Montgomery Street, San Francisco, CA94105(555) 432-1000, resumesample@example.com
Professional Summary
Organized Outpatient Certified Professional Coder in all areas except pediatrics, with
foundation in records management. Provide education to providers on documentation required to support the care provided. Coding specialist with 24 years providing administrative,
physician and patient support in hospital and medical office settings. E/M leveling, ICD, CPT, and HCPCS. Audit Physician records for precise documentation requirements.
Core Qualifications
Health Information Management.
Strong clinical judgment, Coding proficiency.
Insurance/Billing background.
Strong medical ethic, HIPPA compliance. HMO, indemnity, and commercial insurance. Compliance, Patient Confidentiality,
Problem resolution ability
Extensive medical terminology knowledge
Chart preparation/filing aptness
Medical coding capability
Competency in procedure development.
Motivated
Hard Worker
Eager and willing to learn
Knowledge of variety coding software
Microsoft Office
Experience
03/2005 to CurrentMEDICAL RECORDS TECHNICIANUniversal Health Services | Portsmouth, VA,
Performs quality patient record reviews, assigning of accurate codes according to physician documentation to meet coding standards.
Educate, audit providers on documentation requirements for precise coding Auditing of fellow coders when asked to do so.
Ensures all clinical documentation is present in appropriate format, sequence to meet correct coding standards.
Work closely with providers to perform the coding/QM activities with the highest degree of accuracy.
Insures physician documentation supports the diagnoses, evaluation and management codes, CPT, and procedures.
Codes information from medical records of patients to generate a clinical patient care database for the facility Reviews and screens entire medical records to abstract medical, surgical, laboratory, pharmaceutical demographic, social and administrative data from the medical record in a timely manner.
Directly consults with providers for clarification of clinical data and documentation requirements.
04/2004 to 01/2005MEDICAL INSURANCE CODING/ BILLERPerformance Food Group | Tucson, AZ,
Assigns ICD-9 and CPT codes, inputs appropriate billing charges and medical insurance information into computer.
Obtain information, set up charts, file insurance claims.
Request, obtain authorizations from medical insurance companies for services rendered.
Review claim denials for accuracy of information filed.
Make corrections and re-submit claims as needed. Review monthly claim reports, research status of claims and re-file claims as needed.
Maintains credential files on all doctors and assists in re-credentialing.
Assists patients regarding their accounts, review explanation of benefit information with patient's regarding their accounts.
01/2002 to 08/2003CUSTOMER SERVICE REPRESENTATIVESutter Health | Auburn, CA,
Answer, log incoming calls with pertinent information; document, verify complaints, or concern's of calling members.
Quote benefit information to members in accordance with their insurance packages, benefits/limitations.
Extensive knowledge of contracting protocols.
Supervision of Customer Service Reps. Maintain Call Management System; duties included keeping backlog of calls down, assuring that all reps are available to take calls, ensure reporting and submitting daily, weekly, monthly call reports to the supervisors, manager.
Assign lobby duty to 80 Customer Service representatives.
to CASE MANAGEMENT ASSISTANTLakeside Medical | Burbank, CA,
FHP Healthcare Tucson, l Input authorization information into computer, respond to provider's questions and inquiries, receive requests for authorization, furnish authorization numbers to doctor's offices, check for eligibility, prepare ICD-9 & CPT-4 coding and log inpatient/outpatient authorization information l Case management- Collect hospital discharges, bed census, face sheets.
Balance census bed day log.
Input new admissions, discharges, procedures and surgeries.
Prepare weekly, month end reports.
to PRIOR AUTHORIZATION COORDINATORFHP Healthcare | City, STATE,
Review and /or authorize physician requests for outpatient procedures, clarify.
information with the physician's office.
Data entry of referrals, run reports, confer with prior authorization nurse as necessary.
Assign correct CPT/ICD-9 codes.
to PRIOR AUTHORIZATION / CASE MANAGEMENT ASSISTANTFHP Healthcare | City, STATE,
l Input authorization information into computer, respond to provider's questions and inquiries, receive requests for authorization, furnish authorization numbers to doctor's offices, check for eligibility, prepare ICD-9 & CPT-4 coding and log inpatient/outpatient authorization information l Case management- Collect hospital discharges, bed census, face sheets.
l Balance census bed day log.
l Input new admissions, discharges, procedures and surgeries.
l Prepare weekly, month end reports.
Education
Expected in Diploma | General StudiesPima Community College, , GPA: General Studies
Expected in | Santa Rita High School, Tucson, AZGPA: Ms. Terry Young, Lead Operator, Southern AZ VA Healthcare Ph: 777-6629
Mrs. Karen Young, Retired Civil Service Human Resource Office Ph: 722-2881
Mr. Jerry Schuchardt, President, Unicom Business Forms Ph: 571-1741
Expected in 2004Certification through AAPC | Certified Professional CoderLynn Schoeller Coding, Tucson, AZGPA:
Professional Affiliations
Healthcare.
Customer Service to patients and providers.
Certifications
Certified Professional Coder through AAPC. Currently certified ICD-10, ICD-9, CPT, HCPCS, E/M leveling.
Skills
24 years in many areas of medical field. Outpatient as well as Pro Fee Coding. adhere to coding protocols, quality, reporting, research and much more. Expert in Medical Terminology, Anatomy, Physiology. Auditing and education to physicians on documentation requirements for accurate coding. Some supervisory duties such as assist fellow coders in coding depatment with questions. Timekeeping for coding department, other assigned duties as delegated. Health Insurance Customer Service experience Auditing, Balance, benefits, Billing, Case management, Prior Authorization. Some experience in provider relations experience many years ago. Front office experience to include assisting patient, patient care.
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