Carrie N. Peterson

**** ********* ****

Chesapeake, VA 23323

acgd9m@r.postjobfree.com

757-***-****

Objective

To contribute to the overall success of a progressive, growth-oriented organization that

will benefit from my knowledge and skills acquired through education and experience,

and that will provide me with an opportunity to grow professionally.

Clinical Outpatient Coding Auditor June 2008-present

- Performs all activities to identify, monitor and analyze aberrant patterns of utilization

and/or fraudulent activities by health care providers through prepayment claims review

and post payment auditing.

- Develops, maintains and recommends current departmental coding resources.

-Prepare and update orientation and educational materials for meetings.

- Remain current on CPT, ICD-9, HCPC and Modifier coding requirements and payer

requirements.

- Ensure compliance and auditing of chart and billing information to include:

audits performed at request of site manager, provider, billing manager and

administration, in addition to routine audits.

- Prepares audits and summary reports to discuss results with manager, coders,

administration, etc.

- Reviews monthly ABN audit reports and update.

-Have a strong medical background and familiarity with the auditing of documentation.

-Work collaboratively with the billing department to ensure accurate coding in regards to

what procedures were billable according to diagnosis medical necessity issues and

insurance plan.

- Perform medical necessity and billing audits daily. Educate coders on coding guideline

changes,CPT code changes and ICD-9 changes.

-Responsible for performing clinical reviews of medical records and other documentation to

evaluate issues of coding accuracy, medical necessity, and the appropriateness of treatment

setting and services delivered. Primarily responsible for auditing efforts by executing projects

assigned by the Director, Audit Operations or Manager, Audit Operations.

Outpatient and Inpatient Coder May 2003-June 2008

-Analyze outpatient records and inpatient records to determine physician’s diagnoses

and procedures and assigns correct ICD-9-CM or CPT codes.

-Work collaboratively with the billing department to ensure accurate coding in regards to

what procedures were billable according to diagnosis medical necessity issues and

insurance plan.

-Review medical documentation and consult with healthcare providers when

documentation is inadequate/unclear for coding purposes.

-Review each recorded diagnosis and operation/procedure for accuracy completeness

and supportive documentation

-Daily production of 60-70 with an accuracy of 95%.

-Work collaboratively with the billing department to ensure accurate coding in regards to

what procedures were billable according to diagnosis medical necessity issues and

insurance plan.

-Extremely knowledgeable with regards to Medical Coding guidelines and coding

techniques (ICD-9 CPT-4 HCPCS and DRGs) proficient in physician coding inpatient

hospital coding.

-Utilizes coding definitions to accurately sequence diagnoses and procedures.

-Abstracts all mandatory and required elements accurately and enters into computer.

-Responsible for accurate data input into computer systems to ensure integrity of all

databases.

-Effectively utilizes ambulatory surgery payment groups to ensure ethical optimization of

reimbursement by sequencing procedures appropriately.

- Coded inpatient, outpatient, observation, emergency room (trauma registry), and

diagnostic ancillary services.

- Abstracted medical records with ICD-9-CM, CPT, and DRG coding.

- Reviewed charts for correct admit/discharge dates and entered proper surgery dates.

- Attended seminars for updates on ICD-9-CM and completed DRG assurance clinical

documentation.

- Have a strong medical background and familiarity with the auditing of documentation.

-Able to work well independently and possess a strong ability to multi-task.

-Excellent interpersonal communication.

-Extremely detail-oriented and have exceptional organizational and prioritization skills.

-Proficiency in MS Office.

-Ability to successfully complete assessments in data entry accuracy, medical

terminology and medical coding.

- Have training in anatomy and physiology.

-Possess concentration in order to prevent errors.

Professional Experience

Education

Associate degree in Health Information Technology, Tidewater Community College

2003

Licensure

Certified Professional Coder (CPC) American Academy of Professional Coders

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