faxed, filed, copier, 10 key by touch, 62 WPM typing, some soft collections. Outlook, Excel, Word.  Dave Campbell  303 762 7373. 
Out patient registration/Central Scheduling11/2001 to 02/2005Lee HealthCity , STATE
 Handled large volume of patient calls scheduling patients for all out patient testing, obtaining correct dr orders with correct coding.  Obtained and data entry correct patient demographics insurance information at time of out patient testing, verified insurance information, collected co payments, assisted patients to areas of testing.  provide excellent customer service.
Biller/customer service/payment poster11/1998 to 11/200121st Century OncologyCity , STATE
Posted large insurance checks and patient payments to correct DOS in accounts, balance daily, answered patient questions regarding billing/accounts, worked 3rd party denials, timely filing, letters of appeals for Medicare, Medicaid, VA, work comp, commercial insurances, corrected coding errors. worked with patients on payment agreements and soft collections, met daily productivity goals, provided excellent customer service.
Education and Training
Allied Health Business college ICD 10, Certified Coding Specialists Current: NAHP, AHIMA & AAPC memberships.: Emergency Medical Services2002Edison Community collegeEmergency Medical Services
Certifications
CCS  #131578  
EMT  #EMT 306630
Affiliations
AAPC Membership
NAHP Membership
​
Skills
10 key by touch, accounts receivables, RAF, Anatomy, AP, scheduling appointments, AR, auditing, billing, Bookkeeping, Call center, Cardiologist, closing, CMS, CPT II, CPT coding, CPT, excellent customer service, customer service, data analyst, data analysis, data entry, documentation, faxing, filing, Financial, Front Office, home health, ICD 10, ICD-9, injections, Insurance, inventory, invoicing, letters, Director, managing 5, managing, Medical assisting, Medical Manager, Medical Terminology, Meditech, meetings, Excel, Office, Outlook, Word, Nursing, nursing home, ordering office supplies, outside sales, payment processing, pharmacology, Physiology, pricing, processes, Coding, Quality, quick, Quickbooks, radiology, sales, Scheduling, shipping, spread sheet, Supervisor, Surgery, Team player, answering phones, phones, phone, transcription, Triage, phone triage, typing, wound care.
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70Average
Resume Strength
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Resume Overview

School Attended

  • Edison Community college

Job Titles Held:

  • CMS / HHCS/ HEDIS/Coding/ data analyst and quality coordinator
  • Coder/Billing Manager
  • Coder/Front Office Coordinator/coder
  • Coder/Insurance verification specialists
  • Coder/Patient Account Representative
  • Medical Assistant/EMT at Hand Surgery Associates at
  • Medical Assistant/EMT at Associates of Otolaryngology
  • Office Manager
  • Out patient registration/Central Scheduling
  • Biller/customer service/payment poster

Degrees

  • Allied Health Business college ICD 10, Certified Coding Specialists Current: NAHP, AHIMA & AAPC memberships. : Emergency Medical Services 2002

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