Medical Manager
Resume:
Mr. John Nelka, Jr.
Dallas, Texas 75228
**********@*********.***
Certified Professional Coder with more than 15 years of experience in acute care and practitioner
environments seeking challenging position to apply documented skills in medical coding,
credentialing and related fields. Certified in hospital specialization coding with proficiency
certifications in radiology, cardiology and orthopedics. Certified in the Professional Medical
Coding Curriculum of the American Academy of Professional Coders and instructor for
advanced coding classes in both the Dallas and Collin County Community College Districts.
Proficient in ICD-9, CPT, 3M, MedSoft, DRG coding and other IT applications.
Education: B.A. – English, Southern Methodist University
Certifications: Certified Professional Coder-Hospital, 2000
Certified Professional Coder, 1999
Experience Independent Auditor/Consultant (Jan 2010- current)
Perform Inpatient coding RAC auditing for Acute Care Facility
Urgent Care Facility, Step Down Facility, Long Term Care Facility
Interventional Cardiology/Electrophysiology, Hematology/Oncology
Internal Medicine, Home Health Care
Code/Audit medical records with clinical protocol criteria; i.e.
Millman, Robertson, SNOMED, LCD, NCD, guidelines
Utilize software such as Quadramed, 3M, Athena, Medisoft, Lytec
Various equipment HL 7 hardware interface as Varian Radiation
Machines, Electronic Fund Transmissions, EFT, THIN,Availity
Software and McKesson, IVANS, and PECOS clearinghouse
Make Clinical presentations to physicians and recommendations
Perform credentialing, through CAQH, contracting, local IPA’s
Experience: Business Manager
Gulf Coast Oncology Associates (2005-2010)
• Performed all chart audits, charge capturing, data administration
updates
• Conducted all credentialing, networking, contracting for five radiation
treatment centers
• Directed all IPA contracting and hospital privileging
• Performed all marketing and network functions
• Established and credentialed rural clinics
• Hired and terminated staff
• Obtained malpractice insurance and liability coverage on all centers
• Performed all accounts payable/receivable activities
Internal Chart Auditor/Medical Records Manager/HIPAA and Compliance
Officer
CSANT/Cor Medical Services (2004-2005)
• Performed internal chart audits of 53 cardiologists including education
and training
• Responded to all legal depositions, subpoenas, medical malpractice
litigation, and billing records
• Oversaw offsite medical records personnel and Iron Mountain
retention policies
• Oversaw six internal certified coders and three external coders
performing quality reviews
• Served as HIPAA and Compliance Officer
• Provided technical support as hospital liaison
• Performed credentialing of physicians and clinical staff
• Coordinated efforts with consulting group to interview/hire physicians
Senior Billing Specialist/HIPAA and Compliance Officer
Legacy Heart Center (2003-2004)
• Performed daily charge encounter entry for 14 cardiologists
• Conducted revenue/chargemaster analysis for correct reimbursement
• Managed advanced reimbursement audits to ensure maximum revenue
receipt
• Served as chairman of HIPAA/Compliance committee
• Performed credentialing of physicians and appropriate clinical staff
Additional
Experience: Certified Inpatient Coding Specialist (contract position)
Parkland Hospital / Ernst & Young (2003)
Supervisor / Certified Coder
Questcare Practice Management (2003)
Certified Coding Specialist / Senior Project Reimbursement Specialist
Coram Home Care (2002-2003)
Certified Coding Specialist/Senior Collector - Medical City Dallas
Hospital Radiology Consultants of North Dallas (2000-2002)
Senior DRG Negotiator/Discounter
Texas True Choice (1998 -2000)
Coding Specialist/Senior Collector
Insight Health Corporation (1994-1998)
Senior Long Term Care Coordinator
Visiting Nurse Association (1990-1994)
Honors and
Professional
Associations: Past President, American Academy of Professional Coders, Dallas Chapter
National Board Member, American Health Information Management
Association
Member, American Academy of Professional Coders
Member, International Claim Association
Member, Editorial Review Board, STEP-BY-STEP Medical Coding, 2008
ed.
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