Medical Records Physician Coder

Jose V. Formoso

Fort Worth, TX *****

Contact Details: *********@*****.***/718-***-****

Summary:

Detail-oriented Outpatient Physician Coder with over 16 years of experience in analyzing outpatient physician documentation to ensure accurate and complete medical records.

Proficient in assigning appropriate ICD-10, CPT, and HCPCS codes based on coding guidelines.

Skilled in conducting audits and reviews to ensure coding accuracy and compliance with regulatory standards.

Experienced in providing feedback to physicians and clinical staff on documentation improvements and coding accuracy.

Adept at ensuring adherence to federal, state, and organizational regulations regarding coding and documentation practices.

Successfully manages E&M subsequent and critical care visits, ensuring they are electronically received and submitted within the global period according to correct coding guidelines.

Strong communicator with a keen eye for detail and a commitment to maintaining high standards in medical record documentation and coding practices.

Proficient in physician coding, outpatient coding and facility coding.

Strong working knowledge of medical terminology, Anatomy and Physiology and clinical disease process.

Efficient in several coding programs including, Epic, 3M coder and Encoder Pro.

Trained in Medisoft.

Able to communicate with all level associates.

written and verbal communication skills.

Skills:

ICD-10

Epic

PowerPoint

Excel

Word

CPT

Education:

Sanford and Brown Institute, Iselin NJ

Medical Billing and Coding Specialist, Certificate Jan 2007

Tottenville H.S., GED Jun 1992

Certification

Certified Professional Coder (CPC) from American Academy of Professional Coders (AAPC)

ICD-10 Proficiency Certification

Work Experience:

ISG Value – Danvers, MA Jan 2021 – Present

Outpatient Physician Coder/Coder Review Processor:

Audit physician notes to determine if charges were correctly applied.

Analyze outpatient physician documentation to ensure accurate and complete medical record documentation.

Assign appropriate ICD-10, CPT, and HCPCS codes based on physician documentation and coding guidelines.

Conduct audits and reviews to ensure coding accuracy and compliance with regulatory standards.

Provide feedback to physicians and clinical staff on documentation improvements and coding accuracy.

Ensure adherence to federal, state, and organizational regulations regarding coding and documentation practices.

Appeared in court as a material witness to testify codes in litigation process.

Audit orthopedic and pain management surgical cases.

Audit ER facility and physician cases.

Physical out coding

Auto Injury Solutions, Iselin, NJ Feb 2013 – Feb 2021

Coder Review Processor

Audit physician notes to determine if charges were correctly applied.

Appeared in court as a material witness to testify codes in litigation process.

Audit orthopedic and pain management surgical cases.

Audit ER facility and physician cases.

New York Presbyterian Hospital – New York, NY Feb 2010 – Feb 2013

Coder II Outpatient/ Outpatient Physician Coder:

Accurately assign ICD-10, CPT, and HCPCS codes based on outpatient physician documentation and coding guidelines.

Thoroughly review outpatient medical records to ensure complete and accurate documentation.

Ensure coding practices adhere to federal, state, and hospital regulations and guidelines.

Perform regular audits to maintain high standards of coding accuracy and compliance.

Provide feedback and education to physicians and clinical staff on improving documentation and coding practices.

Electronically coded and processed ambulatory surgery cases.

Cases included GI, Interventional Radiology, Ophthalmology, Respiratory, Musculoskeletal, Integumentary & Urinary.

Audited and trained ER coders.

A Clean Bill of Health Physician Billing and Coding Services Corp, Remote May 2009 – Dec 2009

Medical Coder

Received and coded Outpatient office visits and ambulatory surgery cases for Pain Management physician.

Lutheran Medical Center, Brooklyn, NY Apr 2007 – Jan 2010

Physician Billing Coder

Received, coded and processed ED and OR trauma cases, along with two cardiovascular surgeons, while achieving productivity goals.

E&M subsequent and critical care visits are electronically received and submitted within the global period and correct coding guidelines.

Researched and resolved incorrect payments, EOB rejections, and other issues with outstanding accounts.

Audited and trained physicians in order to increase coding accuracy and efficiency.

Lutheran Medical Center, Brooklyn, NY May 2005 – Apr 2007

Ward Clerk

Registered and admitted patients into hospital.

Prepared inpatient and outpatient charts.

Received and sent specimens for laboratory work.

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