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Risk Adjustment Coder-Billing Specialist Resume Example

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RISK ADJUSTMENT CODER-BILLING SPECIALIST
Professional Summary

Licensed RN with 1 year of clinical experience. Seeking to become a top nurse by following protocols and promoting efficiency. As student nurse at Manati Medical Center (Puerto Rico), achieved higher-than-average patient satisfaction and 97% favorable preceptor evaluations.

Skills
  • Patient education
  • Phlebotomy
  • EMR / EHR
  • Record Keeping
  • Medicine Administration
  • Triaging Patients
  • Care and Discharge Planning
  • Assessment
  • Teamwork
Work History
Risk Adjustment Coder-Billing Specialist | Lifepoint Hospitals - Russellville , KY02/2021 - Current
  • Accurately and thoroughly review medical visits and procedures as performed by physician, including but not limited to: patient medical history, procedures, and treatments performed by healthcare professionals, including nurses and physician assistants, patient education and explanations of risks and benefits, Physician-dictated diagnoses, prescriptions and instructions for patient or family members for self-care and follow-up.
  • Spot mistakes or inconsistencies in medical documentation.
  • Apply current ICD- 10 codes as supported by provider's documentation.
  • Apply CPT codes as performed by providers and clinical staff.
  • Apply HEDIS (CPT category 2) as documented by providers and clinical staff.
  • Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
  • Monitor coding changes to ensure that most current information is available.
Coding and Billing Specialist | Arc Of Seneca Cayuga - Penn Yan , NY09/2019 - 02/2021
  • Review medical record information to identify all appropriate coding based on ICD- 10 coding guidelines and current CPT codes.
  • Review referral request as directed by Physician, via provider documented medical record.
  • Send task via EHR to provider to correct information in order to reduce errors.
  • Ensure that all clinical data, lab or other test results, interpretation of results by Physician are recorded accurately in medical record.
  • Provide coding support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards.
  • Provide real-time support and coordination with Primary Care Providers and Care Coordinators for Medicare Risk Adjustment (MRA) coding, HEDIS and STARS.
  • Accurately review and code encounters on timely basis.
  • Researching and address coding questions for multiple providers as directed.
Medical Coordinator | Southwest Key Programs - Casa Mesa Shelter & Staff Secure - City , STATE04/2017 - 04/2019
  • Responsible for assessing, facilitating and monitoring all components of client medical services.
  • Obtain, compile, and maintain medical files on each admission.
  • Ensure proper daily documentation in Southwest Key Program's database ETO, and ORR-UAC Portal and maintain hard copy of required documents and medical record.
  • Schedule and comply with required medical and dental appointments and timelines.
  • Respond and comply to individual emergency medical needs immediately.
  • Maintain and review for accurate and complete list of medical supplies, prescribe medications, and over-the-counter OTC medications according to standing orders.
  • Prepare youth for examinations and record medical intake, take vital signs, height and weight.
  • Initiate routine lab tests.
  • Participate and advocate during medical procedures performed by medical providers and other health services.
  • Assist medical providers' staff with examination procedures when needed, such as patient screening and triage.
  • Dispense medication according to self-administration of medication - SOMA schedule, policies and procedures.
  • Collect, maintain, and submit weekly, monthly, quarterly, and annual reports to supervisor.
  • Facilitate and conduct SOMA, universal precautions, TB 101, allergies and other related training to employees.
  • Provide fail-safe plan with medication count, label accuracy, and SOMA, including over-the-counter drugs.
  • Educate and counsel youth concerning their disease, treatment, and prevention of disease.
  • Schedule and provide transportation to clients on medical appointments with assistance from floor staff as needed.
Education
AAPC - City12/2020Certified Professional Coder: Medical Insurance Coding
EDP University Of PR Inc - City04/2019Associate Degree in Nursing: Nursing
Medical Sciences University Of Granma - City07/2013M.D.: Medicine
Certifications
  • Registered Nurse. License RN9557486
  • ACLS / BLS
  • CRC - AAPC Certified Risk Adjustment Coder
Languages
  • English
  • Spanish
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Your resume earned a perfect score!

Excellent work! Many factors go into creating a strong resume and this sample resume has checked all the boxes. Great job!

100Excellent
Resume Strength
  • Completeness
  • Formatting
  • Word choice
  • Length
  • Measurable results
  • Strong summary
  • Target job
  • Clear contact info
  • Typos

Resume Overview

School Attended

  • AAPC
  • EDP University Of PR Inc
  • Medical Sciences University Of Granma

Job Titles Held:

  • Risk Adjustment Coder-Billing Specialist
  • Coding and Billing Specialist
  • Medical Coordinator

Degrees

  • Certified Professional Coder : Medical Insurance Coding
    Associate Degree in Nursing : Nursing
    M.D. : Medicine

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