Compliance Coding Auditor Specialist

ROGER DALE MOSS JR., CPC, CCP

Murfreesboro, Tennessee 37130

Cell 502-***-**** *********@*****.***

OBJECTIVE:

I would be interested in considering the position in the Certified Compliance Auditor and or Medical Auditor Consultant with EHR Compliance Coding Auditing, with utilizing my skills to succeed in an environment of growth and excellence, with a job which provides me with job satisfaction and self- development (growth). In addition to helping you to achieve organization goals (CSI Company) with regards to Coding and Compliance Issues. I am willing to relocate

(remote) for the right position if needed.

EDUCATION:

2005-2007 Jefferson Community and Technical College Louisville, KY Diploma- Certification Medical Coding 2007

Summer 2018 HEDIS Workshop, Certification 8/2018

AAPC ICD-10 Training Workshop for new onset activation 2015. PROFESSIONAL MEMBERSHIPS; American Academy of Professional Coders-CPC Professional Healthcare Institute of America- CCP Member since 2009. KNOWLEDGABLE SOFTWARE:

Windows10, Microsoft Outlook, AS400, 3M, Assets, Misys, RVI PC Imaging, Smart, CATS Auditing Systems, Eclinica Works, eCW, eBridge, Impromptu, PowerPoint and Microsoft Office. Along with Greenway Intergy EHR Systems, and Greenway Intergy Billing System. NEW system for auditing provider documentation working with (Audit Manager). Current position includes Healthicity Audit Manager System regarding E/M services with provider education. Current

(Pain Management), Also provides CMS guidelines, and ICD-10 and CPT rules and guidelines. SUMMARY OF QUALIFICATIONS:

Auditing of physician medical record documentation, coding, and quality that impact all service lines – Anesthesia, Emergency Department, Radiology, Oncology, Neurology and Office Based Practice, and Pain Management Knowledge of ICD-10 through AAPC workshop, HCPCS and CPT coding under CMS guidelines, with advanced medical terminology and anatomy skills. Outlined a financial impact for the following specialties listed above. This is in regards to over payment and reduction in revenue.

Special projects including MRA coding and HEDIS Measurements and E&M Office Based Coding, with training new associates with all aspects of E&M coding. (HPI, ROS, EXAM 1995 & 1997 guidelines along with all three measures for MDM decision making process, along with HCC’s. Have effective written and verbal communication skills, along with inter-office organization skills. With regards to discrepancies for insurance denial claims and Medicare/Medicaid audits request for additional information upon immediate notification. I am a self-motivated and independent decision maker with creative thinking skills. With the ability to meet multiple deadlines with production and quality compliance coding, by abstracting documentation from EHR/ Multi record Systems. Knowledge of new PQRS Programs through 2017 with Medicare EHR incentives, A team player with training fellow associates with Office Based Coding with E/M procedures along with hospital procedure coding. Training new associates, as part of management as team lead, with Medical Record software experience including Lotus Notes, Internet Excel Microsoft Office, Word and Access Databases along with other office systems listed above.

WORK EXPERIENCE:

2018-Present Physicians Consulting Knoxville, Tennessee Compliance Coding Auditing Specialists

At present I am reviewing patient appointment logs for assessment of medical evaluation of diagnosis and procedure coding documented, Along with correct provider credentialing regarding insurance verification with new and established providers, posting using Greenway Billing System for payment. Following CMS Guidelines assigning the correct evaluation and management levels for the pain management clinic; this includes any and all modifiers. Reviewing all lab documentation for Analyzer and Rapid Cup completed procedures and others; Vsat, HRV, ECG, Sudo, PHQ-9, DME (Durable Medical Equipment)and modifiers, Pulse Waves Velocity. This includes Trigger Point Injections, Dosage Calculation Conversions, and Consent for procedures under HIPPA guidelines. With administration of drugs and waste, and procedures for drug storage, reconstitution and administration should conform to applicable Federal Drug Administration (FDA) guidelines and provider scope of practice. This includes correction of ICD-10 coding regarding cross reference pain management coders documentation, per patient encounter with state guidelines. This also includes providing insurance request for insufficient record information for processing claims (Virginia Premier Health). Assist with startup of quality measures for HEDIS Project, and MIPS replacement for PQRS Program for provider growth percentages. Provided new start up program with Healthicity Audit Manager System with compliance, auditing and analytic solutions to elevate the performance of the organization regarding medical records for correct level of services.

(Regarding Medical level trends). New and Establish patient documentation using E/M guidelines and tools, this program is Healthcare Software and Services. Additional responsibilities include gathering EHR records for CIOX Health Services Audits with complete scanning and record retrieval. Providing E/M audits for correct level of services, with guideline and education new and existing associates regarding Pain Management Services. 2013-2017 Sheridan Health Corp Sunrise Florida

Revenue Integrity Compliance Auditor

Compliance Team Lead Review medical records for compliance. Included but not limited to the following multi specialties: Office Based, Pain Management, OBGYN, Gynecologic Oncology, Perinatal, Anesthesia, Emergency Department Services, Surgery Department, and Radiology.

● identifying compliance risk areas with coding and medical record documentation. ● Collection of medical records processed through AS400, RVI System8, SMART System and physical retrieval. ● Monitoring Local Coverage Determinations Policy’s Southern Florida Region LCD’s ● informing the management team regarding accomplishments and ongoing compliance issues. ● Development of compliance team training for multi specialties with regards to record contents, with one-on-one and group training with Compliance Department. Providing additional compliance guidelines and training when different specialties are schedule to start and end. Department consist of five associates including Compliance Department Manager. Assisted New Compliance Director with education sections for Auditors, regarding continuous education units (CEU’s) scheduling webinars and outside education training. Main AAPC contact personal. 2012-2013 Jewish Physician Group Louisville KY

Chart Review Coding Auditor

● Review medical records for E&M Validation ● Collection of medical records JPG wide (local travel- total state of Kentucky).

● Provider education for corrective coding applications with regards to CMS Compliance, using corporate templates and education with free-hand documentation. Completed E/M projects with HEDIS measurements under stricted guidelines for completion dates and documentation requirements. Organize office storage space regarding medical record documentation easy access for all four coding auditors. No project to big, no project to small. 2008-2012 Humana Corporation Louisville KY

MRA Provider Data Validation/ MRA Operations Auditing Coder Specialist

● Review medical records for coding validations ● Collection of medical records USA based wide. (Air travel) ● Provider and fellow associates education for Medicare reimbursements regarding HCC’s and MRA with correct coding procedures● Assisted in training new coders/ Auditors with MRA Department consist of (30) coding associates ● Completed all projects assigned by management in a timely manner. Including seasonal projects HEDIS. 2007-2008 Professional Office Solution Shepherdsville, KY Certified Coder

● Reviewed medical records and assigned appropriate ICD-9, CPT and HCPCS codes for multiple offices.

This including insurance rebuttals for reimbursement, regarding correct documentation verification per specialty, all within a timely manner. Contact with medical offices for record clarification, regarding patient information and corrected insurance. With wonderful communication skills between upper management and myself, my documentation needs were always completed and understood. The office consisted of five codes and two AR personal. 2007 Avoca Physicians Billing & Management Medical Coding Internship

● Reviewed radiology medical records and assigned appropriate ICD-9, CPT and HCPCS.

●This completed my Medical Coding and Billing courses with my internship for Jefferson Community and Tech College

REFERENCE Available upon request

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