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Certified Professional Coder

Location:
Federal Way, Washington, United States
Salary:
55-60K a year
Posted:
May 16, 2018

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Ronald G Weightman

CPC CMRS CEMA

Cell # (206) ***-****

Email: ac5hkh@r.postjobfree.com

Candidate Highlights

Pro-Fee Coding Experience

Outpatient Coding Experience

E&M Auditing Experience

Epic Experience

OB Coding Experience

Performing Office Procedures

3M Encoder Experience

Anatomy and Physiology

Medical Terminology

Revenue Cycle and Reimbursement

Specialties

Primary Care, Multi-Spec, Psych, Plastic, Transplant, Endo, Neuro/Surgery, Rheuma, Derma, Claim Edits, Denials, OB/GYN, Diagnostic Radiology

Demonstrated ICD-10-CM proficiency

Demonstrated understanding of the CPT guidelines for separate procedures, bundling and add-on-codes

Experience in abstracting medical records for accurate CPT, ICD10 and HCPCS code/modifier assignments

Understanding and application of CMS initiatives including NCCI Edits, PQRS and NCD/LCD polices

Denials, Claim Edits

Physician Education

Certifications

Member of American Academy of Professional Coders CPC (01154201)

ICD-10 Certified

Member of American Medical Billing Association CMRS (6832620)

Member of National Alliance of Medical Auditing Specialists CEMA (12693)

HCC Risk Adjustment-Coding Compliance Institute March 2016

Education

Highline Community College- Medical Insurance Coding, Patient Account Specialist

Work Responsibilities

-Performs medical records and chart audits to ensure all diagnosis and procedure codes that are submitted are appropriate, accurate and sufficiently supported by written clinical documentation including co-morbidities.

-Responsible for abstracting and providing CPT, ICD, and HCPCS codes for procedures. -Resolves coding related edits and denials, and provides ongoing physician feedback and education.

-Identified areas for provider improvement in chart documentation and coding, provided meaningful feedback to providers regarding their coding, and ensured providers received feedback necessary for them to improve their chart documentation and coding in a timely fashion.

-Performs new provider audits per departmental policy analyzing trends for educational opportunities.

-Provided coaching and consultation to providers/managers/directors/staff to ensure understanding of documentation gaps and the revenue cycle.

-Placed emphasis on compliance with Risk Adjustment procedures and protocols, internal controls, while maintaining the highest level of workplace behavior; assist with compliance audits, as needed.

-Ensures compliance through demonstrated knowledge of Federal regulatory and commercial payer guidelines for documentation, coding and billing.

-Assists in the creation of departmental policies and updates forms and manuals to remain current and effective.

-Maintains current on any regulation, best practices, or processes related to the implementation of ICD-10, and provides education and knowledge to all affected providers and staff members.

-Reviewed, analyzed and modified data to meet customer needs.

-Collaborates with Professional Services Coding & Revenue Educator in the creation of documentation and coding job aids and best practice tools related to E&M, procedure and diagnosis coding for providers.

-Provided technical assistance with process improvement tools, methods and data and was a resource for medical coding related issues and questions.

-Maintained confidentiality of records and/or medical center information at all times.

Remote, Temp and Travel Work

ThedaCare-Remote Contract Primary Care, Multi-Spec

Profee/OP Auditor January 2018 – March 2018

UofC-SF -Remote Contract Primary Care, Multi-Spec

Profee/OP Auditor Nov 2017-January 2018

St Luke’s Hospital- Remote Contract Primary Care, Multi-Spec

Profee/OP Auditor Jun. 2017- Sept 2017/ Dec 2017-January 2018

Plastic, Transplant, Neuro/Surgery, Derm, Endocrine

Seattle Children’s- Remote Contract

Outpatient Coder/Auditor Sept 2017-Nov 2017

Cleveland Clinic, Cleveland, OH- Remote Contract

CDI Specialist/Denials Mar. 2017- June 2017

Denials, Claim Edits, Multi-Specialty

UW VMC- Temp Contract

Coding and Revenue Auditor Nov. 2016 – Feb. 2017

Pacific Medical Center-Temp, Seattle

Senior Coding Analyst May 2013 – Jul. 2013

Catholic Health Initiatives, Federal Way, WA

HCC Auditor and Coding Specialist Feb. 2016 – Nov. 2016

The Risk Adjustment Specialist will coordinate and lead a variety of risk adjustment projects across the enterprise. This person will be a subject matter expert in Medicare Advantage, with knowledge across prospective programs, retrospective programs, submissions, and compliance. This person is responsible for monitoring all company processes and activities related to the complete, compliant, accurate, and timely processing of encounter data.

