pro fee coding claims specialist resume example with 10+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:

Self-motivated, efficient, certified professional medical coder with 11+ years of experience in multi-specialty outpatient and inpatient professional coding seeking full-time employment. Excellent documentation review and data entry skills allowing for accurate coding of medical information.

  • Adherent to CPT, ICD-10-CM, and HCPCS guidelines
  • 5+ years experience in pro-fee denials and edits review and corrections
  • Proficiency in HCC coding for risk adjustment
  • Remote worker for 10+ years with exemplary time management
  • Experience with Microsoft Office
  • Experience with Epic, Cerner, and AllScripts EHR systems, 3M 360 Encompass Code Assist system, and Optum360 EncoderPro and VitalWare encoder systems
  • Significant attention to detail and ability to prioritize
Professional Inpatient Physician Coder, 12/2020 - Current
Adventist Health Nw Troutdale, OR,
  • Professional inpatient coding for multiple specialties: Internal Medicine and Pediatrics (Allergy and Immunology, Cardiology, Child Protection, Endocrinology, ENT, Gastroenterology, Hematology/Oncology, Infectious Disease, Nephrology, Newborn Nursery & NICU, Neurology/Neurosurgery, Orthopedics, Palliative Care, Pulmonology, and Surgery specialties within Pediatrics specialty)
  • Coding ED, Observation, and Inpatient visit codes along with bedside procedures for specialties listed
Pro-Fee Coding Claims Specialist, 04/2020 - 08/2020
Morris Hospital Minooka, IL,
  • Reviewed denials of 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 updated workflows.
Coding Compliance Specialist and Clinic Coder, 12/2014 - 03/2020
Carris Health (nee ACMC) City, STATE,
  • As Coding Compliance Specialist, received review requests from Business Office to determine coding accuracy for both patient-disputed pro-fee charges and/or denials. Advised on and completed any supported corrections. If no correction(s) were supported, I provided explanation as to why for Business Office to relay to patient.
  • As Clinic Coder, utilized knowledge of CPT and ICD-10-CM to submit supported outpatient charges for Primary Care and Infectious Disease (same responsibilities as listed in Clinic Coder description for December 2009-November 2012.)
  • Also responsible for working with Purchasing to ensure that new medications and supplies were built into EHR/PPM systems with both accurate NDC's and HCPCS coding information.
Coding Compliance Analyst, 12/2012 - 11/2014
Affiliated Community Medical Centers (ACMC) City, STATE,
  • Completed quarterly audits of documentation from providers of multiple specialties (Dermatology, Family Medicine, General Surgery, Infectious Disease, Internal Medicine, Neurology, Orthopedics, Pediatrics, Podiatry.) 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 both providers and coding team on updates.
Clinic Coder, 12/2009 - 11/2012
Affiliated Community Medical Centers (ACMC) City, STATE,
  • Utilized knowledge of CPT and ICD-9-CM to submit office visit and procedure charges for Primary Care. Procedures included Orthopedic/Podiatric (joint aspiration/injection, ganglion cyst aspiration/injection, lesion debridement, ingrown toenail care, fracture care, etc.) and Dermatological (skin biopsy/lesion removal, lesion destruction, laceration repair, I&D, foreign body removal, etc.)
  • 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
Associate of Arts: Medical Administrative Assistant, Expected in 12/2009
Minnesota State Community And Technical College - Moorhead, MN,
Status -

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


Certified Professional Coder, AAPC, May 2016-Present

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Resume Overview

School Attended

  • Minnesota State Community And Technical College

Job Titles Held:

  • Professional Inpatient Physician Coder
  • Pro-Fee Coding Claims Specialist
  • Coding Compliance Specialist and Clinic Coder
  • Coding Compliance Analyst
  • Clinic Coder


  • Associate of Arts

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