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Microsoft Office Medical

Kings County, New York, United States
May 28, 2018

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*** ********* **, *** **, Brooklyn, NY, 11218; Cell phone: 347- 461-0624; Email:

SUMMARY: Over 24 years of experience in Health Information Management field which includes

performing MS- DRG validation, auditing of all types of coding, review of records for compliance with JCAHO, CMS and other regulatory agencies’ requirements, physician in-services sessions on ICD 10 CM/PCS coding requirements to ensure accuracy of coding and reimbursement with a greater focus on the fundamentals of ICD 10 CM/PCS coding rules and guidelines as well as on the quality of documentation.


RHIA - Registered Health information management administrator (AHIMA)

CCS - Certified Coding Specialist Certification (AHIMA)

1.Special Contribution Award for successful LOS Project in collaboration with the QA Department.


Participated in “Becoming a mentor” training. Received certificate of mentor.


Participated in the following management seminars in NYC:

oHow to lead successfully in a world of volatility, uncertainty, complexity and ambiguity.

oThe art of listening. The power of speaking.

4.AHIMA-Approved ICD-10-CM/PCS Trainer Certificate

Received Certificate of completion for the AHIMA Academy for ICD – 10 and became AHIMA-Approved ICD-10-CM/PCS Trainer


04/2004 – 5/2018 NY Harbor Healthcare System, VA Medical Center,

800 Poly Place, Brooklyn, NY 11209

Health Information Management Department

Coding Compliance Coordinator

Coordinated daily activities of coding unit through VIP/Quantum case assignment report and electronic distribution of inpatient cases; monitored timely closeout of inpatient cases in accordance with VA regulatory requirements.

Coordinated daily activities of ambulatory surgery coding by running “Case Management” filing status report to ensure timely completion of surgical cases.

Developed and implemented Documentation Improvement Program, commonly asked diagnosis clarification (CHF, ARF, MI, PNA, and Sepsis) statistical reports and documentation specialists’ monthly reports.

Coordinated daily activities of documentation specialists to ensure timely completion of “Physician Query Log”, monitored physician’s response rate

Generated various HIMS statistical reports: coders’ productivity report, census report, case assignment report, coded/uncoded inpatient and ambulatory surgery reports, Physician Query Tracking (PQT) reports of incomplete and abandoned queries and physician’s turnaround time.

Daily MS-DRG Validation review and auditing of inpatient cases.

Concurrent review of MI, PNA, CHF, Angioplasty, Neurosurgery and Late Effect of CVA cases for External Peer Review Audits.

Performed inpatient, and ambulatory surgery coding when coding area experienced backlogs.

Monitored Inpatient Fee Basis timely completion of coding for both, BK and NY campuses

Conducted regular in-service training and monthly coding meetings with inpatient, ambulatory surgery coders and documentation specialists as it relates to accuracy of coding, sequencing, POA indicators, coding guidelines and efficient utilization of the Documentation Query log by documentation specialists.

Conducted regular physician training sessions as it relates to Official ICD -10 CM/ PCS coding guidelines, coding and documentation issues, MS- DRG payment methodology based on DRG audit findings, common coding problems and documentation issues identified by coders and documentation specialists.

Conducted audit of Hospital Complications/Hospital Acquired Conditions cases with Present on Admission Indicator ( POA) – N known as SAIL report

4/2011 - 5/2018 Remote Inpatient and Ambulatory Surgery Coding

Performed inpatient and ambulatory surgery remote coding for TCA LLC,

Managed Resources Inc (MRI),T COOMBS & ASSICIATES (TCA), Sierra 7 LLC, Cooper Thomas, LLC

10/2002 – 04/2004 Mount Sinai Medical Center, Mount Sinai School of Medicine/FPA, New York, NY

Office of Compliance & Regulatory Services

Senior Compliance Regulatory Coordinator/Physician Documentation Compliance Auditor

Developed training materials and conducted comprehensive educational and monitoring programs, and detailed audits of documentation, coding and billing for part B professional services as required and delineated in the Institutional Compliance Agreement with OIG of the Department of Health and Human Services (HHS).

Applied knowledge of Federal (Medicare), State and payer specific regulations and policies to response to the physician’s practices’ inquires and resolve compliance issues regarding documentation, coding and billing requirements.

