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Coding Manager Resume Example

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CODING MANAGER
Summary
  • Professionally developed organizational skills in Compliance/Health Information Manager.
  • Experienced in developing guidelines, procedures and policies with a focus on integrating current ICD-10 practices and incorporating education focused on provider billing practices and understanding.
  • Developing and maintaining mechanisms for reviewing, tracking, and monitoring departments within HIM
  • Focus on being a change agent and enhancing a greater than 95% return on services rendered by current providers and their practices.
  • Excellent in abstracting information for use in developing reports for senior management.
  • Providing education to providers, coding department, and management team
  • Excellent computer skills; proficient with Microsoft Word, Microsoft Excel, Medical Software and able to learn proprietary systems/applications quickly and easily; direct data entry.
  • Excelled experience focused on utilization of CMS and the skills needed for focusing on staff development and in achieving greater client satisfaction.
  • Leadership qualifications that have been expressed towards the growth of employee development and education within their current job function, both interdepartmental and in provider practices.
  • Project development and management experiences
  • Seasoned Compliance professional for leading financial institutions with specialization in consumer lending compliance and compliance risk mitigation. Recognized for playing vital role in identifying compliance risks and delivering mitigation techniques. Designs and execute compliance and risk mitigation strategies and change management improvements while alleviating substantial financial loss and reputation risk.
Skills
  • Auditing/Medical Coding
  • Billing
  • Compliance/Risk assessment
  • Documentation validation
  • Educational materials/guidelines
  • Management/Hiring
  • Quality assurance controls
Experience
Northwest Medical Center - Allied Physicians GroupTucson, AZCoding Manager03/2019 to 11/2019
  • Coding Manager for Allied Physicians Group and Hospital Based Providers.
  • Created guidelines based on CMS IOM and NCD/LCD measures.
  • Created a productivity guide for coders.
  • Reported claims completed to Business Director.
  • Developed a physician education model.
  • In charge of hiring new certified medical coders.
  • Developed a query process for coders to use in communicating with providers.
  • Collaborated with other departments/professionals to develop tools for HCC and tracking process.
  • Collaborated with Business director and other department heads to develop a remote coding program.
  • Communicated approved medical coding process to the coding team and ensured implementation.
Arizona Community PhysiciansTucson, AZSenior Compliance Specialist11/2015 to 03/2019
  • Developed an audit process for high risk assessment within Evaluation and Management CPT Codes.
  • Developed and maintained a Breach reporting process for HIPAA reporting to the Office of Civil Rights.
  • Monitored the OIG website for additions to OIG Work Plan to discern areas that need further evaluation.
  • Monthly reports detailing specific findings of high-risk coding areas, disclosing any clinical staff education needed for these specific areas: timeliness of document signing, medical necessity, payment errors including any other errors found.
  • Creating Documentation Improvement Plans to confirm providers retained the education.
  • Perform new employee orientation for an overview of Compliance and Security for ACP.
  • For established employees, documenting and tracking their annual involvement in completing the Compliance and Security review on-line.
  • Interact with operations, the Central Business Office and all providers, including other clinical and clerical staff on compliance-related activities to ensure consistency with Compliance program.
  • Received patient complaints and investigating the complaints by contacting the physician or other non-clinical parties with information pertaining to the complaint.
James E. Van Zandt VAAltoona, PAHIMS Auditor, VERA Coordinator04/2013 to 10/2015
  • Coordinated and assisted in development of standardized guidelines, procedures, educational materials, data validation.
  • Participated in the Compliance committee creating reporting on coding accuracy, breaches within the ROI department, and possible breaches from scanned documents into patients' medical records.
  • Coordinated and led group/individualized training for providers and support services.
  • Monitored ever changing regulatory and policy requirements, Coordinated and developed internal monitoring and auditing activities for compliance with documentation, coding and billing issues.
  • Participated in the Quality Committee and performed reviews to measure that quality guidelines were being maintained in each department.
  • Duties consisted of learning all areas of HIM department and have a working knowledge of ROI, Document Imaging and Coding in order to perform accuracy and productivity audits on MRT Coders, MRT ROI staff and MRT HIT staff.
State Of FloridaSarasota, FLMedical Coder05/2009 to 04/2013
  • Trained employees in the use of FLMMIS, or the Florida Medicaid Web Portal.
  • Initiated the Methadone program for at-risk newborns at DOH-Child Health.
  • Set up the scheduling process for newborns needing Synagis prophylaxis.
  • Started the eligibility process at Child Health including compliance with Medicaid; verified all insurance for incoming clients; trained employees on all aspects of admissions, health information, and chart preparation for appointments.
  • Health Information roles, including validating medical data, analyzing, compiling reports; providing technical advice on health information issues - including adapting guidelines to healthcare practice that are not specific in nature.
  • Followed HIPAA guidelines in all areas of coding.
Education and Training
Master of Applied Science:Health Information Management07/2016College of St. Scholastica, Duluth, MN
Healthcare Services Administration:Healthcare Service Administration12/2012State College of Florida, Bradenton, FL
Certifications

AAPC

Certified Professional Compliance Officer # 01439263

AHIMA

Registered Health Information Administrator # 0039322

Certified Coding Specialist-Physician #1670424

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Resume Overview

Companies Worked For:

  • Northwest Medical Center - Allied Physicians Group
  • Arizona Community Physicians
  • James E. Van Zandt VA
  • State Of Florida

School Attended

  • College of St. Scholastica
  • State College of Florida

Job Titles Held:

  • Coding Manager
  • Senior Compliance Specialist
  • HIMS Auditor, VERA Coordinator
  • Medical Coder

Degrees

  • Master of Applied Science : Health Information Management 07/2016
    Healthcare Services Administration : Healthcare Service Administration 12/2012

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