Customer Service Management

Holly W. Frank, CPC

Email: zq401j@r.postjobfree.com **010 Independence Avenue, Chatsworth, CA 91311 Cell Phone: 818-***-****

Auditor-Coder-Collector

President of Kaiser Woodland Hills Chapter AAPC 2011 __________________________________________________________________

Evaluation & Management Expert Clinical Charge Capture Specialist Effective Trainer/ Communicator

OBJECTIVE: UTILIZE MY EXPERIENCE AND SKILLS IN A CHALLENGING POSITION THAT WILL PROVIDE GROWTH AND OPPORTUNITY.

PROFESSIONAL EXPERIENCE:

Over 10 Years Experience including Outpatient, Inpatient, ASC, ED, and ALTC covering multiple specialties.

Kaiser Permanente, Pasadena, CA. 9/11-2/12

• Coding Auditor/Trainer - Contract Position

n Audited documentation validating supports of E&M/CPT/ICD-9 by MS-DRG/HCC by CMS criteria.

n Requested by management for priority Medicare projects based on proven critical/clinical thinking ability.

n Special audit projects assigned to included NLP, Acute NLP, Infertility, ALTC/SNF, Neoplasm, and DRG.

n Educated auditors/providers regarding details of projects HCC/E&M by documentation criteria.

Reason for leaving: Contract Position which ended.

Presbyterian Hospital, Los Angeles, CA. 6/11-08/11

• Coder/Auditor/Abstractor - Contract Position

n Applied CPT/ICD-9 all Inpatient/Outpatient services determining NCCI/POA by CMS guidelines.

n Determined most correct ICD-9 by MS-DRG of HCC verified details for all category/type of patients.

n Reviewed and abstracted all components of service charge capture by process within 3M software.

n Assigned by management for chart audit review based on proven ability for detail capture/analysis.

Reason for leaving: Contract Position which ended.

U.S. Health Works, Valencia, CA. 1/10–1/11

• Coding Quality Assurance Auditor

n Audited/Analyzed all E&M levels, CPT capture and Modifiers as documented by OMFS guidelines.

n Reviewed audit findings in detail with individual coder providing specified criteria appropriate training.

n Processed reports to determine for billing patterns and review of physician documentation required.

n Created new audit documentation format using updated Excel spread sheets and Word programs.

Reason for leaving: Position Eliminated as part of company nation- wide mid-management lay-offs.

Encino Plaza A.S.C. Encino, CA. 11/08–12/09

• Coder - A/R Collector - Auditor

n Applied all CPT/ICD-9 for ASC service including GI/GU/MS/Neur/Diag/Laser/Pain Manage/Repair.

n Submitted charges all Insurance types including Medicare by Advantage software and GHN clearinghouse.

n Management/Audit of all accounts A/R unpaid, short paid contracts and un-insured up to collections.

n Served as in House support for anticipated audit as the only CPC certified coder during the year 2009.

Reason for leaving: Position Eliminated with completion of anticipated audit.

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Coventry Priority Services, Woodland Hills, CA. 2/06 – 4/08

• Senior Coder-Abstractor-Auditor

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n Selection of E&M/CPT/ICD codes for inpatient/outpatient cases by MS- DRG application as appropriate.

n Determined appropriate ICD-9 diagnosis codes by HCC of multiple acute/chronic criteria consideration.

n Specific categories of CPT coding included but not exclusive to Surgery, Radiology, E&M, and DME.

n Performed Audit of coding team based on Ingenix/CDR/OMFS/CMS/OPPS/IPPS/HCC reference.

n Created new audit spread sheets and documentation format for audit recording using Excel and Word.

Reason for leaving: Position eliminated as part of company nation-wide mid-management lay-off.

Ophthalmology/Strabismus Specialist, Northridge, CA. 12/04-2/06

• Medical Biller–A/R Collector-Auditor

n Completed submission billable outpatient office/inpatient surgery services after validating by review/audit.

n Managed overall A/R for all insurance/patient accounts and provided monthly reports to management.

n Implemented/Provided transformation over to electronic clearinghouse billing from paper system.

n Insurance carriers included Medicare, VSP, Medi-cal, Blue Cross, Blue Shield, Health net, and Aetna.

Reason for leaving: Offered new position of career advancement with another company.

UCLA Physicians Support Services Los Angeles, CA. 9/03 – 8/04

• Collector A/R Specialist-SWAT Team-Auditor

n Researched overall A/R professional services of all previously submitted claims for all Insurances.

n Coordinated with supervisors and directors for all corrections needed after audits to validate file history.

n Communicated with management, coders, physicians, specialty providers, patients and insurance companies.

n Worked with Insurance payers of all types, including Medicare, Medi-cal, and Workers Compensation.

Reason for leaving: Extensive commute became an issue with new office location by LAX.

Aetna US Dental, Simi Valley, CA. 10/01 – 9/03

• Customer Service Professional-Appeals Team

n Advised all patients/members/providers regarding every aspect/detail of group benefits/claims status.

n Researched/audited under multiple systems for various problem cases as assigned/directed by management.

n Selected by management for New Formal Appeals Team to handle legal/non-legal correspondence.

n Reviewed and introduced implementation time efficient Macros to be used by all team members.

Reason for leaving: Offered new position of career advancement with another company.

Providence Saint Joseph Hospital, Burbank, CA. 8/01 – 10/06 (Part time/Per diem)

• Charge Coordinator-Trainer-Auditor

n Abstraction all criteria/detail services specific to ED for submission to TDS specialized in house software.

n Provided training/auditing overall abstraction chart review/submission to all department team members.

n Communicated/Coordinated with all ED staff/providers regarding incomplete documentation issues.

n Assisted with completion/provision month end department specific required abstraction detailed reports.

Reason for leaving: Changed to solely on call per diem status not allowing for separate full time position.

EDUCATION/ASSESSMENT

Associate of Arts Degree - Pasadena City College, Pasadena, CA-1983

Completion and Passing – Kaiser PSC Professional Services Coder Assessment Test

Completion and Passing – Kaiser Physician Clinical Documentation & Audit Coding Assessment Test

Certificate of Completion - Medical Insurance Billing, A/R and Collections, Coding (CPT 4, ICD-9-CM)

Certificate of Completion - Medical Terminology, Anatomy of Diseases, Anatomy & Physiology Course

Microsoft Word, Excel version 2010, Allegro, Ezmed, Medisoft, Rumba, SMS, MCCS, 3M. EPIC

Personal and Professional References can be made available upon request.

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