Mary Flores CPC

* ******** ***** **********, *.Y. 12788

845-***-****

aczf8a@r.postjobfree.com

To fully utilize my knowledge, skills, and experience as a Certified Professional Coder (CPC) in order to ensure accurate clinical documentation for patients & staff, as well as improve operations and increase profitability in a health care facility.

Work Experience:

QA Auditor/OXFORD HIM

Remote QA Auditor

August 2016 to February 2017

Performed random audits sent by facility to include Emergency Room (E&M and Procedures), Same Day Surgery, (APC), and Infusions for facility to validate all ICD-10-CM, CPT and APC codes coded by the coder. Provided guidance on errors based on CPT Guidelines, ICD-10-CM Coding Guidelines, NCCI, NCD, LCD, CPT Assistant and Coders desk reference. Reviewed completed audits with coding manager and coder, reviewed the account and the documentation to explain why the particular account was marked with an error and explain the particular guideline for future reference for the coder.

QA Auditor/ Anthelio HealthCare Solutions

Remote QA Auditor

September 2015 to January 2017

Performed a 100%pre-bill review of all new hires for CHS. Chart types to include ED, Same day surgery for the first three weeks of hire to maintain an accuracy of 97% until released from pre-bill.

Performed quarterly audits on twenty assigned coders ED, Same Day Surgery to include ICD-10-CM, CPT, and APC to maintain 97% accuracy. Provided guidance on errors based on CPT Guidelines, ICD-10-CM Coding Guidelines, NCCI, NCD, LCD, CPT Assistant and Coders desk reference.

Caban Resources

Same Day Surgery Coder

August 2015 to June 2016

Coded Backlog Same Day charts for facility with implementation of ICD-10.

Caduceus

June 2013 to October 2014

QA Auditor Same Day Surgery/E&M Auditor

Audited Same Day Surgery charts coded with CPT and ICD-9-CM. Provided guidance on errors based on CPT Guidelines, ICD-9-CM Coding Guidelines, NCCI, NCD, LCD, CPT Assistant and Coders desk reference.

Audited E&M levels for Inpatient physician rounds with auditing sheet and provided feedback on what documentation was missing to include HPI, ROS, Physical Exam and Medical Decision Making.

Lead Outpatient Coder/Auditor-Keller Army Community Hospital

West Point, NY

March 2006 to September 2015

Supervise 5 Coders, monitor productivity and accuracy, and mentor two Apprentice Coders

• Coordinates education and training programs.

• Collaborate with departments and physicians to improve clinical documentation.

• Facilitate changes to organizational practice, policies and procedures.

• Perform and maintain data/statistics for coder compliance, utilizing charts for data trends and process improvement measures.

• Aid in the development of compliance policy and procedures.

• Responsible for implementing and maintaining a data quality plan for outpatient coding and reimbursement.

• Responsible for the implementation of education and training programs regarding elements of the HIM compliance program.

• Coordinate and conduct reviews of targeted inpatient and outpatient cases to assure timely billing process and accurate hospital reimbursement.

• Responsible to perform random and scheduled audits of both technical and professional charges to validate the accuracy of coding assignments to assure compliance with coding and billing requirements.

• Perform group and individual training sessions on a wide range of coding and documentation topics.

• Develop compliance work plans and coordinate project team activities.

• Perform targeted research and analysis of complex coding, billing, and documentation questions.

• Provide performance feedback to coders and providers from monthly audits.

• Develop process improvement plans/corrective actions to resolve coding issues, to ensure productivity, efficiency and quality.

• Coordinate concurrent and retrospective medical record audits/reviews to ensure quality. Identify trends in down-coding, up-coding, bundling and unbundling.

• Train new employees on outpatient clinics according to Department of Defense (DOD), CMS and national coding guidelines and standards.

• Responsible for participation in monthly mediation audits with PASBA in accordance with CARA Rules of Engagement

• Perform quality coding audits on multi-specialty Outpatient and Ambulatory Surgery records to include Emergency Department, Family Medicine, Pediatrics, Orthopedics. Same Day surgery coding to include Orthopedics, ENT, General Surgery, Podiatry within fifteen days from Date of Service and review results of audits with Coding staff and Coding management.

• Achieve and maintain 97% coding accuracy, Exceeding Auditing Productivity standard of 115 Outpatient encounters per day, Coding Same Day surgery with productivity standard of 60 records per day.

• Reports problems and trends, identifies areas of subsequent audit, prepare reports detailing audit findings and recommendations.

• Research specialty clinic and general coding questions. Review and recommend policy for coding guidelines.

• Train providers on EMR (AHLTA), documentation integrity and RVU optimization.

• Present trend analysis and statistical data concerning accuracy, productivity and acuity level.

• Monitor and assign workload.

• Prepare classes for coders and providers for error trends in documentation and coding.

• Analyze data to assist in business operations for provider productivity.

.

Related Courses and Skills

• Extensive knowledge of medical terminology, anatomy, physiology, pathophysiology, disease process, pharmacology, and surgical procedures to support accurate code assignment.

• Proficient in 3M Encoder, AHLTA(EMR), CHCS, Essentris (EMR) Inpatient

• Advanced knowledge in Microsoft Word, Excel and Outlook functions

• Keyboarding at 50 wpm

• Proven ability in records management

• Highly skilled in multi-tasking, flexible, and adaptable

• Continuing Education credits to increase coding skills

• Current HIPAA training and certification

Self preparation for upcoming impact of ICD-10-CM/PCS

Skills

3M, 3M 360, 3M Administrator, EPIC, HPF, Hyland, AHLTA, CHCS, EPIC Word, Excel, Word

Education

AAPC Certification 8/2004

Certificate in Medical Terminology Course

B.OC.E.S Adult Learning Center

2004

Certificate in Medical Coding Curriculum

B.OC.E.S Adult Learning Center

Contact this candidate