Medical Microsoft Office

Angela Johnston CCS

Phone number: 615-***-****

SUMMARY

I am a Certified Coding Specialist, and holds 10 years of experience in the healthcare industry. I have over 5 years of claims experience and have held roles as a Senior Appeals Analyst and a Remote Coder. Some of my previous responsibilities have included working with ICD-10 and HCPCS coding, applying correct ICD-10 codes.

PROFESSIONAL EXPERIENCE

CGS, Administrators, LLC (Formerly Cigna Government Services) 05/07 - Present

Senior Appeals Analyst

Processes Medicare appeals at the Redetermination level.

Adjudicates claims for Durable Medical Equipment (DME) Medicare Administrative Contract (MAC).

Works with medical records and abstracts data as necessary

Works with ICD 9 or ICD 10 and HCPCS codes daily

Resolves edits, changes diagnosis, and researches/validates support in clinical records

Works with Claims, Appeals, Program Integrity Support with underpayments, overpayments, and Medicare as a Secondary Payor (MSP)

Processes claims with multiple outside contractors: RAC, CERT, SMRC, and etc.

Processes accounts daily based on age

Works with/makes changes to data for incorrect claims and rebills daily

Handles correspondence from payers to ensure all information required for claim processing is provided.

Has gained knowledge of payer policy and procedures and the use of payer websites to handle account receivable (AR) medical collection/overpayment

Has demonstrated proficiency in the use of: Citrix application, Microsoft Office Suite, National Correct Coding Initiative -NCCI edits, medical necessity, Local Coverage Determinations ( LCD)s, National Coverage Determination (NCD)s, and Diagnosis Related Groups (DRG)

Altegra Health/Change Healthcare 04/16 - 06/16

Remote Coder (Part Time Contract)

Coded Outpatient Clinicals

Worked on the Payment Integrity Audit (PIA) project

Applied correct ICD 9 and ICD 10 CM codes

Performed application of Altegra Health Flagged Event codes based on documentation

EDUCATION

Draughons Junior College

Murfreesboro, TN

Associate in Applied Science Medical Coding and Billing

LICENSES AND CERTIFICATIONS

American Health Information Management Association (AHIMA)

Certified Coding Specialist (CCS)

Certified Coding Associate (CCA)

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