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

Acworth, GA. *****

678-***-****

E-mail abllgw@r.postjobfree.com

RHONDA L. CUMMINGS

PROFILE: Professional with expertise in medical coding and solid

experience in management and medical office

operations. Results-driven individual with a

determination to succeed.

EXPERIENCE: iHealth Technologies Atlanta, GA

Manager, Medical Director Assistants 2008-

Present

Responsible for managing 12 Medical Director

Assistants and overseeing daily operations.

. Effectively created and implemented policies and

procedures in order to standardize departmental

operations.

. Collaborate with cross-functional departments to

ensure execution of effective workflow.

. Responsible for successfully interviewing and

hiring appropriate staff.

. Daily coaching and mentoring of direct reports in

order to enhance performance.

. Assisted with the creation of a new on-boarding

tool for new hires

. Manage and implement high priority CPT and ICD-9

coding changes to ensure external client policy

sets are up to date and accurate.

. Facilitate training session on new applications as

the applications are released into production.

. Developed training program for the department.

. Conduct mid-year and annual reviews for all direct

reports.

iHealth Technologies Atlanta, GA

Medical Director Assistant 2006-2008

Supported the Client Team Medical Director and client

teams in researching and ensuring that all client

payment policies are accurate, up-to-date and

complete.

. Responsible for the review of the client's policy

set on a quarterly basis to ensure client payment

policies were current with industry coding

standards.

. Presented high-impact payment policy changes to

the client for approval.

. Accurately and efficiently responded to client

questions during the presentation of the policy

changes.

. Researched and responded to client payment policy

coding questions surrounding claim denials or

appropriate coding scenarios.

. Ensured client's policy set was updated for all

new annual CPT and ICD-9 changes.

. Maintained extensive CMS, CCI, CPT knowledge in

order to provide expertise in coding advice and

support for the client.

. Performed Data Analysis to identify coding

aberrancy and/or provider outliers.

WellStar Health System

Kennesaw, GA

Coding Education Specialist, MA,CPC 2004-2006

Responsible for auditing medical records for the Hospital System to

ensure appropriate reimbursement.

. Conduct chart audits to ensure that the

appropriate ICD-9-CM, CPT-4, HCPCS coding, and

modifiers accurately reflect the nature of the

services rendered.

. Created and presented educational sessions for

physicians and staff based on audit findings.

. Extensively researched the Medicare and Medicaid

regulatory website to support appropriate coding

scenario.

. Audits consisted of multi-specialty physicians

with expertise and a concentration on Evaluation

and Management audits.

. Assisted the Central Business Office in resolving

coding-related denials and appeals by comparing

procedures reported on the claim with the

documentation in the medical record.

Medical Management Professionals Kennesaw, GA

Professional Coder, CPC 2003-

2004

Responsible for accurately coding radiology

services.

. Assign ICD-9-CM, CPT-4, HCPCS codes and modifiers

to all radiology services.

. Responsible for assigning CPT-4, ICD-9-CM for all

global sites.

. Code Interventional Radiology evaluation and

management inpatient /outpatient charges.

. Assist Supervisor with coding audits.

. Responsible for training new hires.

Per-Se Technologies-Compliance Atlanta,

GA

QA and Regulatory Auditor, CPC 2003-

2003

Responsible for performing internal post payment

audits.

Conduct sample audits to ensure that the

appropriate ICD-9-CM, CPT-4, HCPCS codes and

modifiers accurately reflect the nature of the

services rendered.

. Specialties include Radiology, Anesthesia,

Pathology and Emergency Department. Proficient in

Evaluation and Management.

. Ensure sites are following Medicare and Third

party payer guidelines.

. Conduct conference calls with various sites to

review audit findings.

Henry Ford Hospital - Revenue Team Detroit,

MI

Specialty Associate, CPC 2001-2002

As a Specialty Associate, my primary role was to educate physicians

on proper documentation to ensure optimal

reimbursement.

. Read and interpret medical records and other

documentation to determine precise nature of

professional services rendered.

. Conduct chart audits to ensure that the

appropriate ICD-9-CM, CPT-4, HCPCS coding, and

modifiers accurately reflect the nature of the

services rendered.

