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BENIGNO VILLANUEVA, CCS

**** ******* ****** *******, ** 94591 CP: 626-***-**** acwkms@r.postjobfree.com Professional Summary

Job Objective: Being a certified coding specialist, I am in search of an established company or health facility that will further boost my skill and professional growth in the field of inpatient coding and auditing. Brief Qualification Summary:

Nearly 4 years of medical coding experience, mainly inpatient coding and DRG auditing

Competent in the use of 3-M encoder as well as TruCode

Certified in ICD-10-CM and ICD-10-PCS coder

Updated with current guidelines of ethical and appropriate medical coding and auditing

License Certified Coding Specialist No. C027755

Skill Highlights

Competent in abstracting and analyzing inpatient medical records

Abreast with various federal and state laws and regulations

Up-to-date and in-depth knowledge of human anatomy, physiology, pathology and applied clinical medical sciences

Maintain strict patient as well as corporate confidentiality

Proficient user of Microsoft Office application software

Strong work ethics, team player with positive attitudes

Good written and oral communication skills

Background profession, diagnostic radiologist in the Philippines with analytical and critical thinking skills

Professional Experience

Performant Financial Corporation May 2015- May 2016

Performed inpatient coding audits using ICD-9-CM and ICD-10-CM/PCS DRG validation tool (i.e. TruCode encoder) referencing appropriate coding guidelines, such as the instructions under the Index and Tabular List, Chapter-specific guidelines, Official ICD-9-CM and ICD-10-CM Official Coding and Reporting Guidelines, CMS Guidelines, and AHA Coding Clinics, for hospital claims across the country, mainly in the East Coast, reviewed from scanned, electronic and hybrid medical records

Removed from the claims clinical conditions (particularly the major complications) that were not documented by the provider, inappropriate procedure codes as validated from the operative report, and wrongly reported discharge disposition

Added to the claims unreported clinical conditions (particularly the major complications) but were documented by the provider, appropriate procedure codes described in the operative report as well as appropriate discharge disposition

Adjusted the appropriate MS-DRG for claims with findings, which may be originally an overpayment or underpayment

Completed medical record audit by providing the determination rationale supporting the DRG change

Strictly maintained patient and physician confidentiality as stipulated by federal, state and hospital guidelines for release of information 2

OS2 Health Care Solution January 2015- April 2015

Remotely coded for EMSI Leprechaun, capturing hierarchical condition categories (HCC) following CMS regulations and requirements

Captured medical conditions from inpatient and outpatient electronic medical record (EMR) and hybrid medical records that have HCC value

Entered all captured codes into the defined format of EMSI Leprechaun Capitol Coding Management October 2011-July 2014

Carefully abstracted and analyzed all inpatient medical records, ensuring accurate selection of principal diagnosis, other diagnoses, significant procedure, and other procedures and assigned the appropriate present on admission (POA) indicator

Applied knowledge of current instructional notations and conventions, Chapter-specific guidelines, Official Coding and Reporting Guidelines, and advice from AHA Coding Clinics to correct assigning and sequencing of appropriate principal diagnosis, other diagnoses, significant procedure, and other procedures

Utilized an encoder and grouper, i.e. 3M, as an efficient tool particularly for coding and DRG analysis

Queried the provider thru the clinical documentation improvement specialist for conflicting, ambiguous, and nonspecific conditions found in the patient medical record

Completed productivity reports on regular basis, submitting them to medical coding supervisor

Continuing Education

Intra-company (Performant Financial Corporation) Workshop Modular ICD-10-CM and ICD-10-PCS Intensive Training thru AHIMA, with Focus on Application to Recovery Audit Contractor (RAC) Auditing January 23 through February 23, 2016

Inpatient Workshop, AE and Associates, LLC

Inpatient Abstracting and Coding with Emphasis on Updates on Changes from ICD-9-CM to ICD-10-CM and ICD-10-PCS, UHDDS Data Elements, Sources of Documentation, Selection of Principal Diagnosis and Significant Procedures and Reporting of Other Diagnoses and Procedures, Assignment of Present on Admission (POA), Hospital-Acquired Conditions, Compliant versus Noncompliant Query Methods and Improved Clinical Documentation, Office of Statewide Health Planning and Development (OSHPD) Abstracting, Current Office of Inspector General Thrust, and MS-DRG (Medicare Severity) and APR-DRG (All Patient Refined)

July 18 through August 7, 2016

Background Education

Doctor of Medicine

University of the Philippines, Manila, Philippines Residency in Diagnostic Radiology and Radiation Oncology Practiced Diagnostic Radiology in the State of Kuwait and Philippines Medical Coding

Hope of James School of Medical Coding, Covina, CA 91723, USA