**** ********* ****, *****, **, *****, Cell 817-***-****, Email ad35jh@r.postjobfree.com

OBJECTIVE

Seeking to obtain a position in health information management, preferably in OP/IP auditing, which seeks an ambitious and career conscious person, where acquired skills and education will be utilized toward continued growth and advancement. MHIM - Master of Health Information Management

RHIA Certified, AHIMA

BSHIM - Bachelor of Science in Health Information Management ICD-10 Certified, AHIMA

Education and Training

• Inpatient and Outpatient Auditing, Profee Telehealth, Profee Primary Care, Specialty Coding, disputes, denials, edits etc.

• Educated in managing and constructing health information programs to guarantee they accommodate medical, legal, and ethical standards.

• Creation of facility policies and procedures according to governmental compliance standards.

• Release of Information

• 12 years Coding {Inpatient, Outpatient, Recurring, Cancer, ED, Clinics/Physician, Obs, SDS)

• Maintenance, collection, and analyzing of data that is received by doctors, nurses, and other healthcare players.

• Total quality management in the effort to deliver quality healthcare.

• Registry management, data management, and data quality among other areas.

• HIPPA regulations

• Project Management (EHR training, implementation, research, leadership)

• Compliance, quality improvement, release of information, utilization reviews, and risk management.

• Planning of information systems

• Development of health policies

• How to apply the science of informatics to the collection, storage, use, and transmission of information to meet legal, professional, ethical, and administrative records-keeping requirements of health care delivery.

• Clinical, epidemiological, demographic, financial, reference, statistical, and coded healthcare data.

• Operations: staffing, meetings, health human resources, billing, coding, prepping, scanning, quality checks and analysis, reports.

QUALIFICATIONS, SOFTWARE/HARDWARE, AND SPECIAL SKILLS

3M 360, Epic, OnBase, Optum, Acustream, Quadramed systems, Allscripts, Meditech, Horizon Patient Folders, ESmart, Softmed, LOINC, RxNORM, SoftMed, TrueCode, Code IQ

Team Player, Punctual, Reliable, Dedicated, Works well with others, Fast Learner, Communicable, Sociable, Works well and hard under pressure, Capable of any task instructed

EXPERIENCE

Besler

DRG Validation-IP/OP Auditing – 06/2023- Current

Audit IP/OP coders and investigate coding for various medical facilities, using guidelines and indictors to validate, justify and confirm correct reimbursements, conducts inpatient coding quality audits to validate code assignments are supported by clinical documentation in the medical record. Highly proficient in the proper assignment of ICD-10-CM and PCS codes, performs coding audits of a wide variety of complex inpatient records to validate the ICD-10-CM, PCS codes, MS-DRG and/or APR DRG assignments, provides written, detailed rationale and supporting evidence for recommendations on audit findings, Identifies documentation improvement opportunities that impact coding accuracy, collaborates with the clinical documentation improvement team for conflicts between code assignments, reviews and researches billing edits, update billing, assists with DRG denials from payers including researching and writing appeal letters, ability to interpret Medicare and NCCI guidelines, National and Local Coverage Determinations to support coding compliance.

Omega Healthcare

OP Auditing and Coding - 07/2022- Current

Audit OP charts for quality and accuracy, create reports, monitor trends, give educational feedback, Charge viewer, audit team of coders, monitor ques, create educational ppp for the team per trending inconsistencies, collaborates with the clinical documentation improvement team for conflicts between code assignments, reviews and researches billing edits, update billing.

Med Review

DRG Reviewer/Auditor IP, 10/04/2021-03/2022

Audit IP coding and investigate coding for various medical facilities, using guidelines and indictors to validate, justify and confirm correct reimbursements, conduct denials for third party insurance companies, conducts inpatient coding quality audits to validate code assignments are supported by clinical documentation in the medical record. Highly proficient in the proper assignment of ICD-10-CM and PCS codes, performs coding audits of a wide variety of complex inpatient records to validate the ICD-10-CM, PCS codes, MS-DRG and/or APR DRG assignments, provides written, detailed rationale and supporting evidence for recommendations on audit findings, Identifies documentation improvement opportunities that impact coding accuracy, collaborates with the clinical documentation improvement team for conflicts between code assignments, reviews and researches billing edits, update billing, assists with DRG denials from payers including researching and writing appeal letters, ability to interpret Medicare and NCCI guidelines, National and Local Coverage Determinations to support coding compliance.

Maxim Healthcare

OP coding- 10/2021, Current (fulltime/parttime/prn) Profee Experience: E/M Telehealth- Audited telehealth accounts

E/M audits using the E/M Telehealth Guidelines of 2022.

• Audited/Coded telehealth accounts utilizing guidelines, verifying, and confirming POS

(point of service) is captured correctly per location of visit, telehealth modifiers

(Medicare account vs commercial) (G-code vs Numeric code) ...was pt at home, in the office, interactive real time audio/visual teleconference, phone conference, remote

• Ensure the coder understands how to code telehealth accounts by utilizing the guidelines, whether patient is new or established.

• Auditing to ensure all CPT's are captured, whether pt received counseling during the visit, and how to add these CPT codes, in addition to occasioning reason for visit.

• Ensuring coder is accessing and coding per the telehealth hierarchy (ex. Time spent vs MDM hierarchy) which level of service is determined by virtual check in" CPT codes were also required.