Provided clinical departments with information and guidelines regarding regulatory affairs, as it pertains to the physician billing activities, non-faculty billing and reimbursement issues.

Developed educational training materials for physicians and staff members regarding HIPAA Privacy Regulations and assisted practices with implementation HIPAA compliance Policies and Procedures.

04/1996 – 10/2002 University Hospital of Brooklyn, Brooklyn, NY

Health Information Management Department

DRG/APC Coordinator

Carried out responsibilities for DRG validation review and monthly quality assurance reports to ensure quality of coding and correct DRG assignment in order to achieve optimal hospital reimbursement

Regularly conducted in-service sessions for coding staff on common coding problems, coding accuracy, correct sequencing of the diagnoses and procedures, CPT and HCPCS Level II coding guidelines and practices, modifiers guidelines, proper documentation and DRG/APC assignments

Performed inpatient, outpatient and ambulatory surgery coding when coding area experienced backlogs

Prepared and distributed physician reminders and conducted physician in-service sessions in an attempt to identify and resolve chart documentation problems. Performed follow-up assessment to ensure the effectiveness of the reminders.

Performed data quality review on outpatient encounters to validate the ICD-9-CM, CPT, and HCPCS Level II code assignment, APC groupings, and to ensure compliance with HCFA’s diagnostic coding guidelines for hospital-based outpatient services

Monitored outpatient case mix reports and the top 25 medical, significant procedures, surgical service, and ancillary APCs assigned in the facility to identify shifts and trends in the facility’s most frequently assigned APCs

Responsible for IPRO & 3rd party payers (BC/BS, HIP) audit appeals to maximize reimbursement

Monitored outpatient unbilled accounts report for outstanding and uncoded outpatient encounters that need to be completed

Responsible for assuring that all medical records are in compliance with regulatory guidelines of JCAHO, STATE and Federal Agencies.

As a member of the APC implementation team, responsible for training physicians and coders in coding requirements relevant to OPPS issues including appropriate selection of modifiers, E&M compliance requirements, Chargemaster updates, etc.

Worked as a liaison person with Patient Financial Services, Information Technology, Admitting Department, and all third party payers regarding billing and reimbursement.

01/2001 – 01/2004 SUNY Health Science Center at Brooklyn, Brooklyn, NY

College of Health Related Profession (CHRP)


“Case Studies” course for Reimbursement Coding Certification Program

07/1995 – 04/1996 Boro Park Primary Care Center, Brooklyn, NY

Medical Billing Coordinator

Abstracting and coding of medical records utilizing ICD-9-CM & CPT-4 coding

Prepared billing statements for Medicare, BC/BS and other third parties

Weekly billing transaction report generation, review and editing

Followed up on all patients’ claims and payments, including handling denials from insurance companies, prepared inquires if payments from carriers are incorrect

Monthly financial report generation and distribution

04/1994-05/1995 Maimonides Medical Center, Brooklyn, NY

Coding internship

Abstracting of patient records

Coding and sequencing all diagnosis and procedures using ICD-9-CM and CPT-4 codes

Assigning DRGs


09/1997 – 12/1999 SUNY Health Science Center at Brooklyn, Brooklyn, NY

Health Information Management Program

Bachelor of Science

01/1995 – 06/1995 SUNY Health Science Center at Brooklyn, Brooklyn, NY

Medical Coding Program

Certificate in Medical Coding

Major Coursework included:

Medical Terminology. Anatomy & Physiology. Pathology & Pharmacology.

Six months on site ICD-9-CM Coding

Computer based DRGS with code finder

08/1994-12/1994 Brooklyn College, Brooklyn, NY

Medical Manual & Electronic Billing Program

Medical Billing Certificate

Major Coursework included:

Electronic transmissions, appointment scheduling, posting payments;

Third party reimbursement (Medicare, Medicaid, BC/BS and other major insurance carriers) procedures, coordination of benefits

Pegboard system, computing Account Receivable and Payable

DRGs, Account Receivable reporting and inter departmental relations

SKILLS: Proficient in Microsoft Office Word, Microsoft Office Excel, Microsoft Office PowerPoint

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