Pro Fee Coding Claims Specialist Resume Example Centracare Health (Nee Carris Health/ACMC)

PRO-FEE CODING CLAIMS SPECIALIST

Summary

Self-motivated, efficient, certified medical coder with 10+ years of experience in multi-specialty clinic seeking full-time employment. Excellent documentation review and data entry skills allowing for accurate coding of medical information.

Skills

Adherent to CPT, ICD-10-CM, and HCPCS guidelines
Proficient in HCC diagnosis coding for risk adjustment
Strong communication skills that facilitate collaboration
Experience with Microsoft Office

Knowledge of Epic and AllScripts EHR systems and Optum360 EncoderPro and VitalWare encoder systems
Significant attention to detail and ability to prioritize
Remote worker for 9+ years

Experience

04/2020 - 08/2020CentraCare Health (nee Carris Health/ACMC)St. Cloud, MN

Pro-Fee Coding Claims Specialist

Reviewed coding of denied inpatient and outpatient pro-fee charges to determine accuracy. Made any supported corrections. If no correction supported, advised billers/DMR on whether or not to appeal charge, based on review of both insurance's policies and facility's protocols.
Worked with team members to identify and track denial trends and develop appropriate and successful resolutions and workflows.

12/2014 - 03/2020Carris Health (nee ACMC)Willmar, MN

Coding Compliance Specialist and Clinic Coder

As Coding Compliance Specialist, received review requests from Business Office to determine coding accuracy. Advised on and completed supported corrections. If none supported, provided explanation as to why.
As Clinic Coder, utilized knowledge of CPT and ICD-10-CM to submit clinic charges for Primary Care and Infectious Disease.
Also responsible for working with Purchasing to ensure that new medications and supplies were built into EHR/PPM systems with accurate HCPCS coding information.

12/2012 - 11/2014Affiliated Community Medical Centers (ACMC)Willmar, MN

Coding Compliance Analyst

Completed quarterly audits of documentation from providers of multiple specialties. Identified problem areas and provided information and tips to improve documentation.
Maintained current knowledge of both general and specialty-specific documentation requirements and coding information. Educated providers and coding team on updates.

12/2009 - 11/2012Affiliated Community Medical Centers (ACMC)Willmar, MN

Clinic Coder

Utilized knowledge of CPT and ICD-9-CM to submit clinic charges for Primary Care.
Sent queries to providers for documentation issues and sent feedback and education to them, as it pertained to coding protocols and practices.

Education and Training

12/2009Moorhead, MN

Associate of Arts in Medical Administrative AssistantMinnesota State Community And Technical College

Also earned diploma in Medical Coding & Insurance and certificate in Medical Transcription.

Certifications

Certified Professional Coder, certification through AAPC

Resume Overview

Companies Worked For:

CentraCare Health (nee Carris Health/ACMC)
Carris Health (nee ACMC)
Affiliated Community Medical Centers (ACMC)

School Attended

Minnesota State Community And Technical College

Job Titles Held:

Pro-Fee Coding Claims Specialist
Coding Compliance Specialist and Clinic Coder
Coding Compliance Analyst
Clinic Coder

Degrees

Associate of Arts in Medical Administrative Assistant

Pro-Fee Coding Claims Specialist Resume Example

Resume Score: 80%

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