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Senior Coding Auditor Resume Example

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Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
:
Professional Summary
Highly motivated professional offering solid contribution, specialized skills and a desire to succeed. Project a professional company image, especially when working under pressure. Certified Professional Coder with 16 years experience in a fast-paced, multiple client medical billing company specializing mostly in Emergency Room coding. Experienced with healthcare billing, accurate and detail-oriented with knowledge of benefits, eligibility and appeals. Researched denied claims and submitted appeals.
Licenses
Health Information Management Medical Terminology Medical Insurance Billing Certified Professional Coding Specialist Familiar with commercial and private insurance ICD-10 (International Classification of Disease carriers Systems) Certified Experience with Open Practice, Practice Fusion, HCPCS Coding Guidelines Allscripts, eclinical and NextGen Patient chart auditing ability Resourceful and reliable worker
Skill Highlights
  • Guest services
  • Inventory control procedures
  • Merchandising expertise
  • Loss prevention
  • Cash register operations
  • Product promotions
Education and Training
, Expected in Associate of Arts : - GPA :
Southwest Florida College of Business Fort Myers, FL Expected in 1995 Associates of Medical : Administrative - GPA : Administrative
Professional Experience
Aliso Ridge Behavioral Health & Anaheim Community Hospital - Senior Coding Auditor
Anaheim, CA, 05/2013 - 11/2015
  • Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
  • Verified patients' eligibility and claims status with insurance agencies.
  • Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.
  • Researched questions and concerns from providers and provided detailed responses.
  • Accurately selected the proper descriptive code when more than one anatomical location was indicated.
  • Maintained strict patient and physician confidentiality.
  • Resourcefully used various coding books, procedure manuals and on-line encoders.
  • Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories.
  • Initiated, performed and documented quarterly coding audits for physicians.
  • Accurately posted and sent out all medical claims.
  • Submitted electronic/paper claims documentation for timely filing.
  • Responded to correspondence from insurance companies.
  • Posted and adjusted payments from insurance companies.
  • Identified and resolved patient billing and payment issues.
  • Confidently and adeptly handled claim denials and/or appeals.
  • Precisely completed appropriate claims paperwork, documentation and system entry.
  • Correctly coded/audited and billed medical claims for various specialties: Emergency Room, Urgent Care, Pediactric, Physicians Office, Pain Management and Internal Medicine.
Bickford Senior Living - Medical Coder
Macomb, IL, 09/2004 - 03/2013
  • Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
  • Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
  • Utilizing Oracle to code qualcharts and EMR's for various sites for emergency rooms.
  • Coded charts at a rate of 25-30 charts per hour while maintaining 98% accuracy or above.
  • Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge.
  • Responsible for knowledge of various exception codes that gets communicated to the sites to get the proper documentation still needed to properly bill the chart.
  • Assign ICD-9 and CPT codes using Codelink as well as assigning correct ED Clinician numbers.
  • Determining correct MDM level and verify adequate elements for the HPI, ROS, PFSH and the PE.
  • Accurately selected the proper descriptive code when more than one anatomical location was indicated.
  • Researched questions and concerns from providers and provided detailed responses.
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
  • Maintained strict patient and physician confidentiality.
  • Resourcefully used various coding books, procedure manuals and on-line encoders.
  • Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
  • Initiated, performed and documented focused coding audits for various facilities.
  • Supervisor over 8 or more coders, managed their time, one on one coaching sessions monthly, answered help questions pertaining to ED charts, hands on supervisor.
  • Audited a minimum of 100 charts per week per coder to maintain their accuracy and to stay within the coding guidelines.
  • Help teach the companies internal coding class.
  • Each one lasted 6 weeks long.
-
Aliso Viejo, CA, 01/2003 - 08/2004
  • Precisely completed appropriate claims paperwork, documentation and system entry.
  • Diligently filed and followed up on third party claims.
  • Maintained strict patient and physician confidentiality.
  • Managed collections claims for unpaid bills against the estates of debtors.
  • Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations.
  • Accurately posted and sent out all medical claims.
  • Submitted electronic/paper claims documentation for timely filing.
  • Precisely evaluated and verified benefits and eligibility.
  • Responded to correspondence from insurance companies.
  • Confidently and adeptly handled claim denials and/or appeals.
  • Evaluated patients' financial status and established appropriate payment plans.
  • Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.
  • Updated patient financial information to guarantee accuracy.
Aliso Ridge Behavioral Health & Anaheim Community Hospital - Medical Coder
City, STATE, 09/1998 - 11/2002
  • Coded emergency room charts at a rate of 20 charts per hour.
  • Correctly coded and billed medical claims for various hospitals.
  • Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge.
  • Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
  • Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
  • Assigned appropriate medical codes with a 98% or above accuracy rate.
  • Accurately selected the proper descriptive code when more than one anatomical location was indicated.
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
  • Maintained strict patient and physician confidentiality.
  • Resourcefully used various coding books, procedure manuals and on-line encoders.
  • Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
Skills
auditing, benefits, Billing, charts, CMS, coaching, CPT, documentation, filing, financial, government, ICD-10, ICD-9, Insurance, Internal Medicine, Medical Terminology, Office, 98, Oracle, Pain Management, policies, Coding, protocols, Supervisor, Urgent Care

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Resume Overview

School Attended
  • Southwest Florida College of Business
Job Titles Held:
  • Senior Coding Auditor
  • Medical Coder
  • Medical Coder
Degrees
  • Associate of Arts
  • Associates of Medical

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