Medical Manager

Shawn D. Williams CPC, CPC-H, CCP, CCP-H, FCS, PCS

**** ********* **** *******, ** 30038

Cell: 770-***-****

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CAREER SUMMARY

Seasoned professional with 20+ years industry experience seeking a career-defining opportunity which will utilize my vast knowledge in the areas of coding, education and training, auditing, consulting and management

WORK HISTORY

ON-ASSIGMENT HIM MAY 2011-

PRESENT: REVIEW PATIENTS RECORDS AND CODIFYING RESULTS FOR REIMBURSEMENT OR PAYMENT PURPOSES, ABSTRACTING, CODING CHARGING AND SEQUENCING FOR ALL EMERGENCY ROOM RECORDS, DIAGNOSTIC AND ANCILLARY RECORDS ALSO SEQUENCING OF ALL MEDICAL AND SURGICAL PROCEDURES, DIAGNOSIS AND TREATMENT MODALITIES. REVIEW PROVIDER DOCUMENTATION TO DETERMINE PRINCIPAL DIAGNOSIS, CO-MORBID AND COMPLICATIONS, SECONDARY CONDITIONS AND SURGICAL PROCEDURES . MAINTAIN STRICT CONFIDENTIALITY WITH ALL PATIENT DATA, PROVIDE FEEDBACK TO MANAGEMENT CONCERNING POSSIBLE PROBLEM AREAS OR AREAS THAT NEED TO BE IMPROVED. MAKE RECOMMENDATIONS TO IMPLEMENT IMPROVED PROCESSES, AND PERFORM OTHER DUTIES AS ASSIGNED. ANALYZE AND EDUCATE STAFF ON ICD-10 CMS/PCS-GEMS FILE MAPPING, BACKWARD AND FORWARD MAPPING OF ICD-10CM AND PCS, AND DEVELOPMENT OF THE BEST PRACTICE FOR NON-MAPPING CODES.

DEKALB MEDICAL CENTER- OUTPATIENT CODER PT MARCH -2011-MAY 2011 DUTIES WERE TO CODE ALL WORK TYPES FROM ER TO REHAB PT/OT INTERVENTIONAL RADIOLOGY, ANCILLARY SERVICES TO DECREASE DNFB.

ON ASSIGNMENT-TRAVEL CODER-TUBA CITY HOSPITAL OCT. 2010-MARCH 2011

DUTIES INCLUDED CODING ALL FACILITY AND PROFEES FOR THE EMERGENCY ROOM AND CAPTURE ALL CHARGES FOR THE HOSPITAL AND SPECIALTY CLINICS AUDITED PROVIDERS FOR ALL LEVELS OF SERVICE AND ALL CHARGES BILLED FOR THE ENTIRE HOSPITAL OF TUBA CITY.

TRUSTAFF- TRAVEL CODER-GUAM MEMORIAL MAY 2010-SEPT. 2010

DUTIES INCLUDED EDUCATED PHYSICIANS AND STAFF ON OUTPATIENT HOSPITAL CHARGES PRIMARY FOCUS WAS THE EMERGENCY ROOM, RADIOLOGY, AND OR. RESPONSIBILITIES INCLUDED CHARGE CAPTURE AND MISSING CHARGES FOR ALL DEPTS. USING CMS GUIDELINES, MEETING WERE HELD EACH WEEK ALONG WITH EDUCATION AND THE FINANCIAL HOSPITAL TEAM TO SEE THE PROGRESSION AND REIMBURSEMENT GROWTH

Risk Adjustment Management LLC Jan. 2008- Apr. 2010

Consultant for a private company performing chart auditing on-site at a variety of clients including hospitals, physician specialty groups and private practices. The auditing covers a broad spectrum of specialties for both inpatient and outpatient records. Duties include physician and documentation specialist education. Also have worked on Medicare risk adjustment managed care projects.

Medpartners HIM-Auditor/QA/Physician Education Aug. 2007- Jan. 2008

Performed on-site auditing of all remote coders for Kaiser Permanente in Denver, Colorado and gave feedback on coding accuracy. Primary duty was to ensure all coders performed at a 95% accuracy rate. Other responsibilities included physician education regarding proper documentation for their charts and coding. Also performed Medicare risk adjustment including the identification, collection, assessment and documentation of ICD-9 coding information.

American Medical Institute - Dean of Coding March 2003– May 2007

Part-time position- Provided all instructors with the tools and training necessary to teach industry professionals how to obtain their CCS, CPC and CPC-H certifications. Also managed the department, hired all new employees and provided orientation. Provided students with an in-depth knowledge of coding principles, practices, standards and guidelines. Received and reviewed weekly and monthly student retention reports, reviewed monthly instructor observations for creativity and growth in teaching, initiated and conducted all program meetings. Also directed Instructors and assisted them with teaching principles to help ensure classroom control and establishment of optimal learning environments

Medical Career Education – April 2002 – Aug. 2007

Provided training for all new primary care physicians, LCSW’s, and Psychiatrists regarding all E/M documentation, mental health and chemical dependency. Training included coding to the highest level and supporting it with proper documentation. Also provided a monthly audit report to help the providers see the relationship between proper documentation and their reimbursement levels. Handled all coding updates within the physician education department along with fraud and abuse issues which were discussed at the weekly and monthly management meetings.

Medical Claims Consultant (Part-time) Oct. 2003 – Aug. 2007

Performed coding and abstracting for Mental Health and Psychiatry and Primary Care services. Also performed chart audits and utilized the findings to provide staff education.

HITech Institute - Program Director for Coding/Billing Oct. 2004 – Feb. 2005

Part-time teaching position. Provided training and orientation for all new instructors and served as a backup instructor as needed. Maintained all student records and grades for the department and handled all student related issues. Also conducted a weekly retention meeting with other program directors.

Georgia Medical Institute Instructor- Billing/Coding Jan. 2003 – Oct. 2004

Part-time teaching position. Provided training in Medical Terminology, ICD-9 and CPT coding as well as utilization of software such as Medical Manager and Medisoft.

Baptist Medical Center Hospital- Billing Specialist March 2002 – Dec. 2002

Follow-up on all commercial claims, rebilled claims before timely filing limit.

Research for missing payment for all commercial claims with hospital system.

Worked all outstanding EOB’s for commercial carriers that were not yet posted.

Billed all professional fees for commercial claims.

Montefiore Medical Center-HIM Supervisor Sept. 1987 – Feb. 2002

Supervised a department of 55 employees with duties ranging from handling all HIM and Business Office functions to performing physician education and chart audits and coding updates within the physician education department.. Also resolved complex and escalated claim issues and patient related issues, analyzed fee schedules and performed on-site enrollment meetings for managed care plans.

TECHNICAL SKILLS

Software Utilized:

3M Encoder, Encoder ProMisys Tiger, Medisoft, Centricity, Medical Manager, HBOC, AS400, Meditec, Lytec, Famous, Merritt, Peoplesoft, Epic, Practice Partner, ChartMaxx

Education:

Anthem College – Phoenix, Arizona

Associate of Science Degree, Medical Coding & Billing, February 2005

Associations & Certifications:

NCCT- CICS Coding and Billing Certification- Received 2004

AMCS-American Medical College Specialists-Received 2007

AAPC-American Academy of Professional Coders-Member 2007

PHIA-Professional Healthcare Institute of America-Received 2008

References Provided Upon Request

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