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Medical Manager

Location:
Oakland, California, United States
Salary:
80,000.00
Posted:
November 16, 2018

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Resume:

Narda J. Mattos, CCS, CPC, CPC-I, CPMA

Certified Coding Specialist

Certified Professional Coder

Certified Professional Coding Instructor

Certified Professional Medical Auditor ac7pux@r.postjobfree.com

121 Embarcadero West Apt. 2224

Oakland, CA 94607

Home: 209-***-****

Professional Profile Certified Coding Specialist with 25 years in the industry, with specific expertise in coding and revenue cycle for Medicare, Medicaid, PPO and Workers Comp. Also experienced in the FQHC/RHC (Federally Qualified Healthcare Clinic/Rural Health Clinic) setting. Skilled in CPT, ICD-9, ICD-10, HCC, HEDIS Measures, HCPCS, compliance, instruction, code-set training and official guidelines. Most recent experience includes proficiently coding/auditing/training physicians in accurate coding and documentation. Proficient in Coding Clinic, 3M software, Epic, Cerner, Excel, Word, Power Point as well as the ability to research the internet for multiple resources to perform my duties.

Experience July 2017 – Present University Healthcare Alliance – Stanford Healthcare

Coding Quality Coordinator – Chart Pursuit

Responsible for training physicians in P4P, HEDIS/Quality Measures

Review assigned medical records to abstract clinical data elements for P4P/HEDIS reporting, e.g. results of laboratory tests, the most recent blood pressure reading, prenatal and postpartum care services, etc.

Document abstraction findings into HEDIS database tool

Communicate additional pursuit strategies for additional medical records, if needed, to other members of the team

Integrate data collected from a variety of electronic and paper sources

Communicate significant findings, including potential risk management issues, to the Lead Population Health Nurse in a timely manner

Nov 2016 – Present Dec 2015 – June 2017 Kaiser Permanente

Manager, Finance Department

Manage 15-28 Remote Auditors to ensure quality documentation by clinicians

Review disagreements by QA department and discuss with staff/auditors

Manage/discuss appeals with remote auditors

Provide daily/weekly/monthly feedback with auditors regarding disagreements/appeals

Create and conduct monthly webinars for auditors and QA staff to ensure consistent distribution of information throughout the department

Promote the highest quality output of information to leadership

Complete and conduct yearly evaluations for staff

Dec 2013 – Oct 2015 Golden Valley Health Centers Merced, CA

Director of Revenue Cycle Department

Project Lead, ICD-10 Implementation

Direct billing management and staff to ensure that accurate submission of all claims and timely collections occurs in accordance with all third-party contract terms including, Medicare, Medi-cal, managed care, commercial insurance, and direct patient pay

Manage medical coding department, auditing of charts and provide feedback to clinicians to ensure coding integrity throughout the organization

Manage continuous improvements within the revenue cycle process

Provide mentoring, coaching and performance reviews for direct reports

Manage all outreach billing operations, including hiring, orientation, training, development, coaching, corrective actions, and ongoing monitoring of all staff work-related activities

Ensures consistent quality of the billing services by distributing and assigning duties and responsibilities to employees, ensuring skill levels are appropriate to the assigned tasks, and monitoring the department’s productivity

Sept 2010 – 2013 Kaiser Permanente-DSA Walnut Creek, CA

Data Quality Trainer

Responsible for auditing Clinical Documentation Integrity, both in the outpatient and acute inpatient areas

Audit ICD-10 CM and PCS for readiness. Develop and deliver training material to ensure that physicians and staff would be prepared for rollout.

Responsible for training and providing feedback to clinicians in order to properly capture, document and address conditions which are reported to CMS and other payers

Assist auditors in providing quality feedback for CMS reporting purposes

Develop and deliver detailed training materials for clinicians to ensure proper coding and documentation of chronic conditions

Have been an instrumental part in increasing physician coding accuracy by 20% in the past 12 months

2008-2010 Kaiser Permanente-Regional Livermore, CA

Medical Documentation Auditor

Responsibilities included auditing diagnoses to validate HCC’s and identify problem areas for better physician training and feedback

Responsible for auditing E&M, CPT, ICD-9 and HCC codes for outpatient, ambulatory and ED

Identify and report missed opportunities

Research all coding and reimbursement sources to accurately identify correct coding

Jan-Apr 2008 Alta Bates Comprehensive Cancer Center Berkeley, CA

HIM Coder

Responsibilities included abstracting pertinent medical information from patient charts

Assigning correct and accurate CPT, Diagnosis and HCPCS codes including correct use of modifiers to ensure maximum reimbursement

Preparing reports to identify missing information

Attention to detail when coding for accuracy

2001-2009 MedTech Medical Billing Tracy, CA

Revenue Cycle Director

Responsibilities included managing and directing all activity for the billing and coding departments with a staff of 10+. This included verifying all patient and insurance information

Posting all services; including office, inpatient and outpatient surgery, Medical Legal Reports, deposition and expert testimony

Weekly reporting of all activity to client. Involved with decision making to improve the quality assurance and accounts receivable in the billing department. Responsible for reviewing CPT, ICD-9, HCPCS and their accuracy for reimbursement purposes

1998-2001 No. Ca. Neurosurgery Fremont, CA

Medical Billing Manager/Coordinator

Responsibilities included managing and directing all activity for the billing and coding departments. This included verifying all patient and insurance information

Posting all services-including office, inpatient and outpatient surgery, Medical Legal Reports, deposition and expert testimony

Weekly reporting of all activity to the clinicians and President/Owner of the company. Involved with decision making to improve the quality assurance and accounts receivable in the billing department

Responsible for assisting with the professional growth of the billing staff in order to provide support for a more productive billing department, while keeping the overhead costs at a minimum. Responsible for decreasing A/R by 25%

Education 1986 A.A. Stagg - Stockton, CA

2008 LS Coding/CPC preparation

Certificates Certified Coding Specialist, AHIMA. Certified Professional Coder, AAPC, Certified Professional Medical Auditor, AAPC, Certified Professional Coding Instructor, AAPC. Currently hold certificates for Medical Manager Fundamentals Training, and Report Generation. I also hold Certificates of Completion in Professional Supervision Skills, State of California-Division of Workers’ Compensation, Billing Management, Medicare and Private Insurance Workshops, Extended Training for billing by the American Association of Neurological Surgeons, Collection Law, and various awards of excellence from my previous employment, including Perfect Attendance and Appreciation Awards. Also am current with Medicare Compliance Rules and Regulations.

Computers NextGen, Lytec, Medical Manager, Infinity, Epic. Coding Clinic, 3M, Windows, Microsoft Office, Word, and Excel, Fully literate with Internet Services. Well versed in remote work.



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