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Certified Professional Coder

Location:
Converse, Texas, United States
Salary:
52000 / year
Posted:
August 23, 2018

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Resume:

Kristie Foster-Bennett

**** ******* **** • Converse, Texas 78109

210-***-**** • ac6sge@r.postjobfree.com

Career Objectives

I look for career advancement success in a dynamic environment of growth and excellence within a reputable organization.

Professional Experience

MCCI Medical Group March 2016 – December 2018

Family / General Practice Medical Coder (HCC, Risk Adjustment)

Pre and Post visit audit review to identify chart completeness of patient diagnosis, manifestations, and comorbidity documentation and denial patterns to ensure successful capture of complete and accurate diagnosis codes including HCC, Risk Adjustment coding with appropriate ICD-10, CPT, CPT2, and HCPCS.

Assigns ICD-10, CPT, CPT2, and HCPCS codes and performed required analysis of physician documentation to ensure all medical records were coded consistently and accurately to the highest level of specificity supported by the documentation including review of Specialist referrals notes (Cardiology, Nephrology, Neurology, Ophthalmology) in accordance to the rules and regulations set forth by CMS.

Demonstrated strong analytical skills for reviewing and abstracting clinical data, and keen attention to detail with interpretation of clinical data including medical terminology and disease process.

Proactively seek strategies to address documentation gaps in the overall patient healthcare by clinical documentation gathering.

Proper coding and documentation guideline education to complete office staff including providers on critical documentation requirements for coding patient encounters to the highest specifity with ICD-10, CPT, CPT2 and HCPCS codes (HCC, Risk Adjustment, HEDIS) regulations set forth by CMS.

Following claim edits rules and guidelines; review denied claims for CCI or DX errors; adjusted codes as needed per medical documentation and sent for resubmission.

Optum Health (Contract) September 2015 – March 2016

Medical Coder, Medicare Clinical Review (Family Practice & General Practice)

Demonstrated strong analytical skills for reviewing and abstracting clinical data, and keen attention to detail with interpretation of clinical data including medical terminology and disease process.

Review clinical documentation and provide education to physicians to ensure successful capture of complete, accurate, and highest specifity of ICD-9 (prior to Oct 2015), ICD-10, CPT, CPT2, HCPCS HCC, Risk Adjustment coding according to CMS’s HCC methodology.

Review and identify denial patterns by claim edits. Maintain updated rules of claim edits, and documentation requirements

Proper coding and documentation guideline education as a Coder to Physician Trainer and staff advocate for ICD-9 (prior to October 2015) ICD-10, CPT, CPT2, and HCPCS.

Acquisition Billing Services/National Neuromontoring (Contract) May 2015-August 2015

Medical Coder

Assign appropriate ICD-9, CPT, and HCPCS codes for Pro & Tech Claims with complete accuracy in a timely manner for IOM-Interoperative Monitoring and orthopedic surgeries. (including but not limited to spinal surgeries for Scoliosis, Kyphosis, Herniation, stenosis, compression, degenerative dx)

Review denied claims for CCI or DX errors; adjusted codes as needed per medical documentation and sent revised coding back to appeals department for resubmission.

Review clinical documentation and provide education to physicians to ensure successful capture of complete, accurate, and highest specifity of ICD-9, CPT, HCPCS coding.

Capstone Chiropractic, Inc., San Antonio, Texas July 15, 2013 – December 8, 2014

Medical Coder/Collections, Office Manager

Responsible for coding all patient charts for Chiropractic and therapy care.

Supervised the daily operations and implemented policies and procedures to ensure the clinic ran efficiently and provided back-up to all departments as needed.

Correspondence with legal offices on letters of protection and reductions. Collected and verified pertinent patient information with the highest level of attention to detail.

Custodian of records: organized, maintained and provided medical records according to HIPAA guidelines.

Demonstrated working knowledge, education and experience with ICD-9, CPT, HCPCS, EHR, EMR and filing claims with insurance, disability, and department of labor.

