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outpatient coding specialist resume example with 19+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
  • :
Professional Summary

Hardworking professional applies official coding conventions and rules established by American Medical Association and Centers for Medicare and Medicaid Services. Confident Medical Coder adheres to data confidentiality and privacy rules in all workflows and promotes dynamic interpersonal skills.

Skills
  • ICD-10-CM
  • ICD-10-PCS
  • HCPC
  • Anatomy and Physiology
  • Pharmacology
  • 3M
  • Epic
  • CAC
  • DOMA
  • Pricer Systems
  • RRS
  • CMMS
  • MC400
  • SAS
Work History
Outpatient Coder II, 11/2022 to Current
Lowell General HospitalMalden, MA,
  • Review outpatient records and interpret documentation to identify diagnoses and procedures.
  • Review, analyze and manage coding of diagnostic and treatment procedures contained in outpatient medical records.
  • Resourcefully use various coding books, procedure manuals and on-line encoders.
  • Apply official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
  • Guarded against fraud and abuse by verifying coded data accurately reflected services provided
Outpatient Coding Specialist, 06/2010 to 11/2022
PrometricWashington, DC,
  • Executed interpretation of medical terminology to translate into coding software and obtain accurate reimbursement from insurance companies and healthcare programs.
  • Reviewed, analyzed and managed correct coding of diagnostic and treatment procedures contained in outpatient medical records with recent 2022-6 month audit with 100% accuracy rate
  • Resourcefully used various coding books, procedure manuals and on-line encoders.
  • Achieved production goals of over 105 charts with +98% accuracy while ensuring accurate code assignment
  • Maintained knowledge of current trends and practices in coding principles and government regulations. Attends educational meetings and seminars.
Inpatient Coding Boot-Camp, 06/2015 to 06/2016
AvantorMissouri City, TX,
  • Assigns codes into hospital encoder system within established Health Information Management standards with over 12 years of experience.
  • Abstracts and codes Inpatient records and all others as assigned based on deep functional expertise
  • Determines principal and secondary diagnoses and procedures
  • Inpatient records, for Commercial, Mom, and Baby, and Commercial cases
  • According to all applicable coding rules and regulatory standards
  • Assigns medical diagnoses and surgical procedures codes and abstracts necessary data elements for billing, reimbursement and state reporting
  • Codes are used to calculate MS-DRG assignment required for reimbursement, as well as APR DRG used for Quality metrics and analysis
  • Ensures all collected data is accurate, complete and compliant with state and federal regulations as well as Coding Guidelines
  • Coding and Reporting and Sutter defined coding policies and procedures
Customer Service Representative, 05/2009 to 06/2010
Health Net Federal ServicesCity, STATE,
  • Performed assistance with State Health Programs (SHP) such as Medi-Cal, Healthy Families (HF), AIM, and Healthy kid's members and providers
  • Perform updates to assist pharmacies, members, and hospitals in analyzing and updating patient eligibility based on research using State
  • AEVS program
  • Analyze denied claims for providers and advise of reasons for denials
  • Assist members with Utilization Management, authorizations, and referrals
  • Maintain clear verbal/written communication with members, providers, and co-workers; provide support with appeals, grievances, 15-day cap deductions, transportation requests, EOB, check tracers, claim escalations, and appeals escalations.
  • Provided primary customer support to internal and external customers.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Trained new personnel regarding company operations, policies and services.
Education
Certified Coding Specialist: Health Information Technology, Expected in 03/2014 to Cosumnes River College - Sacramento, CA
GPA:

Certified Coding Specialist- CCS passed 98%

Associate of Science: Health Information Technology, Expected in 09/2011 to Cosumnes River College of Sacramento - Sacramento, CA,
GPA:

RHIT Program

Graduated Highest Honors GPA: 4.0

Medical Assistant Certificate Program: Medical, Expected in 06/1994 to Western Career College of Sacramento - Sacramento, CA,
GPA:
Certifications

AHIMA Certified- Active

,
Affiliations

AHIMA 2010-Current

CHIA 2010-Current

Languages
Spanish:
Native or Bilingual
Negotiated:

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Resume Overview

School Attended

  • Cosumnes River College
  • Cosumnes River College of Sacramento
  • Western Career College of Sacramento

Job Titles Held:

  • Outpatient Coder II
  • Outpatient Coding Specialist
  • Inpatient Coding Boot-Camp
  • Customer Service Representative

Degrees

  • Certified Coding Specialist
  • Associate of Science
  • Medical Assistant Certificate Program

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