• Ensuring the correct information abstracting from, is a licensed individual and that all documentation is authenticated in completeness.

• Audited to ensure correct codes were used per licensed practitioner based on the service and the practitioner. There are designated codes per E/M service and type of practitioner. (ex. Physicians, nurse practitioners, clinical nurse specialists, certified nurse midwives and physician assistant's vs Registered dieticians, social workers, speech language pathologists and physical and occupational therapists).

• Code ED's, Urgent Care

E/M Profee for an Endocrinologist/PCP/Obesity Clinic-- Batch of 200 accounts Audited for the 4Q 2021.

E/M Auditing-

• Ensuring coders are capturing diagnoses per Federal Coding Guidelines.

• Ensuring correct calculations for injections per unit were being coded/captured.

• Ensuring all CPT were documented per time vs MDM vs established or new patient.

• Ensuring all counseling codes were captured.

• Ensuring all POS codes were documented correctly.

• Ensuring all chronic illnesses were coded that were integral to the visit.

• Ensuring modifiers were captured and correct per the visit and services rendered.

• Ensuring all documentation was authenticated per practitioner and level of service for said visit.

• Verified billing and coding were in sync.

Oxford Healthcare Staffing

IP Coding- 06/02/2021-07/05/2021 Temporary Assignment Apply appropriate diagnostic and procedural codes to individual patient health records for claims processing, data retrieval and analysis. Primarily codes more complex and difficult inpatient medical records. Identifies and abstracts specified information from the patient medical record and enters data into the medical record abstract data base system for billing. Mira Med/On Call Staffing- 04/14/2021- Temporary Assignment, still current temporary worker employee

IP Coding

Apply appropriate diagnostic and procedural codes to individual patient health records for claims processing, data retrieval and analysis. Review claims data to ensure that assigned codes meet required legal and insurance rules and that required signatures and authorizations are in place prior to submission. Primarily codes more complex and difficult inpatient medical records. Identifies and abstracts specified information from the patient medical record and enters data into the medical record abstract data base system for billing. UT Southwestern Medical- 09/03/2019 - 01/10/2020 (was laid off during the pandemic) OP Coordinator for Coding and Data Integrity

Auditing, overseer of a team of 13, monitored daily workflow to assure organizational, departmental, and team goals are met. Conduct Prebill Audits, prepare daily volume reports, is responsible for multiple work queues including but not limited to claim edits, monitor work ques, manage leadership work ques, coding questions, customer service, Edits, denials, disputes, provide education, handle combined/uncombined accounts. Performs coding audits and reports results to the coding manager. Develops coding education materials in collaboration with the coding manager and delivers education to coding and/or CDI teams including but not limited to 1-10 updates, CPT, HCPCS, audit and/or edit trends, compliant queries, and system updates. Works in collaboration with coding leadership and other departments to provide coding support through data analysis and system functionality. Functions as a resource for the coding team and other personnel to answer questions, assist with problem resolution, and special projects assigned by department leadership. Provides back up coverage for the coding team as needed. Provides new coder onboarding education/ training in collaboration with the coding manager. Other Duties: Performs other duties as assigned.

OU Medicine Health Systems - 01/08/2018- 08/09/2019 OP Coding Supervisor

Auditing, overseer of a team of 21, trained on-boarders, answer coding questions, supervise ques, reviews work for accuracy and conformance with departmental policies and procedures; tracks and monitors production goals and standards, compose correspondence or prepare reports on own initiative, demonstrates maturity and accountability for job performance, supports the philosophy, objectives, and goals of the HIM department, and assesses areas of personal and professional growth, assist in coding ques E-requests, mocks, ref accounts, coordinate meetings, etc.

Christus Healthcare- 07/24/2015-01/04/2018

Coder Analyst II,

ED and CLI, RCR

Experience applying International Classification of Diseases and Procedures (ICD), and Current Procedural Terminology (CPT) code sets and associated Medicare/Medicaid rules and guidelines. Reviews and interprets patient medical record documentation to identify pertinent diagnoses and procedures and assigns ICD-9-CM, ICD-10-CM/PCS, and CPT 4 codes accurately and timely to the highest level of specificity based upon physician documentation for inpatient, observation, and outpatient ambulatory procedures/treatment room records. Validates the coded data to one or more Diagnosis Related Groupers (DRG) validates the Present on Admission (POA) indicators for accuracy and identifies and reports hospital acquired conditions

(HACs). Also created policies and procedures for compliance purposes for the Coding Department.

HCA-Parallon- 05/2014-07/2015

Coder Analyst 111-

1P and OP coding (ED)

Utilize specialized medical classification software to assign procedure and diagnosis codes for insurance billing. Review claims data to ensure that assigned codes meet required legal and insurance rules and that required signatures and authorizations are in place prior to submission. Conducts medical records research and corresponds with insurance companies and healthcare professionals to resolve the issues. Primarily codes more complex and difficult inpatient medical records. Identifies and abstracts specified information from the patient medical record and enters data into the medical record abstract data base system for billing. EDUCATION

Texas State University

Master of Health Information Management

May 2017

Texas State University

Bachelor of Science in Health Information Management December 2011

Dunbar High School, Fort Worth, Texas, May 1994

Contact this candidate