Review denied claims for CCI or DX errors; adjusted codes as needed per medical documentation correcting and resubmitting claims from the EOB.

WellMed, San Antonio, Texas (Contract) August 3, 2012 – April 12, 2013

Medical Coding Analyst

Demonstrated proficiency in using medical coding systems (e.g., eClinical 7.5 and 9.0,and RightFax), ability to review hand written and EMR progress notes for Risk Adjustment to assign appropriate ICD-9-CM, HCC codes to patient records in DataRapa.

Performed data entry of vitals, supplemental data and any pertinent lab results.

Verified and ensured accuracy, completeness, specificity and appropriateness of the diagnosis codes based on physician’s documentation and according to CMS’s HCC methodology.

Demonstrated strong analytical skills for abstracting clinical data, and keen attention to detail with interpretation of clinical data including medical terminology and disease process.

PacifiCare Secure Horizon, San Antonio, Texas (Contract) January 2006 - August 30, 2009

Medical Call Center Patient Advocate

Assisted members and providers with Network provider contracts, benefit eligibility verification, pre-authorizations, PCP, Specialist and Medical Group enrollment and changes

Assisted utilization management and appeals team in collecting and recording all necessary patient information for claim handing, corrections and resubmission

Troubleshoot COB (Coordination of Benefits) and EOB (Explanation of Benefits) to members

Cambridge Integrated Services, San Antonio, Texas August 15, 2000 – October 6, 2005

Worker's Comp. Adjuster Assistant

Organized and structured an efficient file room, multi-task receptionist.

Promoted to Assistant Adjuster; processed all adjuster files from the initial set up to preparing files for audit, completion of workers compensation and liability information forms, provider check authorization and payment release through Ovation.

Provide correspondence to and from providers, claimants and city officials.

Gathered documentation and procedure requirements to meet all Worker’s Compensation regulations.

Occupational License and Certification

American Academy Professional Coders License Expires September 2019

Education

Hallmark College Associates Degree in Applied Science (Registered Medical Assistant) San Antonio, TX Graduation Date: 4/2012

Sanford Brown College Certificate- Medical Coding and Billing San Antonio, TX Graduation Date: 6/2010

ionHealthcare 2017 RISK ADJUSTMENT: Predictive Modeling, Documentation, & Capture of Diagnosis Codes. (2 day Bootcamp with - Brian Boyce, BSHS, CPC,CPC-I, CTPRP)

Key Skills

Multi-Specialties: 5+ years of direct experience coding complex specialties such as chiropractic, general medicine, family practice, general surgery and geriatrics with accurate application of ICD-9, ICD-10, CPT, HCPCS and E/M codes.

Extensive experience in requirement gathering, clinical documentation and pre/post audit reviews of medical records for appropriate supporting documentation for ICD-CM, HCPCS, CPT and E & M codes. Demonstrated effectiveness in conducting provider queries and reviewing audit claims/denials and communicating with auditors and providers.

As a Certified Professional Coder (CPC), has advanced knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT) as well as working knowledge of industry nomenclature, medical and procedural terminology, anatomy, physiology, pharmacology, and disease processes, and medical records procedures. Demonstrated expertise and competence utilizing ICD-9-CM, ICD-10 CM, CPT, E/M and HCPCS coding guidelines, as well as compliance with CMS guidelines and policies for Risk Adjustment and HEDIS.

Proficiency in use of medical coding software such e-Clinical Works, RightFax and Data Rap, Trinity and REM; and MS Office Suite (Word, Excel, PowerPoint, Outlook). Expertise in medical claims and billing processing.

Strong written and oral communication skills; ability to build rapport and effectively interact with providers and clinical staff and collaborates closely with providers and coding team.

Highly experienced Data Analyst with demonstrated ability for abstracting clinical data to correct and improve coding. Analyzed and interpreted clinical notes, physicians’ documentation and medical records. Regularly communicates with coders and conducts feedback as needed after provider queries.



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