Senior Medical Coder, Senior Claims Specialist

Frances Sutay, CPC, Fairfield County

Phone: 203-***-****,E-mail: *******.*****@*****.***

mailto:*******.*****@*****.***

Objective: Medical Coding professional with 18

+ years’ experience looking for new areas in the medical field to expand my expertise and utilize the latest professional physician coding, outpatient surgery coding, reimbursement, appeals and auditing skills. Open to remote opportunities.

Experiences:

2013 – 2/2019 Roger Williams Medical Cancer Center – Providence, RI I work at the Roger Williams Cancer Center primarily for Outpatient Surgery Accounts. I review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-9-CM and CPT-4 codes for hospital reimbursement, mortality & morbidity outcomes, governmental compliance coding, research & statistical and regulatory compliance. Abstract codes and assigns necessary demographic and clinical data elements required for meaningful use records. Effectively utilizes 3M encoder software to ensure appropriate reimbursement and accurate assignment. Completes all work in accordance with defined productivity and quality standards. I request from the physician if needed additional information or clarification of diagnoses, co-morbidity/secondary conditions, and procedures. Provides physicians education on coding, documentation requirements and medical necessity. Assures optimal ethical reimbursement for coded encounters and assures coding practices fall within established compliance guidelines.

2011- 2012 Charge Capture Coding Specialist Multi-Specialty Group at Saint Vincent’s – Bridgeport CT

Assign appropriate diagnosis and CPT procedure codes based on Physician notes from encounter forms. Conduct charge reconciliation to ensure optimal charge capture. Assist EHR and Practice Management Analysts to resolve problems with EHR billing issues. Proficient in Practice Management, EHR practices, notes and form input. Review and audit patient billing in EHR Allscripts and make adjustments when necessary. Help with coding and billing policies and procedures. Review Physician Surgery and OP reports and assign appropriate diagnosis - procedure codes. Provide support to physicians regarding payment, proper coding and billing guidelines. Attend Webinars and meetings to discuss the latest Meaningful Use and ICD10 Guidelines and Standards. Multiple specialties Coding includes: Internal Med,ENT, Surgical Oncology, Trauma, Hospital Intensivists, Palliative Care, Geriatric Medicine and Pediatrics.

2008 - 2010 Claim Processor III HealthNet Northeast – Shelton, CT

Charged with third party payer claims re adjudication process after denial, claim analysis, clean claim submission review, maintain compliant coding guidelines and educate staff. Governmental plans – Medicare/Medicaid claim review and claim submission process. Complete special projects for upper management executives.

2006-2008 Research and Adjustment Specialist II HealthNet Northeast – Shelton, CT

Primary responsibility: TPA - Special vendor- Taft Hartley and Mashantucket Pequot claim review, claim analysis, for multiple specialties. Staff training and education program creation on latest insurance standards. Investigate and resolve physician inquires, problem solving finding resolution on incomplete or incorrect billing patterns, process of uncollectable adjustments, quality measurement of correct claim adjustments.

2005-2006 Research and Adjustment Specialist HealthNet Northeast – Shelton, CT

Primary responsibility: Claim adjustment corrections, heavy telephone contact with physicians from multiple specialties regarding claim denials and reprocessing corrected claims. Customer service representative.

2003- 2005 Clinical Appeals Review Specialist HealthNet Northeast – Shelton, CT

Primary responsibility: Ensuring proper paper clinical intake, review of claim denials, claim analysis, claim evaluation on denied claims, and handle all correspondence, incoming calls and these documentation to all inquiries. Effectively communicate verbally and orally with claim staff and direct management. Kept HealthNet business policy and procedures current and notified staff of any changes. Solid problem solving skills. Patient accounting and billing.

1999-2003 Service Operation Representative HealthNet Northeast – Shelton, CT

Primary responsibility: Technical support to physicians regarding payment, coding, billing, claim submission guidelines and grievance process. Reprocessing denied medical claims. Physician training on correct ICD-9 and CPT coding. Maintain productivity quality and accuracy levels which meet company standards including average handle time and number of calls on the telephone daily. Worked with Medical Review Unit nurses; reviewing medical documentation to determine correct claim processing status.

Certification: Certified Professional Coder, CPC, ICD 10 certified. Attend AAPC meetings to attain CEU’s, In training for Certified Electronic Health Record Specialist.

Technical Skills: Microsoft Word/Excel/Power Point/Medisoft Advanced/ Outlook /Access (For Auditing), Trizetto,

Spring Chart EMR, Medi Tech, Allscripts EHR and Practice Management. Healthpak Clearing House, GE Centricity Enterprise, 3M Coding, IDX

Education: 2010-2011 – Branford Hall Career Institution/ Health Claim Specialist Program

2010-2011 – Branford Hall Career Institution/Allied Health National EMR Preparation

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