Efficient coding and billing professional with 15 years of experience. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving. Proficient in reading, interpreting and implementing legal rules and regulations. Excellent multitasking and coordination abilities. Passionate about perpetuating company values through impeccable work ethic and drive. Decisive and persuasive communicator with leadership, planning abilities and the versatility to learning new skills.
Skills
Quality Assurance Management
Company database maintenance
Operational processes performance knowledge
Proficiency in Microsoft office, ModMed, MDaudit, Nexgen, Allscripts, Cerner
Maintain Compliance
Records Review
Electronic Health Records
Excellent Communication
Chart Management
Cpt Coding, ICD-9/ICD-10
Clinical Documentation
Regulatory Requirements
Conference Calls
Collaborative Relationships
Communication
CMS Guidelines
Work History
09/2019 to Current
Revenue Integrity AnalystAnmed Health – Clemson, SC,
Responsible for assisting Revenue Cycle Manager and Vice President of Business Service in managing all compliance-related activities and initiatives.
Thoroughly and accurately posting 130 professional and facility surgery charges per day.
Must maintain expert skills in the proper use of coding manuals (E&M Codes, ICD-10, CPT, HCPCS) and Medicare's National Correct Coding Initiatives (NCCI) edits.
Ensures adherence to all healthcare compliance activities and federal and state regulations.
Recognizes significance and value of comprehensive medical record documentation.
Assists with daily operations of Coding Quality Team, identifying opportunities and collaborating with leadership to train, coach, mentor, streamline workflow, establish and communicate standard operating procedures, and manage reporting requirements.
Consistently demonstrates communication skills, organization, prioritization, and professionalism.
Working knowledge of entire revenue cycle including credentialing and enrollment, appointments, eligibility, benefits, referrals, pre-certification and pre-authorization, coding, billing/claims, payment posting, adjustments, response to patient account inquiries, and customer service advocacy.
Communicate with patients in ways that is perceived thorough and clear, answer questions about financial concerns, and collaborate with clinic and central business office when needed.
Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology
Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices
Reconciled codes against services rendered
03/2016 to 05/2019
Compliance & Coding AuditorGw Medical Faculty Associates – Bethesda, MD,
Performed standard audit procedures relating to facility and physician specialty medical documentation.
Ensured application of all appropriate procedural, diagnosis codes, and modifiers to all professional and outpatient hospital services identified for auditing purposes.
Reviewed governmental and third-party payer requests such as ADR's, CERT, RAC, pre-payment probes and audits.
Reviewed medical records and prior billing statistics by provider.
Conducted sample and concurrent reviews of provider charting based on annual compliance work plan.
Entered all audit findings in MD Audit systems ensuring that all audit findings are accurate and depicted in applicable, billing systems status post compliance review.
Conducted new provider and audit training to physicians and staff to ensure compliance of federal, state, and local laws.
Contributed efforts within 5-person compliance team to address compliance program quality and provide operational support to management
Managed practical action plans to respond to audit discoveries and compliance violations
Used MDaudit to create reports to keep senior management informed of operations and progress of compliance efforts
Counseled committees and department heads regarding compliance risks and standards
09/2011 to 03/2016
Coding SpecialistAdventist Health System – Clyde, NC,
Responsible for ensuring optimum reimbursement based on accurate coding and for maintaining quality patient clinical database.
Assigned accurate diagnosis and procedure codes and captures pertinent clinical data elements on all inpatient/outpatient medical records of discharged patients.
Reviewed E&M levels selected by physicians on monthly basis and provided feedback in order to increase awareness and accuracy.
Verified insurance and participated in monthly in-services keeping abreast of new policies.
Provided training for 15 physicians.
12/2007 to 09/2011
Remote Coding ConsultantMedAssurant – City, STATE,
Accurately and efficiently conducted medical record review and abstraction.
Maintained accuracy and productivity standards on all assigned projects.
Maintained ongoing communication with supervisor regarding issues/nuances that arise during review processes;.
Submitted complete, timely and accurate information as per protocol.
Attended all department meetings and trainings as directed;.
Maintained appropriate certification as required in this position.
Coded facility and outpatient services at rate of 7 per hour with consideration of chart complexity
Education
Expected in 04/2020 to to
Masters of Public Administration: Health Administration Grand Canyon University - Phoenix, AZ, GPA:
Expected in 03/2015 to to
BBA: Health Management And Clinical Assistance Brooklyn College of The City University of New York - Brooklyn, NY GPA:
Expected in 02/2006 to to
No Degree: Medical Coding National Medical Coding Institute - Atlanta, GA, GPA:
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Resume Overview
School Attended
Grand Canyon University
Brooklyn College of The City University of New York