Customer Service Manager
Resume:
R
***** ******* **** ** *********, NC ***** 919-***-**** *********@***.***
Certified Coding Specialist
Over 7 years experience in healthcare & reimbursement. Including Management, Medical Coding, & Denial Resolution.
Over 5 years of combined training and experience in inpatient, outpatient, and Emergency Department coding.
Over 12 years of Management experience in high volume retail environments.
Over 2 years of auditing experience.
Software Knowledge: EPIC / Maestro Care, Allscripts, SSI, Siemens, Sorian, IDX Term, IDX Web, MedAssets, QuadraMed, Cerner PowerChart, Chart Navigator, ReconEdge, EDM, CDR2 and 3M Encoder & Resource Materials.
Strengths: Excelling in a fast-paced, productivity based environment. Commended for high accuracy.
AHIMA member and participant in the AHIMA Mentor Program; AAPC member; completed ICD-10 CM/ PCS training.
Core Competencies
ICD-10-CM & PCS/ ICD-9-CM / CPT-4
Computer Assisted Coding
3M Coding and tools
Dual Coding
Inpatient Coding
Outpatient Coding
Management Experience
Epic Experience
Multi-Level Trauma Coding
Denials Management
HIPAA
Professional Background
Medical Coding
Independent Consultant – Inpatient Coding/ DRG Specialist June 2016 – present
Ardent Health Systems/ TN, OK, NM, & Tx/ 2,194 beds spread across 14 hospitals/ Level I Trauma Center
Review documentation to determine principal diagnosis, MCC’s/ CC’s, secondary conditions, and surgical procedures
Utilize coding guidelines to assign appropriate ICD-10-CM diagnoses and PCS procedures
Follow up on missing documentation, including the generation of appropriate queries
Submit charts to clinical documentation improvement (CDI) for review and follow up with final coding analysis
Meet weekly productivity quotas for accuracy and completion rate.
Independent Consultant – Inpatient Coding/ DRG Specialist December 2015 – June 2016
Owensboro Medical Health Systems/ Owensboro, Ky/ 477 beds/ Level III Trauma Center
Review documentation to determine principal diagnosis, MCC’s/ CC’s, secondary conditions, and surgical procedures
Utilize coding guidelines and MS-DRG reimbursement expertise to assign appropriate ICD-10-CM diagnoses and PCS procedures
Assign present on admission (POA) value for inpatient diagnoses
Review clinical documentation improvement (CDI) entries and add final coding analysis
Meet weekly productivity quotas for accuracy and completion rate.
Coding Services Group – Inpatient Coding Specialist June 2014 – December 2015
Kaweah Delta/ Visalia, Ca/ 581 beds/ Level III Trauma Center and teaching hospital
Leesburg Regional Medical Center/ Leesburg, Fl/ 300 beds
The Villages Regional Hospital/ The Villages, Fl/ 223 beds
Review documentation to determine principal diagnosis, MCC’s/ CC’s, secondary conditions, and surgical procedures
Utilize coding guidelines and MS-DRG reimbursement expertise to assign appropriate ICD-9-CM diagnoses and procedures
Assign present on admission (POA) value for inpatient diagnoses
Identify non-payment conditions (HAC) and when required, report through established procedures
Review documentation to verify or abstract clinical data such as the patient’s discharge disposition, and MD info for hospital statistics and reporting
DRG and APC assignment analysis to ensure accurate reflection of diagnoses and procedures during coding finalization
Review clinical documentation improvement (CDI) entries and add final coding analysis
Dual Coding to ensure maintained accuracy and productivity during ICD-10 transition
Verisk Health- Remote HCC Coding Specialist June 2014 – September 2015
Perform daily Quality Assurance assessments on charts previously coded by our remote and in-house staff.
Audit charts for proper diagnosis coding in various chart types (inpatient, outpatient, and ED).
Ensure the highest level diagnosis code/ combo code was utilized in each date of service reviewed.
Meet weekly productivity quotas for accuracy and completion rate. Currently maintaining a 97% accuracy rate.
Hospice of Wake County- Coder & Clinical Analyst October 2013 – June 2014
Audit codes entered by RN’s.
Interpret patient's chart and referral information to assign the appropriate hospice diagnosis and related co-morbidity codes.
Assist clinical team leaders in maintaining Medicare defined quality measures through the research and gathering of information, and creation of spreadsheets/ reports for their review.
Transcribe physician narratives, including: Face to Face sheets, Recertification’s, and Medication Status sheets.
Duke Hospital- Coder II June 2013 – October 2013
Durham, NC/ 957 beds/ Level I Trauma Center and teaching hospital
Abstracted diagnoses and procedures from medical records of claims that were denied due to improper coding.
Researched and applied 3rd party/ NCCI rules and regulations to claims.
Analyzed and resolved complex coding related denials to ensure optimal reimbursement.
Assisted professional & technical divisions in eliminating their backlog.
Management
Store Manager February 2000 – December 2010
GameStop * Family Christian * Aerosoles * Best Buy (Supervisor)
Produced and monitored reports used in maintaining accountability of employee productivity and customer service.
Held workshops, keyed inventory counts, produced reports, provided troubleshooting for equipment.
Increased sales and profitability for each facility, exceeding district goals and averages.
Screened applicants, contacted potential employees, conducted interviews, hired associates, and trained new hires.
Achievements
Reached top 2% (Top 100 out of 4600+ stores) in trade comp at Game Stop.
Lowered shrink at Family Christian by .5% by catching mistakes on the previous year’s inventory.
Reached top 15% in the company rankings at Family Christian Stores.
Was able to produce sales in excess of $1million at Aerosoles after originally trending $700k.
Was commended by the CEO of Aerosoles for outstanding customer service after being secret shopped by him.
Was elected as the facilitator of weekly national conference calls for outlet stores at Aerosoles.
Hosted merchant meetings within Jersey Gardens Mall to promote the “hot” products at Aerosoles.
Became the #1 department in UPT against all departments in all stores at Best Buy.
Assistant Store Manager
Eckerd’s Pharmacy * CVS Pharmacy
Trained on HIPAA and Patient Confidentiality to run the pharmacy front end during high traffic/ short staff situations.
Coached and trained staff on customer service and goal management.
Education
Western Governors University – Bachelor of Science (B.S.), Health Informatics Graduation: Spring 2017
Fayetteville Tech & Career Step (Dual Enrollment) - Inpatient & Outpatient Coding Graduated with Honors in 2012
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