Shielah Matito Villanueva, CCS, CPC

Arleta, CA 818-***-**** adi5zp@r.postjobfree.com linkedin.com/in/ShielahV

Qualifications

Inpatient and Outpatient coder with over 19 years of experience including coding, charging and auditing same-day surgery (SDS), ER/ED, Chemotherapy/Infusion/Injections, Clinical Diagnostic, HCC, and E/M charts. Proven track record of coding at teaching and trauma (all levels) facilities and professional offices including at TENET, Children’s Hospital, Cedars Sinai, KP, Stanford, and at DHS LAUSC County. Query physicians with clinical data and provide feedback to improve documentations in a diplomatic and constructive manner. Collaborate with CDIS to optimize DRG reimbursement for all case mix accounts.

Software and Knowledge: 3M Encoder, CAC Optum, Quadramed, 3M 360, EPIC, Cerner, NextGen, Siemens, Meditech, Medhost/AS400, Clinview, PBAR, HPF, Softmed/Clintac, Document Viewer, M-Modal, SMS, SMART, Invision, MedAssets, CARDS Edit, Affinity System, KP HealthConnect, Pathophysiology, Anatomy & Physiology, Pharmacology, Medical Terminology, Microbilogy, NCD/LCD edits, UHDDS guidelines and Data Requirements and Reporting, and AHIMA & AAPC Coding Ethi

Experience

UHS - Palmdale Regional Medical Center Palmdale, CA Aug 2018 – Present

HIM Remote Inpatient & Outpatient Coder

Abstract and code Inpatient and outpatient medical records

Query physicians and collaborate with CDIS to optimize DRGs supported by documentations

Collaborate with QA and CDI to optimize facility services reimbursements

Meet quarterly coding accuracy requirement

TENET Conifer Health Solutions Frisco, TX Nov 2015 – May 2019

HIM Remote Inpatient Coder

Abstracted and coded Inpatient medical records

Queried physicians and collaborated with CDIS to optimize DRGs supported by documentations

Collaborated with QA and CDI to optimize facility services reimbursements

Met monthly coding accuracy requirement

Miramed On-Call Consulting Thousand Oaks, CA June 2012 – Sept 2014 / July 2015 – May 2017

HIM Remote Inpatient & Outpatient (ED & HCC) Coder

Abstracted and coded Inpatient and Outpatient (HCC) medical records for Acute Care hospitals including Level 3 Trauma

Reviewed inpatient and outpatient medical records and extracted/coded all diagnoses

Assisted in auditing a project for smaller hospital facility, partnering with the compliance director for guidance

Marina Del Rey Hospital Marina Del Rey, CA Jan. 2015 – July 2015

HIM Inpatient and Outpatient Coder

Abstracted and coded Inpatient and Outpatient hospital records for facility reimbursements, dual coding in both ICD9 and ICD10

Directly queried physicians using both electronic and paper documentation

Maxim Health Information Services Gardena, CA July 2010 – Nov 2014

HIM Outpatient Remote Coder/Data Integrity Specialist

Cedars Sinai Hospital Project (Level 1 Trauma Center and Teaching Facility, 880 beds)

Abstracted and coded Outpatient hospital records for the Cancer Center including neoplasm/infusion, pain management, orthopedic, anesthesia, s/p transplant, general surgery and clinical diagnostic charts for facility reimbursements

Stanford University Hospital Project (Level 1 Trauma Center and Teaching Facility, 474 beds)

Abstracted and coded Outpatient hospital records for facility reimbursements, researched and ensured compliance with state and federal regulations on coding guidelines

Audited Outpatient CPT and ICD codes as well as E/M records, checking for appropriate modifiers

Altru Project

Performed Outpatient coding compliance audits on outpatient care billing documentations to ensure adherence with CPT4 and ICD-9 coding guidelines as well as federal, state, and commercial payer billing and payments

Altegra Health/The Coding Source, LLC Los Angeles, CA Sept. 2009 – Oct. 2010 / Dec 2013 – Oct. 2014

HIM Inpatient Remote Coder and HCC Coder

Abstracted and coded Inpatient and Outpatient (HCC) medical records for MD Anderson (Teaching Facility; 654 beds) and Parkland Hospitals (Level 1 Trauma, 800 beds)

Advised physicians through electronic system on how to improve their documentation

Reviewed medical records and extracted/coded all diagnoses based on CMS-HCC guidelines

Providence Holy Cross Medical Center Mission Hills, CA Oct. 2009 – Sept. 2010

HIM Outpatient Coder (Per Diem)

Abstracted and coded Ancillary medical records for facility services reimbursements

DHS- LAUSC – Hudson OP Clinic Commerce, CA Dec. 2008 – June 2009

Acting OP Medical Coder (Hired as Medical Transcriber)

Abstracted and coded medical records from various outpatient services for both facility and physician billing

Assisted in auditing physician clinical documentation for compliance based on state and federal guideline

AE & Associates Corona, CA March 2008 – Nov 2008/June 2010 -Dec 2010

Physician Medical Coder/Charge Capture Coder

Kaiser Permanente Hospital

Abstracted and analyzed inpatient and outpatient patient records to be coded for charge captured reimbursements.

Reviewed denied accounts for appeal/re-appeal to collect appropriate reimbursements.

CHLA – Physician Medical Group

Abstracted and analyzed patient both inpatient and outpatient records to be coded for financial reimbursements.

Reviewed denied accounts for appeal/re-appeal to collect appropriate reimbursements.

Performed internal queries to physician for documentation clarification and improvement.

WestAid Medical Supply and Pharmacy Los Angeles, CA May 2004 – Feb 2008

Medical Coder/Biller

Coded and billed physician prescriptions for DME and pharmaceutical supplies reimbursements.

Reviewed denied accounts for appeal/re-appeal to collect appropriate supplies and drug reimbursements.

UCLA Medical Center Los Angeles, CA June 1999 – April 2004

HIM Medical Abstractor/Patient Access Financial Specialist

Assisted in ancillary coding from laboratory and radiology medical records for reimbursements.

Functioned as liaison between departments (HIM, Admission, and Utilization Review).

Education & Certificates

Registration in Health Information Technology – Santa Barbara City College Santa Barbara, CA In progress

Certification in Coding Specialist – East Los Angeles College Monterey Park, CA 2007

AA in Liberal Arts and Sciences (Pre-Nursing) – Los Angeles Valley College Valley Glen, CA 2005

Professional Associations

American Health Information Management Association (AHIMA)

American Academy of Professional Coders (AAPC)

California Health Information Association (CHIA)

Contact this candidate