Medical Record Records

Candace Brooks RHIA

**** ***** ****** ** ** Atlanta, GA 30329 H: 470-***-**** E: ad5o58@r.postjobfree.com

Summary

Inpatient and outpatient medical record coding and auditor specialist with ICD-9, ICD-10 and ASC coding expertise. Familiar with commercial and private insurance carriers. Seeking position of increased responsibility and authority. Hands-on professional offering a keen understanding of data confidentiality and HIPAA regulations.

Skills

Health Records Analysis

Policy Interpretation

Staff Education

Shift Supervision

ICD-10/CPT-4 Codes

Hospital Consulting

DRG and APC Audits

Solid knowledge and understanding of clinical criteria documentation requirements used to successfully substantiate code assignments

Experience

SENIOR CODING CONSULTANT 12/2015 to Current

St Christopher Hospital For Kids - Philadelphia, PA

Consistently maintained a 98% accuracy rate assigning ICD-10 and CPT4 codes for inpatient and outpatient charts

Responsible for performing coding audits on peers.

Guarded against fraud and abuse by verifying all coded data accurately reflected services provided

Reviewed charts and established correspondence with physicians for clarification of inconsistent documentation within the medical record for optimal coding validation

DRG QUALITY CONTROL CODER 03/2021 to 03/2023

Ceris – Fort Worth, TX

Reviewing medical records to determine accuracy of billing through verification of coding and supporting clinical documentation

Conducting audits to ensure accurate charge capture, enhancing reimbursement and identifying potential savings

Demonstrated knowledge of, ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid with the ability to work independently with minimal supervision and demonstrate initiative

Performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided

CODER III 06/2016 to 1/2021

Piedmont Healthcare – Atlanta, GA

Consistently maintained a 98% accuracy rate assigning ICD-10 and CPT4 codes for inpatient and outpatient charts

Guarded against fraud and abuse by verifying all coded data accurately reflected services provided

Reviewed charts and established correspondence with physicians for clarification of inconsistent documentation within the medical record for optimal coding validation

Senior Coding Quality Analyst 08/2018 to 6/2020

Northside Hospital - Atlanta, GA

●Responsible for performing DRG audits on Medicare charts for all 3 hospitals within the organization

●Guarded against fraud and abuse by verifying all coded data accurately reflected services provided

●Reviewed charts and correspondence with physicians for clarification of inconsistent documentation within the medical record for optimal coding validation

●Provided medical coding education and updates for the department on a quarterly basis

●Participated in conducting peer educational reviews on coding guidelines, federal laws, and regulations

SENIOR CODING CONSULTANT 10/2009 to 06/2016

Himagine Solutions Inc. (formerly Kforce) - Jacksonville, FL

Assumed full responsibility for consulting at various specialty hospitals (i.e Mayo Clinic and Boston Medical Center) while participating in performing DRG audits on Medicare charts

Participated in conducting peer educational reviews on coding guidelines, federal laws, and regulations

Consistently maintained a 98% accuracy rate, assigning ICD-10 and CPT-4 codes for inpatient and outpatient records

Education and Training

Temple University - Philadelphia Bachelor of Science

Health Information Management

3.06 GPA

Certifications

Registered Health Information Administrator, certified by the American Health Information Management Association

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