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CPC, CMRS

Location:
Waseca, Minnesota, United States
Salary:
59,500
Posted:
September 17, 2018

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Resume:

Julie Keane, CPC, CMRS

507-***-****

ac62zb@r.postjobfree.com

Professional Summary

Results driven, client focused administrative professional with progressive responsibility. Proven success in building relationships and providing support to all levels of the organization, ensuring organized office management processes that drive the short and long-term strategic goals of the business.

EXPERIENCE

The CSI Company, Inc May 2017-July 2018

Telecommute/Contracted HCC Sr. Coding Auditor, Certified Professional Coder

Certified Medical Reimbursement Specialist

Responsible for auditing HCC codes on medical provider clinical documentation while adhering to Medicare Advantage Plans regulations and Risk Adjustment guidelines. ICD-10 Certified, ICD-9, CPT and HCPCs knowledge.

Review and analyze patient documentation to assign correct HCC codes for reimbursement

Sustaining the accuracy of data inserted in the company software and completing around 26-33 charts every day.

Strong knowledge base of medical terminology, Medical abbreviations, disease processes

Met daily production goal and quality goals

Ability to be flexible in work environment with organization skills

Adhere to The Health Insurance Portability and Accountability Act (HIPPA)

Maintain professional certification

Staying abreast with changing coding guidelines

Hennepin County Medical/Trauma Center-Minneapolis, MN January 2016-May 2017

Telecommute Certified Professional Coder II, Certified Medical Reimbursement Specialist

Responsible for assigned medical charts to code for family practice clinics, dental clinics and outpatient, CDT, ICD-10 Certified, ICD-9, CPT, HCPC, Medicare Risk Adjustment-HCC, charge entry, medical terminology; required knowledge of Medicare requirements, Federal and State billing regulation/coding changes.

E/M leveling (Evaluation and Management Coding)

Reviewed and analyze patient medical charts electronically

Abstracted and code diagnosis documentation information

Provided effective feedback to the providers and fellow coders

Met daily production goal and quality goals

Identified and resolved clinical documentation and charge capture discrepancies

Maintained coding education and certification

Accurately assign and sequence ICD-10-CM and CPT-4 code(s) for multiply specialties

HCC auditing-2+ years

Mayo Clinic Health System Faribault/Owatonna/Waseca, MN January 2006-January 2016

Certified Professional Coder II

Responsible for clinic patient medical coding; Medicare Risk Adjustment (HCC), ICD-10 Certified, ICD-9, CPT and HCPCS, charge entry, Prior authorization coding for outpatient physician and medical terminology; requires knowledge of Medicare requirements, federal and state billing regulations/coding changes.

Analyzed clinical documentation; assigned appropriate diagnosis and procedures

E/M leveling for Provider Based specialty clinics and Critical Access Hospital

Abstracted the codes and other clinical data

Identified and resolved clinical documentation and charge capture discrepancies

Provided feedback to the physicians and fellow coders

Met departmental quality and productivity standards

Accurately assign and sequence ICD-10-CM, HCPCS and CPT-4 code(s) for multiply specialties

Staying abreast with changing coding guidelines and government regulations as well as insurance specific coding guidelines.

Certified Medical Reimbursement Specialist January 2006- January 2008

Responsible for clinic medical coding; ICD-9, CPT and HCPCS, charge entry, insurance billing and claims for various insurance carriers (Tri Care, Tri Care for Life, VA, MMSI, M.A., NO Fault, WC, MC/Uni Care, MMSI/SCHA); requires knowledge of Medicare requirements, federal and state billing regulations/coding changes, MN Work Comp law, HCFA 1500 and UB94 insurance claim forms, explanation of benefits statements, preauthorization and medical terminology.

Processed inpatient and outpatient claims as well as secondary insurance billing for hospital and clinic

Completed work comp and disability forms for physicians for review and approval; provided chart, dictation and relevant information needed to complete and remit forms

Identified unpaid claims; researched and resolved by providing supporting documentation or appropriate coding to ensure timely and accurate payment; requested reprocessing as needed to ensure accurate payment

Generated and reconciled daily/monthly reports for clinic and hospital accounts; reprocessed outstanding items, reconciled lab and charge slips and completed all required documentation for insurance submission

Served as liaison between patient and insurance carrier to resolve issues related to coverage for procedures, reason for non-payment or delay in payments; ensured dictation accompanied claim to ensure appropriate payments

Program Assistant - Adult Mental Health Case Management January 2009-October 2010

South Central Human Relations Center, Owatonna, MN

Manage administrative data regarding client service eligibility to ensure timely and accurate responses.

Oversee case manager’s maintenance of the necessary monthly paperwork

Drive client information for administrative reports in order to maintain the integrity of the data

Lead and coordinate the flow of information for claims submission

Provide customer service by answering phones and directing calls to the appropriate case managers

Complete general office duties

Generate monthly billing for adult case managers and child case managers

Rep-Payee Assistant; pay bills and balance clients checking accounts monthly, file and keep accounts organized

Cashier 2006-2009

Wal-Mart, Waseca, MN

Participated as a member of interior construction crew responsible for initial store set up; assembled shelving, set up displays and stocked inventory according to store instructions and parameters; performed a variety of other responsibilities

Served as cashier providing customer service/check out; answered phones and directed callers for multi-line phone system; responsible for balancing register of receipts ranging from $10,000 to $20,000 per shift

Customer Service/Classified Ad Specialist 1998-2006

Arabian Horse Times Magazine, Waseca, MN

Provided clerical support to classified advertisement and graphics departments by working with customers to prepare advertisements and type classified ad within tight timeline; cleaned, cropped and retouched photos in preparation for print

Served as receptionist and answered multi-line switchboard; directed callers, resolved issues and answered questions from advertisers and horse owners

Responsible for shipping magazines and merchandise to customers; saved $10,000 a month in shipping costs by selecting most appropriate delivery method

Recipient of employee of the month award; awarded for teamwork, initiative and managing costs

ADDITIONAL SKILLS

Standard Microsoft Office Suite: Outlook, Word, Excel, Internet, PowerPoint

Medical claims and billing systems: HCC Coding Assistant, Epic, Cerner, Meditech, LSS, MRMS, Rycan, Quantum, MedAssist/Code Correct, ICD-10 certified, ICD-9, CPT, HCPCS, CDT, EMR

EDUCATION

Certified Medical Reimbursement Specialist (CMRS): U.S. Career Institute, AMBA

Certified Professional Coder (CPC): AAPC Certified Coder Training: LS Coding & Education LLC

Online Evaluation and Management Training

Online HCC Risk Management Training

Medical Billing and Claims Specialist Diploma: U.S. Career Institute

ICD-10 Certified

Quality Supervisor Management Certificate, Medical Terminology: Riverland Community College

Phi Theta Kappa: Riverland Community College

Certified Dental Assistant, Certified Dental Practice Management: Rochester Vocational Technical Institute

ACTIVITIES

American Medical Billers Association (AMBA) Member

American Academy of Professional Coders (AAPC) Member

Waseca Co. Red Cross Executive Board Member/Chairman

Waseca Co. 4-H Project Leader



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