medical coder

KINJAL PATEL

Address: ***-**** ****** **, ******, SASKATCHEWAN,

CANADA - S4S 6W2

Phone: 306-***-****

Email: adcxjy@r.postjobfree.com

PROFESSIONAL EXPERIENCE SUMMARY

Jr. Medical Coder Optimum sourcing 1st July, 2011-30th June, 2014 Quality Auditor Mednautix Outsourcing Pvt Ltd 1st July 2014-30th June, 2015 Quality Auditor Advantmed LLC 1st July, 2015-30th Nov, 2016 Quality Auditor Advantmed LLP 1st Dec, 2016-30th June, 2017 Sr. Quality Auditor Advantmed LLP 1st July, 2017-31st Dec, 2019 EDUCATION

Bachelor of Pharmacy, Gujarat University, Gujarat, India 2007 – 2011 Higher Secondary School, Ahmedabad, Gujarat, India. 2006 - 2007 PROFESSIONAL CERTIFICATION

Certified Risk Adjustment Coder (CRC) August, 2015 TTT Certification (Train The Trainer) October, 2017 AN OVERVIEW

1. Have outstanding work experience in Health Information Management profession. 2. Bright and enthusiastic personality with excellent verbal and written communication skills. 3. Adept and interested in maintaining good communication with colleagues to promote a positive, efficient work environment.

4. Excellent interpersonal skills with technical proficiency in the MS Office program. 5. Proficient mathematical skills like ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals, ability to compute rate, ratio and percent. 6. Physically fit to successfully perform the essential job functions like frequently repetitive hand actions, stand or walk, bend, twist or squat and reach above shoulder height and below waist level. In addition to that fit to occasionally lift and/or move up to 30kg (66lbs.) weight. 7. Perform tasks involving firm grasping and have sufficient co-ordination. JOB PROFILE

Jr. Medical Coder:

1. Read valid document and understand codable diagnosis considering all possibilities. 2. Translate each diagnosis in to appropriate code using ICD-CM book. 3. Collect health information as documented by medical specialist and code it. 4. Follow coding clinic guideline and coding clinic news letters to cross verify what code should be use if not sure.

5. Analyze patient chart carefully and abstract diagnosis code for each diagnosis from physician not, diagnosis report and procedure report.

6. Code according to the government regulation and insurance payer policies of health care. Also ensure that coding system meets acceptable standards.

7. Use online medical retrieval system for medical retrieval to simplify record retrieval. 8. Operate information system to review and annotate medical record, also to abstract health information and maintain classification system with great control and complete transparency. 9. Quantitative analysis- Performs a comprehensive review for the record to assure the presence of all component parts.

10. Maintain and store the health record.

Quality Auditor:

Including above duties of Jr. Medical Coder also include below for quality auditor: 1. Mentor and assist other coder within department and audit clinical data abstracted by medical coders.

2. Audit the records coded by Jr. Medical coders and perform error analysis of HCC (Hierarchical Condition Category) Coding.

3. Maintenance of audit reports and spreadsheets, gathering information specific to coding measures and verifying accuracy reports.

4. Maintain compliance with all HIPPA and other security privacy policies. Senior Quality Auditor:

Including above all duties of Jr. Medical Coder and Quality Auditor also include below for Senior Quality Auditor:

1. Serves as SME (Subject Matter Expert) by providing training, new updates and solving day by day coding issues to other coding staff.

2. Attends training and be updated about new coding rules as codes change from time to time. 3. Give Training of Out Patient coding, Inpatient coding and House call form to agents as per standard coding guideline.

4. Including above, Maintains productivity level as determined by the Quality Improvement Manager and Quality Improvement Director.

5. Serves as SME for discussing coding issues/queries with USA Team on calls and get the best solution for coding scenarios.

6. Maintains a quality in record abstraction and data entry. HEDIS Index Specialist:

1. Also work as HIS during HEDIS season Every year in same position. 2. Reviewing and comparing data abstracted from medical records by third-party vendor with the appropriate measure guidelines

3. Researching any discrepancies found by reviewing medical records, claims data and any other relevant information

4. Identifying trends and documenting any errors found 5. Applying structured auditing criteria to medical records to determine compliance with HEDIS standards 6. Demonstrating expertise in the requirements and parameters of mandated HEDIS performance measures

7. Maintaining productivity levels as determined by the Quality Improvement Department 8. Accurately entering the results of chart audits into a database (e.g. Quality Reporter) 9. Monitoring progress towards completion of the annual HEDIS chart abstraction process 10. Utilizing various software applications to support HEDIS operations Knowledge, Skill and Abilities:

1. Work in both Out patient and Inpatient record coding as per coding clinic guideline 2. Work in both HCC and HHS coding.

3. Working knowledge of the methods and techniques of abstracting clinical information from medical records Page 2 of 2

4. Working knowledge of and proficiency with Windows-based PC systems and Microsoft Word, Excel, Outlook, and database and spreadsheet software

5. Some knowledge of the concepts of managed health care 6. Some knowledge of the HIPAA Privacy and Security Rules 7. Ability to plan and organize data collection activities 8. Ability to understand, interpret and consistently apply clinical audit criteria 9. Ability to accurately evaluate medical records and other health care data 10. Ability to maintain a less than 2% error rate in record abstraction and data entry 11. Ability to understand and apply HIPAA Privacy and Security Rules 12. Ability to maintain confidentiality and security of sensitive medical information 13. Ability to navigate multiple windows while operating a computer 14. Ability to produce organized, accurate, and detail-oriented work 15. Ability to think and work effectively under pressure 16. Ability to function effectively within multidisciplinary teams 17. Ability to establish and maintain effective and cooperative working relationships with Alliance staff and others contacted in the course of work

STATUS AT CANADA

1. New Immigrant as a Permanente Residence of Canada. 2. Having an International English Language Test (IELTS) Certificate. (CLB-7) REFERENCES: References available on request

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