Medical coding
Resume:
Diane Jensen CPC, CRC
W***N**** Manhatten Dr. Phone: 414-***-****
Menomonee Falls, WI 53051 Email: *****.******.**@*****.***
• CERTIFIED PROFESSIONAL MEDICAL CODER •
Motivated professional seeking position that will utilize my education and experience to benefit your organization
Key Attributes and Technical Skills
Proficient knowledge of ICD-9, ICD-10, CPT-4
And HCPCS coding.
Proficient knowledge in Risk Adjustment coding.
Recognize reimbursement, HIPPA, and
Compliance Processes.
Recall ICD-10 development, improvements, uses,
Guidelines, and assign ICD-10 diagnoses codes.
Identify ICD-9 characteristics, conventions, uses,
Guidelines, and assign ICD-9 diagnoses codes.
Strong analytic, organization, communication, and writing skills.
Ability to work independently and efficiently under
Pressure. .
Understanding of Anatomy and Physiology
Understanding of Medical Terminology related to Major Body Systems
Ethics and Professionalism
Recognize reimbursement, HIPPA, and
Compliance Processes.
Recall ICD-10 development, improvements, uses,
Guidelines, and assign ICD-10 diagnoses codes.
Identify ICD-9 characteristics, conventions, uses,
Guidelines, and assign ICD-9 diagnoses codes.
Recall inpatient coding guidelines.
Understanding of Medical Reimbursement
Education and Certifications
Certified Professional Coder Certification #01318858 AAPC Milwaukee Chapter
Risk Adjustment Certification AAPC Milwaukee Chapter
ICD 10 Certified AAPC Milwaukee Chapter
Risk Adjustment and HCC Coding Boot Camp Compliant Coding Systems
Medical Coding Allied Business Schools, Laguna Hills, CA
Medical Transcription Certificate ..Allied Business Schools, Laguna Hills, CA
Professional Experience
Aurora Advanced Healthcare, Germantown, Wisconsin 1999 – Present
~ Patient Accounts Specialist II, Medicare Dept. ~
Assists in ensuring maximum reimbursement, meeting compliance standards, using correct
Procedures by auditing billing and coding practices.
Reviews and analyzes insurance rejections by analyzing diagnostic codes and identifying issues
that can be corrected.
Acts as liaison between the Medicare and other Aurora departments and entities to
assist in resolving payment and coding disputes and issues
Recognize reimbursement, HIPPA, and compliance Processes
Proficient knowledge of ICD-9, CPT-4 And HCPCS coding.
Analyze code edit denials and the combination of codes billed to determine if the combination is billed appropriately according to CPT standards as well as payor reimbursement rules
Determine accuracy of insurance denial based on insurer’s code edit software
~ Denial Management Patient Account Auditor ~
Assists in ensuring maximum reimbursement, meeting compliance standards, using correct
Procedures by auditing billing and coding practices.
Reviews and analyzes insurance rejections by analyzing diagnostic codes and identifying issues
that can be corrected.
Acts as liaison between the third party payers and other Aurora departments and entities to
assist in resolving payment and coding disputes and issues
In conjunction with the revenue cycle, coding, and billing departments, identifies and corrects
coding errors to increase reimbursement.
Provides claim resolutions on inquiries from patients, physicians, insurance companies and
internal staff.
Proficient knowledge base and understanding of department-specific billing, cash and insurance
follow-up procedures
Recognize reimbursement, HIPPA, and compliance Processes
Proficient knowledge of ICD-9, CPT-4 And HCPCS coding.
Analyze code edit denials and the combination of codes billed to determine if the combination is billed appropriately according to CPT standards as well as payor reimbursement rules
Appeal code edit denials by assembling the necessary information needed to ensure proper reimbursement by the insurance company; enter essential information into Access database
Analyze medical records, review code, edit software to determine if charge was billed appropriately or requires further review
Determine accuracy of insurance denial based on insurer’s code edit software
Review correspondence from insurance companies in response to an appeal that was filed
Track denial and billing error trends and provide suggestions on how to reduce denials to supervisor
~ Business Service Representative ~
Answered telephones and directed calls to appropriate staff promptly and professionally
Greeted and checked in patients as they arrived for an appointment
Assisted patients with billing questions; paid close attention to details
Maintained patient privacy and confidentiality at all times according to established procedures
Independent Contractor with NP Healthresources 11/2014 - present
Contracted Remote Medical Coder with Altegra Health 11/2014 – 08/2014
Review medical inpatient, outpatient and professional documentation and assign appropriate ICD-9 codes for chronic conditions that risk adjust.
AHDI – Association for Healthcare Documentation Integrity
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