. Develop and conduct training and educational

sessions on ICD-9-CM, CPT4, HCPCS coding.

. Provide on-going charge document training and

consulting support to the providers.

. Create and review billing forms (HFHS OMR) for

quality assurance.

. Serve as a liaison among the assigned departments

and/or physicians.

. Review ED and all primary care documentation.

. Support ED coders by keeping them apprised of new

coding issues via monthly ED meetings.

. Generate rejection reports for physicians.

. Review insurance rejections and identify error

trends.

William Beaumont Hospital - Outreach Royal

Oak, MI

Office Manager 2000-2001

As an Office Manager, I provided daily support and direction to both

the physician and staff. Other responsibilities

included:

. Managed Accounts Receivable.

. MBS experience (electronic billing system).

. Implemented policies and procedures.

. Responsible for managing staff and the scheduling

thereof.

William Beaumont Hospital - Medical Staff Royal

Oak, MI

Practice Operations Assistant 1998-2000

As a Practice Operations Assistant, I provided operational support

under the direction of the Operations Manager. My

responsibilities included:

. Coordinated and assisted in the setup of multiple

practice sites, including the purchase of

equipment and supplies.

. Developed and implemented policies and procedures.

. Monitored physician enrollment.

. Assisted in the preparation of financial

spreadsheet data.

. Responsible for interviewing and hiring physician

support staff.

. Supervision and training of medical staff.

. Prepared offices for insurance credentialing

inspections.

. Set up CLIA Certifications for the various

physician offices.

. Provided support to physician and employees

through effective communication and organizational

skills.

Beaumont Reference Laboratory Royal

Oak, MI

Technical Field Representative 1995-1998

As a technical field representative for Beaumont Reference

Laboratory, my responsibilities include:

Assist the Sales Department in maintaining and supporting a client base.

Troubleshooting problems, determining appropriate action, and implementing

client solutions.

3. Created and implemented a Customer Satisfaction Survey.

. Maintained knowledge of Healthcare insurance

changes.

. Travel to various clients assuring customer

satisfaction.

William Beaumont Hospital-Troy Troy,

MI

Phlebotomist 1990-1995

As a Phlebotomist my responsibilities included:

. Collection of patient blood specimens.

. Acted as Team leader coordinating workflow.

. Assisted in computer down times, HDS proficient.

EDUCATION: Oakland University

Completed 72 credit hours towards Nursing Degree

St.Clair Community College

Completed pre-requisite classes toward Nursing Degree.

Macomb Community College

Completed pre-requisite classes toward Nursing Degree.

Carnegie Institute

Completed Medical Assistant Program.

CERTIFICATION: Certified Professional Coder (CPC-P, CPC-H) through AAPC.

KNOWLEDGE AND SKILLS:

. Extensive, in-depth knowledge of ICD-9-CM, CPT-4,

HCPCS coding, modifiers usage, and Physician

Medicare Fee Schedules.

. Extensive knowledge of CMS, OIG regulations, and

policies relating to medical billing and

reimbursements.

. Extensive research skills

. In-depth understanding and interpretation of

medical coding for Physician, Outpatient and

Ambulatory Surgery

. Knowledge of Windows 97, Microsoft Office software

(including Microsoft Word 7.0 and Microsoft Excel

7.0), Word Perfect

.

REFERENCES: Available upon request.

Rhonda Cummings

2307 Starr Lake Drive

Acworth, GA 30101

678-***-****

E-mail: abllgw@r.postjobfree.com

To Whom It May Concern:

I recently learned you are looking for an ambitious individual to join your

team.

As you can see from my resume, my twenty years experience in healthcare and

working with physicians coupled with my coding, and communication skills

would enable me to successfully promote the growth of your organization. In

addition, I possess the skills and knowledge needed in government rules and

regulations, management, and third party billing. All the above skills have

familiarized me with time management, which enables me to effectively meet

deadlines.

I am extremely ambitious and have a need to become successful in everything

I do. My work experience gives me the background I need to ensure a

prominent future. I am confident I could make a significant contribution to

your company.

If you have any questions regarding my resume please feel free to contact

me at 678-***-****. I am looking forward to hearing from you and am

excited at the prospect of becoming a part of your organization.

Respectfully,

Rhonda L. Cummings

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