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DRG Validation Resume Example

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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 Validation MedPartners 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 Validation Contract Auditing/Coding - St. Lukes Cornwall Hospital 10/2008 - 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/Auditor Westchester Medical Center - Valhalla, New York 09/2002 - 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 Coder Olean General Hospital - Olean, New York 06/1996 - 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/Auditor Independent Contract Coding/Auditing - New York Presbyterian Hospital 07/2006 - 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/Auditor Clinical Coding Solutions - Remote for Geisenger Medical Center 01/2008 - 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 Management State University of New York College of Technology at Alfred - Alfred, New York 1999
  • 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.
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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

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