DRG Validation Resume Example Medpartners HIM/CDI

DRG VALIDATION

Professional Summary

Certified Medical Auditor/Coder with 18 years experience in hospital and nursing facilities. Accurate and detail-oriented with knowledge of coding, validation, and appeals. Organized DRG Validation with foundation in records management. Experienced in billing and collection procedures. Advanced medical terminology knowledge.

Skills/System Experience

ICD-10 (International Classification of Disease Systems)
Inpatient records coding/Auditing proficiency
Familiar with commercial and private insurance carriers
Excellent problem solver
Close attention to detail
Excellent knowledge of 3M, Quantum, Quadramed, CAC, Clintegrety360 coding systems.

Medical terminology expert
Patient chart auditing ability
DRG and PC grouping
Office management professional
Adept multi-tasker
Excellent verbal communication
Excellent knowledge using Meditech, HPF, HDM,EPIC and many more home grown systems.
Resourceful and reliable worker

Work History

DRG ValidationMedPartners HIM/CDI - Mount Sinai Hospital, New York, NY(Remote)04/2012 - Current

Code/Validate inpatient charts at a rate of 2 per hour or 20 per 10 hour workday.
Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
Maintain updated knowledge of coding requirements, through continuing education and certification renewal.
Audit/Code high dollar and high volume complex inpatient records(Transplants, Cardiac, Interventional Radiology, Cancer, Neurology, OB, Newborn, Gastrointestinal,Trauma etc).

DRG ValidationContract Auditing/Coding - St. Lukes Cornwall Hospital10/2008 - Current

Meticulously identify and rectify inconsistencies, deficiencies and discrepancies in medical documentation.
Correctly code and bill medical claims for various hospital and nursing facilities.
Validate inpatient charts at a rate of 2 per hour or 10 per day as needed per facility(Number of hours vary from week to week).
Maintain updated knowledge of coding requirements, through continuing education and certification renewal.
Review and process Medicare, Medicaid, Commercial insurance, and RAC denials and appeal if necessary.
Perform monthly compliance reviews and educate coders in needed areas based on reviews.
Communicate directly with physicians and director regarding queries, documentation etc.
Act as Liaison between coders and CDI.

Inpatient Coder/AuditorWestchester Medical Center - Valhalla, New York09/2002 - 04/2012

Coded/Audited inpatient charts at a rate of 3 per hour or 24 per 8 hour work day.
Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms).
Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
Resourcefully used various coding books, procedure manuals and on-line encoders.
Served as Taskforce Manager for Clinical Documentation Program.
Coded/Audited inpatient Rehabilitation records using the IRF-PAI payment method.

Inpatient/Outpatient CoderOlean General Hospital - Olean, New York06/1996 - 09/2002

Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
Coded inpatient charts at a rate of 3 per hour or 24 per 8 hour workday.
Coded/Audited Emergency room records at 5 per hour on average using E & M coding.
Coordinated and managed the development of chargemaster.

Coder/AuditorIndependent Contract Coding/Auditing - New York Presbyterian Hospital07/2006 - 08/2010

Coded/AuditedEmergency roomcharts at a rate of 5 per hour using E & M codes and current coding guidelines.
Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
Maintained updated knowledge of coding requirements, through continuing education and certification renewal.

Contract Coder/AuditorClinical Coding Solutions - Remote for Geisenger Medical Center01/2008 - 06/2008

Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories.

Education

Associate of Science: Health Information ManagementState University of New York College of Technology at Alfred - Alfred, New York1999

Health Information Technician (RHIT) coursework
Coursework in Business, Accounting and Healthcare Administration
Coursework in Healthcare Management

Certifications

Registered Health Information Technician (RHIT), November 2007.
Certified Coding Specialist - Hospital Based(CCS), June 2004.
AHIMA approved ICD-10-CM/PCS Trainer, October 2011.

Resume Overview

Companies Worked For:

MedPartners HIM/CDI
Contract Auditing/Coding
Westchester Medical Center
Olean General Hospital
Independent Contract Coding/Auditing
Clinical Coding Solutions

School Attended

State University of New York College of Technology at Alfred

Job Titles Held:

DRG Validation
Inpatient Coder/Auditor
Inpatient/Outpatient Coder
Coder/Auditor
Contract Coder/Auditor

Degrees

Associate of Science : Health Information Management

DRG Validation Resume Example

Resume Score: 60%

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