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Medical Manager

Irmo, South Carolina, United States
January 09, 2017

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**** ******* **** **. ****, South Carolina 29063

Tel: 803-***-**** Cell: 803-***-****



Facility knowledge: Level I Trauma, Teaching, Burns, Obstetrics, Neonatal, Orthopedic, Cardiovascular, and Critical access, just to name a few.

Coding knowledge: APC, MS-DRG’s, APR-DRG’s, ICD-9 CM, ICD-10 CM/PCS, CPT, HCPCS II, Evaluation and Management-professional and facility, Pathology, Trauma, Interventional Radiology, Cardiology, Orthopedic, Oncology, Gastroenterology, Dermatology, Anesthesia, Respiratory, Diagnostic, Same day Surgery, Acute hospital Coding, Durable Medical Equipment Coding and much more. Auditing knowledge: Coding Audit for DRG and MS-DRG acute care records and APC Outpatient records, EM level audits on pro-fee and facility. Financial charge audits on UB-04 and CMS-1500 billing forms.

EHR/Encoder knowledge: Epic, Sovera, Cerner, Meditech, McKesson, Meta, Medic, ClinTrac, 3M 360, Optum CAC, WebStrat, WinStrat, Quantim, Clintegrity 360, Quadra Med nCoder+, Codelink, CPSI Evident

Medical knowledge: Anatomy and Physiology I and II, Medical Diagnostics and Coding, Medical terminology and therapeutic tests, surgical operations and procedures Insurance knowledge: HMO, PPO, and private insurance, UB-92, CMS-1500 billing system Computer knowledge: Literate in Microsoft Applications such as: Excel, Word, Access, Powerpoint, Internet Explorer, and Outlook 365, Keyboarding speed of 65 plus word per minute PROFESSIONAL CODING/BILLING EXPERIENCE- 20 years combined Nuance Communications (Coding Manager/Clinical Language Analyst - FULL TIME STAFF) Remotely March 2012- November 2016

Managed coding process

Audit inpatient records from various facilities to ensure accuracy of coding

Audit outpatient/ancillary records from various facilities to ensure accuracy of coding

Assign CPT and ICD-10 codes for Outpatient encounters and ICD-10 Diagnosis and ICD-10- PCS, codes and DRG for Inpatient encounter.

Code multiple record types for Teaching Facility, and other various facility

Abstract coding data relevant to emergency department medical records

File appeals on account improperly reimbursed/Resolves any unusual denials, low payments, or requests for information, including appeals.

Utilized 3M & Clintegrity 360 (Quantim)

Provides for ICD-10 CM and PCS annotation and coding for Phase I of the computer assisted coding project.

Responsible for identifying differences in coding practice among different coders and clarifying differences between ICD 9 and ICD 10.

Provides ongoing consultation and for ICD-10 CM and PCS coding that contributes to the both software development and coding practice guidelines.

Dual I-9 and I-10 auditor making sure that the coder’s apply the appropriate code on encounters according to Official Coding Guidelines.

Ouzts & Associates, Inc (Certified Professional Coder Remotely Full-Time) January 2007 to March 2012

Responsible for ICD-9 and CPT Emergency Medicine coding for Greenville Memorial Pediatric and North Greenville Memorial Hospital systems averaging 2,800 patients a month.

Provide physicians with feedback to better the reimbursement for the facility.

Audit physician’s medical records for compliance issues. Premier Orthopedic Specialists/Palmetto Health (Billing Coordinator/Coder Full-Time) October 2005- January 2007

Responsible for all Surgery, Office and Consult CPT and ICD-9 coding for the practice.

Post all money that is received.

Handle all aspect of the billing including electronic claim submission; follow up with insurance on claims, appeals and refunds.

Work with patients and collection agencies to collect money due to practice.

Post all charges for facility including tracking RVU’s for doctors.

Keep track of monthly procedures performed by the physicians.

Shadow physicians during surgeries to better code the more complex procedures. Responsible for the end of the month process and make sure all surgery/office visits are accounted for.

Review operating room log monthly.

Generations of Chapin (Business Office Manager Full-Time) June 2002 to August 2005

Responsible for accounts payable, billing, taxes and payroll for six facilities.

Worked with administrators to secure payroll.

Compiled insurance and retirement for approximately 120 employees.

Oversaw Worker’s Compensation and unemployment claims.

Handled discrepancies in resident’s billing with responsible parties.

Managed resident’s funds as needed. Utilized acquired nursing skills and background with regards to resident care, including independent living neighborhood. Lexington Medical Center Irmo Outpatient Surgery (Business Office Specialist/Coder Full Time) January 1994 to January 2002

Collected all funds for surgery.

Managed registration and insurance information for patient’s records, including ICD-9 and CPT coding for surgery cases.

Responsible for billing, including entry and charges.

Completed daily balance sheets (deposits, charges and discrepancies). EDUCATION

2007 American Academy of Professional Coders Columbia, SC CPC- Certified Professional Coder/AAPC Member

2007 Midlands Technical College Columbia, SC

Certified Professional Coder, Billing, Medical Terminology, Anatomy and Physiology courses

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