Review outpatient medical record information on both a retroactive and prospective basis to identify, assess, monitor and document claims and encounter coding information as it pertains to risk adjustment and quality metrics
Ensure that the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe
Conducts physician chart audits to identify incorrect coding, prepares reports of findings and any compliance issues. Audits performed for both provider coding accuracy and documentation support as well as coding teammate accuracy
Reports coding patterns identified within the audit process to the Manager, and identifies corrective measures to compliance problems
Maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current CPT-4, HCPCS II, and ICD-10 materials, the Federal Register, and other pertinent materials
Assess adequacy of documentation of claims and query outpatient provider claims to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding
Interacts with coding teammates to deliver coding audit findings, discuss corrective measures and any necessary training required, and reports findings back to Coding Manager
Performs related work and projects as required
Medical Coder, 06/2017 - 05/2019 Greater Atlanta Women’s Healthcare – City, STATE,
Reviewed outpatient records and interpreted documentation to identify all diagnoses and procedures.
Abstracts clinical information from a variety of medical records and assigns appropriate ICD 10 CM and/or CPT codes to patient records according to established procedures
Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations
Follow up with the provider on any documentation that is insufficient or unclear
Communicate with other clinical staff regarding documentation
Search for information in cases where the coding is complex or unusual
Receive and review patient charts and documents for accuracy
Review the previous day's batch of patient notes for evaluation and coding
Ensure that all codes are current and active
Medical Coding Reviewer , 06/2015 - 06/2017 Change Healthcare – City, STATE,
Perform member and provider interviews, and review medical documentation as needed
Gather and analyze data and information gathered to determine behavior and understand provider/scheme at issue
Utilize appropriate documentation and tracking controls in the case tracking system to ensure compliance and audit ability requirements are met
Apply knowledge of coding guidelines to determine validity of aberrances
Gather all relevant facts to articulate behavior through an Investigation Summary and compliance package. Communicate clear rationale for investigation processes and outcomes to Client, Regulator and stakeholders
Collaborate with a variety of external sources to identify current and emerging patterns and schemes related for FWA to ensure additional TIP submission
Coordinates research and responds to system inquiries and appeals.
REMOTE CODER/Medical Biller, Accounts Receivable, 10/2013 - 05/2015 GEORGIA STATE HEALTH – City, STATE,
Reviewing and following up payment denials, contacting insurance carriers for payment resolution, filing appeals, submitting insurance claims to clearing house or individual insurance companies, retracting claims, and processing write offs/adjustments for non-payable charges according to payer contract.
Analyzes and interprets the medical record in its entirety to ensure accurate, complete and consistent selection of diagnoses and procedures to assure the production of quality healthcare data and accurate facility payment.
Applies understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable codes.
Utilizes resources and reference materials (e.g., on-line sources, manuals) to identify appropriate codes and reference code applicability, rules and guidelines.
Enter information necessary for insurance claims such as patient, insurance ID, diagnosis, treatment codes, modifiers, and provider information. Ensure claim information is complete and accurate.
Prepare appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal
Check insurance payments for accuracy and compliance with contract discount.
Education
: Medical Coding, Expected in - American Academy of Professional Coder CPC - AAPC, GPA:
Emory Clinic: Certification of Electronic – Medical Billing, Healthcare, Expected in - Emory Healthcare - Atlanta, GA GPA:
High School Diploma: , Expected in 4/2000 - Eastside High School, The Galatians Group, Inc - Gainesville, College Park, FL, GA GPA:
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