Coding specialist, coding manager/educator

Marijo Georgic, RN, CPC

**** ** **** ***.

Cape Coral, FL 33993

Home: 239-***-****

Cell: 239-***-****

*********@*******.***

Proficient in use of:

•PC applications: Microsoft Word, Excel, PowerPoint and Outlook programs.

Detailed oriented, conscientious, organized, multifaceted business professional.

Effectively handles new or increasing levels of responsibilities. Excel in written/oral

communication.

• ICD-10 CM certified by AAPC

Employment History:

Source Medical-Revenue Cycle Solutions, Ft. Myers, FL Jan. 2011-Present

Coding Specialist

• Code Ambulatory Surgery Center operative reports. Assigned CPT and ICD-9 codes with appropriate

modifiers. Utilize NCCI edit software for unbundling. Specialty coding includes: General, Gynecologic,

Plastic, Reconstructive, ENT, GI, Orthopedic, Ophthalmologic, Vascular, Pain Management, Podiatry,

Spine, and Radiology.

• Provide end of month reports for all missed charges to Client Service Manager.

• Communication with surgery center for requests for addendums by the physician to compliantly meet

appropriate CPT code(s) and/or ICD-9 code(s).

• Meet productivity and quality standards.

• Assign appropriate HCPCS codes for implants/medications and pricing with invoices.

LEE MEMORIAL HEALTH SYSTEM, Ft Myers, FL 2002- 2010

Coding Educator

•Provided individual coding education for multispecialty physicians and mid-level providers per CMS,

ICD-9-CM and CPT coding guidelines.

•Performed individual provider data quality reviews in professional coding and billing with respect to

modifiers, diagnoses and level of specificity, levels of service, bundling, diagnosis linking, payer specific

guidelines, interpretation of medical terminology with respects to coding, and coding changes. Written

report provided to individual provider of results of scheduled prospective review audits.

•Designed and used audit tools to monitor accuracy of professional coding.

•Assisted in writing policy and procedure for provider audits.

•Supervised CPC reimbursement specialist scheduled prospective E/M audits and operative

procedures claim reviews for coding transfer accuracy.

•Written coding and documentation tools provided to aid practitioner to meet compliance and optimize

revenue.

•Coded operative reports including general, oncologic, plastic surgery, pain management, cardiology

and interventional cardiology/vascular procedures. Appropriate modifiers applied utilizing NCCI

edits and Medicare Physician Fee Schedule.

•Assisted in design and development of dictation templates for billing pain management services.

•Conducted quarterly basic and advanced coding classes for practice staff and billing department staff

with manuals and Microsoft PowerPoint presentations.

•Timely prepared and provided quarterly reports of physician audit coding results with Microsoft Word,

Excel and Access programs to billing director.

•Provided timely documentation to appropriate departments of new coding, changes, and/or updates.

MARIJO GEORGIC – Page 2

COVENTRY HEALTHCARE, Cranberry, PA 2001-2002

Medical Claims Review Nurse

•Reviewed/adjudicated claims for HMO and PPO products, Emergency Room claims. Effectively

collaborated with the Medical Directors and the Health Plan on medical payment policy decisions.

•Identify unbundling of CPT codes using McKesson Claim Check code editing software to determine

physician reimbursement. Resolved provider requests for reconsideration on claims denied for

unbundling, mutually exclusive and incidental edits.

•Provided coding education internally to claims staff/ provider relations, and externally to physician groups

on coding issues.

ADVANTAGE HEALTH/ QUALMED INC., Pittsburgh, PA 1997-2000

Medical Claims Review Analyst

•Researched and analyzed commercial HMO, PPO and Medicare HMO claims and provider appeals based

on requirements for prior authorization, retrospective review per Utilization Management guidelines,

National Committee for Quality Assurance Standards, Medicare guidelines, provider contracts and

benefit group contract provisions.

•Wrote policies and roadmaps for Utilization Management retrospective review for NCQA review.

•Effectively collaborated with the Medical Director and/or peer review physician following established

procedures when required to determine medical necessity.

•Prepared and submitted concise written and /or verbal reports of review/audit findings.

•Met and exceeded corporate and departmental quality and production standards.

INTERIM HEALTH CARE, Pittsburgh, PA 1995-1997

Case Manager/Field Nurse

•Implemented skilled nursing assessment and documentation utilizing Interpath assessment record for adult

and pediatric clients in the home setting.

METLIFE, Pittsburgh, PA 1993-1995

Utilization Review Coordinator

•Obtained information for hospital inpatient admissions and determined initial length of stay.

•Updated inpatient continued stay based on medical necessity.

•Waived second surgical opinion for outpatient procedures based on set criteria.

•Managed Point of Service and Indemnity health insurance products.

NORTHSIDE MEDICAL CENTER, Youngstown, OH 1986-1994

Staff Nurse, Post Anesthesia Care Unit

St. ELIZABETH HOSPITAL MEDICAL CENTER, Youngstown, OH 1977-1986

Staff Nurse

MERCY HOSPITAL, Pittsburgh, PA 1976-1977

Staff Nurse, Cardiovascular Recovery Room

Certifcation

Registered Nursing License in Florida

AAPC-Certified Professional Coder

Education

St. Francis Hospital of New Castle School of Nursing, New Castle, Pa. - Diploma of Nursing

Pittsburgh Hospital School of Nursing, Pittsburgh, Pa.

Pennsylvania State University, McKeesport, Pa. - Earned 32 credits.

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