AAPC Certified Professional Coder with 10+ years of experience in Outpatient coding, seeking a Remote Outpatient Coding opportunity.
Proficient knowledge of CPT, ICD-10, and HCPCS Level II codes
Solid knowledge of Medical Terminology/Anatomy and Physiology
Strong E/M coding
Inpatient Pro-fee coding
Embedded coder in Mental Health Dept
Exceptional Data Entry skills inputting data in coding software and Audit findings in Excel spreadsheets.
Excellent Time Management skills
Strong attention to detail
Ability to perform detail oriented work auditing coders and providers.
Medical Records Coder-Auditor-Remote City, StateCompany Name/Apr 2020 to Apr 2021
Responsible for performing monthly, quarterly, and yearly audits of coded data to identify areas of non-compliance in coding.
Completed monthly CBI (Compliance and Business Integrity) Coding Audit for inpatient and outpatient facility coders, contract coders and all hospital and clinic providers.
Developed criteria, collected data, analyzed results and formatted data into Excel Spreadsheets for reporting to leadership and Compliance committee.
Performed monthly and quarterly Coding Audits; provided education to coding staff on inadequacies and weaknesses, new coding changes and new or changing VA guidelines.
Performed Provider Coding Audits as part of VA yearly provider coding monitor, reported data to coding supervisor/CDI and gave feed back to facility providers via Microsoft Teams, or Email.
Completed other reviews, and audits as requested, such as Case Comments, RNB reports, investigation of billing and coding denials, and coding for VERA.
Applied codes based on guidelines specific to VERA (Veterans Equitable Resource Allocation) program that categorizes all VA patients into specific classes representing their clinical conditions and resource needs.
Worked weekly/monthly RNB (Reason Not Billable) list, identifying issues and errors in coding and documentation. Communicated via Microsoft Teams and Email with providers regarding the particular issues, re-coded the encounter if applicable.
Coded monthly Neurosurgery Evaluation and Management visits for contract Fee-basis physician to be paid by VA facility.
Provided training to new employees on use of Compliant Coding Module (CCM), as well as VA EMR programs such as CPRS, and VistA Imaging.
Worked with CPAC billing unit coding encounters that needed immediate attention.
Used computer applications to produce reports in order to abstract records and review assigned codes.
Demonstrated the ability to adhere to schedules, deadlines, and other requirements without the need for follow-up.
Medical Records Outpatient Coder City, StateCompany Name/Oct 2012 to Apr 2020
Mental Health Coder embedded in the hospital's Mental Health Dept. from Dec 2018- April 2020. Audited Mental Health providers coding and documentation giving feed-back as needed on areas of needed improvement. Provided education on changing guidelines enacted during COVID-19 pandemic.
Reviewed and abstracted relevant clinical data from electronic medical records to select the appropriate CPT, ICD 10-Diagnosis and HCPCS codes and entered data into Nuance Coding Software-Compliant Coding Module (CCM)
Maintained 95% accuracy rate and productivity requirements.
Coded outpatient encounters as assigned for a wide variety of specialties in the VA which included; Cardiology, ENT, Gastroenterology, General Surgery, Hematology, Oncology, Dermatology, Audiology, PT, OT, SP, Radiology, Laboratory, Pathology, Chemotherapy, Mental Health, Ophthalmology, Emergency Dept, Dental, Neurology, Neurosurgery, Endocrinology, Primary Care, Urology, Nephrology, Orthopedics, Vascular Surgery and Anesthesia. Also served as back up Surgery coder, and Prosthetics coder.
Coded Inpatient Professional Fees along with outpatient encounters from 2012-2019, at which time I trained 4 inpatient coders to do their Inpatient Pro-fees.
Conducted Monthly Peer review coder audits.
Conducted reviews of coding for VERA, and other duties as assigned such as RNB list, Legal encounters.
Instructed new coders and students from Local HIM programs in coding.
Maintains 36 CEUs as required every 2 years for CPC certification through AAPC.
Medical Coder-Biller City, StateCompany Name/Aug 2009 to Aug 2011
Verified and abstracted all medical data to assign appropriate codes for outpatient office visits, office procedures, nursing home visits, and hospital inpatient visits for the MD and NP.
Correctly coded procedure and diagnosis codes for insurance billing using PC-ACE-Pro 32 and Availability to transmit claims to various insurance companies, Medicare, and Medicaid.
Hand printed HICFA 1500 claims and mailed to secondary and tertiary insurance companies.
Printed EOBs and thoroughly reviewed all remittance codes from insurance companies, Medicare and Medicaid. Investigated denials, called insurance companies regarding non-payment and denials, corrected errors and re-filed if necessary.
Reviewed received payments for accuracy and applied to intended patient accounts.
Reviewed account information to confirm patient and insurance information is accurate and complete.
Communicated with the MD and NP regarding coding and documentation to promote accuracy.
Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes.
Researched and communicated insurance requirements, including patient financial responsibilities and fee-for-service. Educated front office staff regarding collection of co-payments, deductibles and old balances.
Organized information for accounts past due, created letters to send to patients regarding past due balances and when needed, sent accounts to collection agency.
Credentialed with new insurance company.
Medical Records Coder-ROI Specialist City, StateCompany Name/Aug 2008 to Aug 2009
Coded and filed Office visits, office procedures, Surgery, and Sleep Studies for 6 physician practice. Checked Super-tickets for proper E/M leveling and diagnosis codes.
Worked Claim denials, and followed up with insurance companies. Filed secondary and tertiary claims, and paper claims.
Pulled hard copy patient records and copied information to send to requesting party, such as insurance company, hospital, physician's office, Attorney/Legal request such as Subpoenas, Work-Comp. Verified record copies before handing each over to requesting party according to state, federal and HIPAA guidelines.
Responsible for charging for records according to state guidelines, and the collection of payments.
As a Special Accounts Rep, worked closely with LA Vocational Rehab, Work-Comp carriers, Barksdale AFB, and many other Shreveport, LA businesses, scheduling hearing exams for their employees.
Education and Training
Associate of Applied Science: Physical Therapy AssistantSouthern UniversityMay 2000City
Certified Professional CoderAAPCMay 2009City
Certified Medical CoderLSUS2008City
Basic Medical CodingBossier Parish Community College2006City, State
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Bossier Parish Community College
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Job Titles Held:
Medical Records Coder-Auditor-Remote
Medical Records Outpatient Coder
Medical Records Coder-ROI Specialist
Associate of Applied Science : Physical Therapy Assistant Certified Professional Coder Certified Medical Coder Basic Medical Coding Coding
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