Essential Duties

•Understand and adhere to all Risk Adjustment regulations and deadlines set forth by CMS

•Work with third party vendors to implement risk adjustment projects

•Oversees clinician chart audit activities and coordinates operational aspects of clinical chart reviews, including identifying and data mining patient lists, coordinating chart provisions with reviewers, communicating results to rendering physicians and tracking and analyzing findings

•Analyze and interpret encounter data to identify trends and the root cause of errors

•Work with claims, enrollment and Medicare teams to resolve data submission errors from Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS)

•Assist in developing Risk Adjustment Data Validation (RADV) audit procedures and provide support in a RADV audit

•Assist in developing monthly and ad-hoc reports on risk adjustment project status, both financial and operational in nature

•Assist in developing Risk Adjustment departmental policies and procedures to support Risk Adjustment

Facilitate regularly scheduled Risk Adjustment work group meetings

Provide status updates and review of programs to management

Create a team oriented work climate that enables professional development and encourages creative solutions and strategies to issues and projects

Provide mentoring of project team with the goal of developing and retaining talent within the organization

•Contribute to team efforts

Mednax Hospital- OutPatient, Seattle, WA

Certified Professional Coder II Dec. 2013 – Nov. 2014

Clinic, In/Outpatient, ED and Profee. Abstracting ICD9 codes most appropriate per provider documentation and medical necessity

Review denials, correct errors, review trending and educate clinic, business office staff and providers

Perform audit review of medical record documentation and recommend appropriate documentation coding corrections

Review business office performance and recommend appropriate changes to increase productivity

Assist billing staff with charge posting, preregistering and cash posting when needed

Review balances owed, ABN’s, Promissory notes, and EOB’s with patients

Review CPT and diagnosis code assignment for correct coding (highest degree of specificity). Evaluate accuracy.

Perform provider chart audits to determine if documentation supports coding.

Review exams that have been pended for incomplete documentation.

Review feedback from external auditors and help to educate providers..

Assist in auditing US and radiology reports to assist providers education.

Assist in providing feedback to the Coding Supervisor for development of department documentation for all coding processes.

Participate in meeting end of month assignments to ensure office production is maximized and month end disruption minimized.

Group Health Cooperative/Kaiser- Tukwila, WA

Billing/Coding Specialist II Jun. 2011 – Apr. 2013

Multi-Specialty clinics, Behavioral Health and Hospital based. Reviews coding on denied claims for multiple specialties physician practices, inpatient, outpatient and ASC. Resolves complex payer denials related to coding issues. Analyzes medical records and abstracted data to determine the accuracy of payment and code assignment and adequacy of clinical documentation in accordance with regulatory requirements. Provides feedback and documentation advice to the appropriate individual as trends are revealed.

A3 thinking/process. LEAN concept

NeighborCare Health, Seattle, WA

Certified Professional Coder Feb. 2011 – Jun. 2011

Multi-Specialty clinics and Behavioral Health. Assign diagnostic and procedural codes to patient charts of moderate to high complexity levels using ICD-9 and CPT, HCPCS, and any other designated coding classification system in accordance with coding rules and regulations. Essential functions include but are not limited to:

• Reviews medical records for the determination and accurate assignment of all documented diagnoses and procedures.

• Assigns and sequence codes based on medical record documentation.

• Abstracts and enters coded data and designated quality management data for reporting requirements.

• Communicates documentation improvement opportunities and coding issues (discrepancies, physician queries, etc.) to the appropriate personnel for follow up and resolution.

• Serves as a functional resource for entry-level coders and mentors/trains other coders as needed.



Contact this candidate