Medical Records Physician's
Resume:
Ophelia Calixte
Delray Beach, FL *****
******************@*****.***
Medical Site Reviewer (1099)
March, 2012 – currently
Medical reviewers work in hospitals, physician offices, nursing homes, and for independent auditing firms.
Review or audit medical records for completeness and accuracy by looking at various pieces of documentation. Incorrect or missing documentation can result in loss of hospital accreditation, a physician's license, or Medicare status.
Medical reviewers look at each individual medical record to check for missing documentation; they also check for physician's notes that show any evidence of patient neglect or abuse and verify that the correct member of staff has signed all paperwork.
When the reviewer finds a problem with the record, a citation is issued to the medical staff member. The member is given a deadline to fix the mistake.
A follow-up conducted by the reviewer is done to ensure the record is up to compliance.
Communicated effectively with clients and medical professionals
Scheduled clients serving four medical offices, taking into consideration client location, facility capabilities, insurance requirements, and type of exam
Followed up with doctors' offices to ensure proper exams are scheduled for clients
Consistently recognized as top scheduler to achieve company benchmarks
Performed administrative tasks as needed
Scheduling Home Healthcare – Evaluation RN, PT, RN, NA
CareCentrix, Carelon, Availality etc.
Remote Customer Service Representative
Diagnostic Professionals, Inc. - Fort Lauderdale, FL
August 2014 to 2016
The final product of a diagnostic imaging study is the completed image set on the radiologists’ PACS and radiology information system worklist. Before the case is completed, multiple prior steps are required:
1. Order received from referring physician.
2. Examination protocol must be completed by radiologists.
3. Insurance preauthorization must be obtained.
4. Schedulers check availability and book the imaging examination.
5. Assign anesthesia to the case if needed.
6. Calls to patient with date/time of examination.7
7. Advise Preparation and protocol for upcoming procedures
Instructor, Medical Billing and Coding, Robert Half Contract
Centura College, South Carolina, April, 2011 – January, 2012
Facillitate and/or instruct associate coding education programs’
Advises current associates relative to their coding education performance and maintains appropriate documentation thereof.
Under the direction of the HIM Coding Education Director the HIM Coding Educator will:
Assist with development and coordination of coding education and coding training to all appropriate personnel, including HIM coding staff, physicians, billing personnel, and ancillary in areas relevant to health information management including appropriate documentation, accurate coding, modifier assignment, compliance and data management.
Assist with coding consultants and other contracted entities (for example, outsourced coding personnel) to ensure that they understand and agree to adhere to the organization’s HIM education requirements.
Manages implementation and maintenance of education programs pertaining to Inpatient and Outpatient Coding DRG assignment, APC coding, POA assignment, Discharge Disposition assignment, coding compliance education and assists with ongoing monitoring of coding accuracy and documentation adequacy
Work collaboratively with Coding Compliance. Reviews audit results and performs trend analyses to identify patterns and variations in coding practices and case-mix index which require education.
Serves as a resource for department Directors, staff, physicians, and administration to obtain education, training or information on accurate and ethical coding and documentation standards, guidelines, and regulatory requirements.
Ensures maintenance of attendance rosters and documentation (agenda, job aids) for HIM training programs.
Ensures development or procurement of instructional materials to include course plans, objectives, audiovisual aids, lab activities, and evaluation tools.
Ensure instruction of associates is appropriate and effective. Assesses course effectiveness through associate evaluations
Accurate and timely completion of patient record coding.
Performs coding activities to assure accurate completion of coding for all patient records; including reviewing for each charge submission for accuracy, adding appropriate modifiers, scrub claims, technology scrub, prepare for insurance, and close the clean batches.
Investigation and resolving coding related issues
Analyzes medical records for completeness of documentation with direct communication to providers for clarifications on any incomplete or conflicting documentation.
Keeps current on all coding related regulations, standards, guidelines, industry trends and Medicare announcements. Serves as a coding expert and resource for all payers.
Assists in providing coding compliance activities by conducting random audits on medical charts.
Educates physicians, clinicians, and other healthcare staff on changes to coding standards and regulations and advocates proper documentation practices.
Assistant Administrator, Health Services
NHP - Miami, FL
June 1992 to August 2011
Assist in the daily operation
Creation of business plan
Site planning
Clinical safety measurement and outcomes analysis
Preparation of a Medicare cost report
Creation and analysis of appointment access indicators
Third-party reimbursement and contracting analysis
Patient Relations - patient satisfaction analysis
Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
Maintain internal provider grid to ensure all information is accurate and logins are available
Update each provider’s CAQH database file timely according to the schedule published by CMS
Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
Complete re-credentialing applications for commercial payers
Credential new providers and re-credential current providers with hospitals at which they hold staff privileges
Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
Supervision of patient scheduling, registration, financial counseling, medical records, billing and collection, data entry and processing, and cash posting
Promoting excellent customer service
Develop, implement, and maintain office policies and procedures
Interview, hire and train a productive medical office team
Education
Congress of Christian Education
Nashville, TN Remotely (presently) Graduating April, 2023 Phase One
Skills
Medical Terminology, Coding, Word Excel, E-file, Credentialing, Workers’ Comp/Legal Assistant etc., Patient Sync
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