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Solution Design Analyst for E/M Coding Resume Example

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SOLUTION DESIGN ANALYST FOR E/M CODING
Professional Summary

Enthusiastic medical coding/auditor eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Clear understanding of medical knowledge and terminology and training in developing accurate and fast data. Motivated to learn, grow and excel in the medical industry.

Skills
  • System information
  • Company standards enforcement
  • Service agreement information
  • Coding and designing
  • Performance goal achievement
  • SNOMED and IMO information system expertise
  • Policy development and enforcement
  • Troubleshooting and problem resolution
  • Problem anticipation and resolution
  • Policy enforcement
  • Evaluation and Management design
  • Knowledge of medical and psychiatric terminology
  • Medical evaluation
  • Medical insurance
  • Ability to read medical records
  • Medical bill auditing
  • Medical practice management
  • Medical team collaboration
  • Filing medical bills
  • Medical data entry
  • Processing medical claims
  • Understanding of medical affairs
  • Medical device knowledge
  • Medical insurance knowledge
  • Medical database expertise
  • Examining medical histories
  • Analytical and critical thinking
  • Research and Development
  • Application development and implementation
  • Agile Methodology
  • Usability understanding
  • Operational Improvement
  • MS Office
  • Problem Resolution
  • Relationship Development
  • Customer Service
Work History
Solution Design Analyst for E/M Coding, 04/2016 to Current
Cerner Corporation – Kansas City, MO
  • Devoted special emphasis to analyze and maintain a distinguished solution to generate appropriate coding and processing for physician records.
  • Wrote and optimized test cases to maximize success of manual software testing with consistent, thorough approaches.
  • Identified and tracked defects with Charge Asssist and supported developers in resolving problems by completing additional tests.
  • Used classification manuals to gain additional knowledge of disease and diagnoses processes.
  • Knowledge of ICD-10-CM, CPT, PCS, HCPCS
  • Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
  • Supported research and development efforts to create new products, equipment and processes.
  • Monitored CDC and online sources for industry trends.
  • Developed team communications and information for improvement and development based meetings.
  • Developed individualized education programs for all outpatient specialties to increase best practices and standards for physicians and administrations teams to ensure success, employing wide breadth of learning and motivational strategies.
  • Prepared vendor files accurate and up-to-date with areas of improvement to increase revenue and decrease audit risks with working papers, reports and supporting documentation with audit findings.
  • Resolved conflicts and negotiated mutually beneficial agreements between parties.
  • Implemented new coding procedures that reduced mistakes by and simplified processes.
PhD Administrative Assistant, 05/2005 to 04/2016
Pediatric Care Specialists – Overland Park, KS
  • Conducted preliminary evaluations with parents about their child concerns.
  • Relayed triage information and facilitated communication between provider and patient concerning patient disposition.
  • Explained visit information to patients to reduce anxieties and increase patient cooperation.
  • Scheduled appointments and registered patients.
  • Accurately posted and sent out all medical claims.
  • Determined prior authorizations for outpatient visits.
  • Precisely evaluated and verified benefits and eligibility.
  • Maintained and updated coding guidelines.
  • Evaluated patients' financial status and established appropriate payment plans.
  • Researched CPT and ICD-10-CM coding discrepancies for compliance and reimbursement accuracy.
  • Monitored outstanding invoices and performed collections duties.
  • Developed rapport with clients and vendors to cultivate loyalty and satisfaction.
  • Wrote compliance and procedure policies for Behavioral Health.
Senior Billing Specialist, 06/2003 to 04/2016
Pediatric Care Specialists – Overland Park, KS
  • Followed updated ICD-10-CM, CPT and E/M coding guidelines.
  • Audited charts and reviewed clinical documents to verify accuracy.
  • Researched CPT and ICD-10-CM coding discrepancies for compliance and reimbursement accuracy.
  • Used classification manuals to gain additional knowledge of disease and diagnoses processes.
  • Flagged incomplete or inaccurate information.
  • Implemented education programs for providers to improve documentation accuracy.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Promoted office efficiency, coordinating charts, completing insurance forms and helping patients.
  • Implemented care and efficiency improvements to support and enhance office operations.
  • Maintained accuracy, completeness and security for medical records and health information
  • Kept vendor files accurate and up-to-date to expedite payment processing.
  • Located errors and promptly refiled rejected claims.
  • Accurately posted and sent out all medical claims.
  • Verified vendor accounts by reconciling monthly statements and related transactions.
  • Generated financial statements and reports detailing accounts receivable status
  • Printed and reviewed monthly patient aging report and solicited overdue payments.
  • Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
  • Posted and adjusted payments from insurance companies.
  • Verified accuracy of accounts payable payments, resulting in reduction in payment errors and check reissues.
  • Communicated effectively with staff, patients and insurance companies by email and telephone.
  • Maintained and updated collections tracking spreadsheet to help organize payment information.
  • Printed and reviewed monthly patient aging report and solicited overdue payments.
  • Evaluated patients' financial status and established appropriate payment plans.
  • Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
  • Increased customer satisfaction by resolving billing issues.
  • Resolved conflicts and negotiated mutually beneficial agreements between parties.
  • Pre-certified medical and radiology procedures.
  • Oversaw monthly projects to revamp filing system, improving department productivity.
  • Collected all pertinent data and calculations to aid physician in interpreting results.
  • Led billing team in delivery of new EMR system, resulting in accuracy, policy and procedures.
Education
Associate of Arts: Liberal Arts And General StudiesJohnson County Community College - Overland Park, KS
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Resume Overview

Companies Worked For:

  • Cerner Corporation
  • Pediatric Care Specialists

School Attended

  • Johnson County Community College

Job Titles Held:

  • Solution Design Analyst for E/M Coding
  • PhD Administrative Assistant
  • Senior Billing Specialist

Degrees

  • Associate of Arts : Liberal Arts And General Studies

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