IVETA GOMES

*** ******* *******, ******, ** ***** Tel. 908-***-**** Email: acvwux@r.postjobfree.com

Objective

I am a results oriented project leader with excellent organization and communication skills. I have a systematic approach to problem solving and ability to manage tight deadlines, challenging roles and assignments. I am seeking to obtain a position within an establishment that will allow me to utilize my current skills and further enhance my experience and knowledge.

Skills Summary

Epic and EMR

Medical Manager

MS Word, Excel, PowerPoint

Medical Necessity Management

ICD9 and CPT 4 Coding compliance reviews

Administrative and Clinical proficiencies

Mortality and Morbidity reporting & presentation

Strong analytical and problem solving skills

CPR Certified, EKG and RMA eligible

Tri-lingual (Fluent English, Spanish and Portuguese)

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Professional Experience

UMDNJ – Trauma Surgery, Newark, NJ

Principle Technical Assistant Nov. 2010– Apr. 2013

Validated and provided updates for correct coding initiatives (ICD9 and CPT 4) as pertained to carrier medical policies and patient medical record documentation.

Documented all invasive procedures performed from admission through discharge.

Researched and compared medical records to ensure billing compliance and medical necessity was met.

Reviewed carrier policies for medical necessity requirements.

Analyzed data utilizing various reporting systems on excel spreadsheets.

Identified and troubleshot workflow processes.

Assisted in the development of the Trauma Registry flow sheet used by quality assurance team to gather required data for accreditation for the American College of Surgeons.

Provided and presented information for Mortality and Morbidity conferences.

Assisted in Resident training classes (moulage application and victim simulation/positioning)

Primary source of contact for any questions related to the Trauma Registry.

University Physician Associates-Orthopaedic Trauma, Newark, NJ

Medical Receptionist Apr. 2006 – Nov. 2010

Managed patient appointments and assembled patient charts.

Triage patients according to urgency of care.

Telephone conferences with case managers regarding medical necessity denials.

Prepared letters of appeal to insurance carriers that were not paid, or paid at an incorrect rate.

Reviewed various systems for medical records, patient insurance information, waiver forms etc. to have outstanding claims resolved.

Performed extensive account follow-up on insurances to monitor claims that where billed in error or denied.

Heavy contact with carriers to obtain proper documentation for Medical Necessity request including letters and carrier policies.

Obtained patient information such as eligibility and insurance plan type and update registration screens.

United States Army-101st Airborne, Fort Campbell, KY

Automated Logistical Specialist Nov. 1996 – Jan. 2004

Oversaw a platoon of 28 soldiers including training exercises and strategic planning

Army Achievement Medal recipient

Certificate of Appreciation for valuable contributions to overseas deployment missions.

Conducted overseas deployment training

Managed Data entry for inventory and stock of military supplies

Maintained and operated several types of military vehicles and equipment.

Orthopaedic Physician and Surgeons, Woodbridge, NJ

Medical Assistant Sept. 2000 – Sept. 2002

Performed patient care and administrative activities for orthopaedic.

Verified patient eligibility by phone.

Obtained Authorizations and referrals as necessary.

Advised patients of department and insurance policies such as if the provider would be billed in-network or out of network and what their responsibilities might be.

Collected patient payments such as co-pays, deductibles, and open balances.

Answered and screened phone calls, registered patients, assisted in completing forms and translated when needed.

Education

Ultrasound Diagnostics School, Iselin, NJ Feb. 1998 – Feb. 1999

Medical Assistant Program

References available on request

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