Qualty Coding Assurance Auditor Resume Example Corporate Services Prisma Health Upstate

QUALTY CODING ASSURANCE AUDITOR

Professional Summary

Senior Medical Coding Auditor and outstanding performer within the Healthcare Industry. Proven success in operational excellence and organizational development with keen understanding of elements of state and federal medical coding guidelines. Recognized for inspiring team members to excel and encouraging creative work environments. Experienced medical coder with over 20 years of experience in the healthcare industry, both clinical and administrative. Excellent reputation for resolving problems, improving customer satisfaction, and driving overall operational improvements.

Work History

Corporate Services - Prisma Health-Upstate - Qualty Coding Assurance AuditorGreenville, SC03/2015 - 05/2020

Conduct random reviews of coded professional services in accordance with Compliance Work Plan. Independently conducts moderate or high complexity medical coding audits as warranted.
Reviews patient medical records and procedures performed in selected patient care areas to ensure all policies relating to documentation are followed uniformly.
Conducts/coordinates routinely scheduled audits of providers' documentation involved with professional fee billing, for accuracy of coding and compliance of regulatory guidelines.
Audits consisting of, but are not limited to, ambulatory Evaluation/Management services, office procedures as well as hospital admissions, subsequent visits, hospital procedures, and all other services performed or supervised by providers.
Analyzes results to assess compliance with regulations, identifies procedural weaknesses and education needs that contribute to instances for non-compliance. Ensures that proper billings from individual patient medical records are justified with proper supporting documentation.
Prepares formal written reports summarizing current state (findings), desired future state, and critical success factors (recommendations). Applicable policies or federal/state/agency laws or regulations are referenced and explained. Findings presented in order of importance and are meaningfully condensed and presented in Executive Summary.
Report document findings in well-organized work papers as reviewed and deemed necessary. Reports are accurate, concise, organizationally fluent, and grammatically correct. Communicate findings and co-develop corrective action plans for strengthening of internal controls with management of audited area.
Participated in closing meetings with appropriate levels of management. Concisely presented findings and recommended corrective action plans. Cite and summarize applicable policies, laws or regulations.
Continuously gained knowledge of CPT, ICD-10, HCPCS and business/industry/legislative issues relating to and impacting Coding Audit and Compliance issues. Increases knowledge by attending coding conferences, workshops, webinars and in-house sessions to receive updated coding information and changes in coding and/or regulations.
Assisted Coding Compliance Supervisor in training of other auditors and new team members as stated in Coding Compliance New Hire Training as well as through leading projects and working together to complete projects.

Upstate Medical Rehabilitation - Prisma Health - Senior Coding SpecialistGreenville, SC12/2012 - 02/2015

Obtained and reviewed documentation for compliance and to ensure documentation supports medical necessity for charges that are submitted for proper reimbursement.
Maintains updated knowledge of coding/billing and reimbursement issues.
Used classification manuals to gain additional knowledge of disease and diagnoses processes.
Updates physicians and staff regarding coding/reimbursement issues as needed.
Provides coding support to providers and staff by performing periodic coding education and training sessions.

Upstate Medical Rehabilitation-Prisma Health - Medical Coding SpecialistGreenville, SC06/2012 - 11/2013

Code outpatient medical records using most accurate and appropriate ICD-9-CM and CPT codes in accordance with regulatory coding guidelines, best practice in industry and HIA policy and procedures.
Reviewed charts and flagged incomplete or inaccurate information.
Used classification manuals to gain additional knowledge of disease and diagnoses processes.
Maintained accuracy, completeness and security for medical records and health information.
Communicated effectively with staff, patients and insurance companies by email and telephone.
Utilized EHR to manage and confirm patient data, such as insurance, demographic and medical history information.

Skills

Exhibiting confident and competent verbal communication skills
Report writing
Audit coordination
Financial Reporting
Continuing education

Regulatory Compliance
Risk mitigation strategies
Profits and losses tracking
EHR software

Education

2006Stark State CollegeCanton, OHAssociate of Applied Science: Healthcare

Certifications

Certified Professional Coder

AAPC-American Academy of Professional Coders November 2012

Certified Professional Medical Auditor

AAPC-Americal Academy of Professional Coders August 2016

Resume Overview

Companies Worked For:

Corporate Services - Prisma Health-Upstate
Upstate Medical Rehabilitation - Prisma Health
Upstate Medical Rehabilitation-Prisma Health

School Attended

Stark State College

Job Titles Held:

Qualty Coding Assurance Auditor
Senior Coding Specialist
Medical Coding Specialist

Degrees

Associate of Applied Science : Healthcare

Qualty Coding Assurance Auditor Resume Example

Resume Score: 80%

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