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Certified Coding Specialist/RN

Location:
Green Mountain, North Carolina, United States
Posted:
November 11, 2018

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Resume:

Sandra Pletz

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

Green Mountain NC 28740

Contact No. 484-***-**** • ac7nzq@r.postjobfree.com

PROFESSIONAL SUMMARY

Dedicated Registered Nurse with over 20 years of experience. Focused on providing high quality care and service. I have a Bachelor’s Degree in Nursing (BSN) and am a Certified Coding Specialist (CCS). I have extensive experience in assessment, ICD 9/10 coding, auditing, Medicare, Medicaid, Managed Care Insurance and Federal & State guidelines. Holding roles in Clinical & Administrative Nursing, Diagnostic Coding, MDS Coordinator, Medical Record Review, Management, Utilization Review, Reimbursement, Remote Data Coding/ Hedis Abstractor and Consultant.

QUALIFICATIONS

• AHIMA Member • Inpatient/Outpatient coding • ICD-9/10/DRG/HCPCS Coding

•Customer Service oriented • Hedis measures • Medical Record/Claims Review & Auditing

• Quality Assurance • Computer proficient • Analysis & Coverage Determinations

EXPERIENCE

Asheville HCC, Asheville, NC

Medicare Coordinator/Certified Coder/RN 7/2018 - present

Medical record review, assessment, auditing and Diagnosis coding of sub-acute facility records for accurate billing and documentation requirements for skilled patient population.

Conduct chart reviews for identifying, confirming and documenting appropriate medical coding/Diagnosis and supporting documentation - working with physicians, staff to comply with federal/state guidelines and Insurance companies contract guidelines.

Inovalon, Inc., Bowie, MD

Remote Coding Data Review Consultant (Hedis Project 2018 - Temp/Contract) 2/2018 – 6/2018

•Conduct chart reviews for identifying, confirming and documenting appropriate medical coding/Diagnosis and extracting data to assigned computer systems according to Hedis measures/guidelines.

Brian Center Rehabilitation & Care (Sava Senior Care), Weaverville, NC Registered Nurse Assessment Coordinator 4/2016 – 2/2018

•Excellence in collaboration with providers, physicians, patients, families and other parties to facilitate optimal assessment, care and discharge planning.

•Medical record review, abstraction, auditing and coding of records daily with efficient completion for quality care outcomes, accurate billing and documentation requirements.

•Effective in meeting deadlines, working under pressure and multi-tasking in a busy 130 bed SNF

Sandra Pletz pg. 2

Buckingham Valley Rehab & Nursing Center (Global Health LLC), Newtown, PA

Registered Nurse Assessment Coordinator, Care Manager 8/2007 – 12/2015

•Lead MDS Coordinator for a busy 130 bed long term care and sub-acute rehabilitation facility. Completed federally mandated MDS/Medicare PPS assessments, Coding and care plans with the Interdisciplinary team.

•Experienced in Survey process, Case-Mix, Triple-Check Billing monthly, QI/QM process.

•Effectively communicated in role as Case Manager with multiple insurance companies and conducted comprehensive assessments and status updates on managed care patients weekly.

Select Nurse Staffing

Consultant 6/2004 – 8/2007

•Consultant to facilities for auditing, and performance/documentation improvement, cost reduction, education and development of effective strategies to improve outcomes.

EDUCATION

Capella University, MN Bachelor of Science in Nursing (GPA = 4.0)

March 2014 to June 2017

St Luke’s School of Nursing, Bethlehem, PA Registered Nurse - RN504119L (active)

1992 to 1994

North Carolina Board of Nursing Registered Nurse - Cert. No. 283256 (active)

January 2016

CERTIFICATIONS

Certified Coding Specialist (CCS) – AHIMA – Credential # 221215 5/16/18 – 8/15/2020

Certified Coding Associate (CCA) – AHIMA – Credential # 220863 7/17/18 – 7/16/2020

AHA - Basic Life Support Provider (CPR & AED) Program 2018 - 2020

Certified MDS Assessment Coordinator (CMAC) 2016 – present

Resident Assessment Coordinator – Certified (RAC-CT) 2010 – 2016

TECHNICAL SKILLS

Proficient in Microsoft Word, Excel, PowerPoint, Outlook and multiple healthcare software applications.



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