JACQUELINE A. DAWLEY

**** ******** **** ****, *******, IA 52101 C: 563-***-****

Work email: adjxjd@r.postjobfree.com. Home email: adjxjd@r.postjobfree.com

PROFESSIONAL SUMMARY

Organized and flexible coding specialist. Currently looking for remote employment.

Certified as a CCS-P by the American Health Information Management Association (AHIMA) since 2002.

Certified as CEMA, certified Evaluation & Management Auditor by National Alliance of Medical Auditing Specialist (NAMAS) in 2017. Experienced in Critical Access Method II Professional coding, Teaching Physician and Rural Health Professional coding for outpatient and inpatient settings as well as nursing home. Expertise is in Medicare and Medicaid, Government Insurance Payer coding rules and regulations. Also experienced compliance specialist and clinical documentation auditor. Desire a position that will stimulate as well as enhance my vast skill set.

LICENSES

CCS-P Certification from AHIMA in 2002.

CEMA Certification from NAMAS in 2017.

SKILL HIGHLIGHTS

·Maintains strict confidentiality

·Knowledge of Critical Access Hospital, provider based and Method II, Rural Health coding, teaching physician coding and billing rules

·Working knowledge and experience with Meditech and LSS billing systems.

·Current Electronic Health Record knowledge and experience with EPIC system.

·Trusting working relationship with all providers and nursing staff

·Serve as a resource for Providers, Nurses, Coding and billing staff

·Knowledge of Medicare Advantage plans and Medicaid privatization plans

·Coding experience in OB-GYN, General surgery, ENT, Dermatology, Podiatry, Urology, Orthopedics, Gerontology, Palliative Care, Internal Med & Family Practice

·Experienced in Insurance Denial Management

·Experienced in Revenue Cycle functions and collections

·Managed care contract knowledge

·Electronic Medical Record (EMR) software Core Team and Application Champ

·CPT, ICD-10CM and HCPCS coding

·HCC Coding

·HIPAA compliance

·Strong planning skills

·Strong work ethic

·Team player with positive attitude

·Deadline-driven

·Good written communication

·Exercises good judgment

·Experienced and trained in Documentation auditing

·Experienced in exceptional customer service relations

PROFESSIONAL EXPERIENCE

11/2019 to Present Remote OP Coding Specialist II

Baylor, Scott and White Healthcare - Dallas, TX

Analyzed and interpreted patient medical records to determine

billable services. Interpreted medical reports to apply appropriate ICD-10CM, CPT-4 and HCPCS codes. Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.

Ensured timely and accurate charge submission through electronic charge capture. Accurately entered procedure codes, diagnosis codes and

Patient information into billing software. Reviewed diagnostic and procedural

terminology for consistency with acceptable medical nomenclature.

Consistently ensured proper coding, sequencing of diagnoses and procedures.

Quickly responded to staff and provider inquiries regarding coding. Acted

In helping resolving billing denials for reimbursement accuracy. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information. Received, organized and maintained all coding and

reimbursement periodicals and updates.

7/2019 to 7/2020 Contract Profee Coder -Part time and PRN/Remote

DoctorsManagement, LLC - Knoxville, TN

Analyzed and interpreted patient medical and surgical records to determine

billable services. Interpreted medical reports to apply appropriate ICD-10CM, CPT-4 and HCPCS codes. Evaluated the accuracy of dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.

Posted charges, payments and adjustments. Ensured timely and accurate

charge submission through electronic charge entry, including the billing and

Coded professional charges for outpatient, observation, inpatient, and nursing home encounters. Accurately entered procedure codes, diagnosis codes and

patient information into billing software.

Consistently ensured proper coding, sequencing of diagnoses and procedures.

Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.

07/2010 to 8/2019 Compliance Specialist

Winneshiek Medical Center-Mayo Clinic Health System Decorah, IA

Ensured compliance with medical/legal requirements, JCAHO standards.

Consistently ensured proper coding, sequencing of diagnoses and procedures.

Quickly responded to staff and client inquiries regarding CPT codes. Acted as a

liaison between the business department, billers and third party payers in

resolving billing and reimbursement accuracy.

Responsible for taking patient calls regarding billing, insurance denials, coding

and insurance coverage questions. Demonstrated knowledge of HIPPA

Privacy and Security Regulations by appropriately handling patient

information. Received, organized and maintained all coding and

reimbursement periodicals and updates. Added modifiers as appropriate,

coded narrative diagnoses and verified diagnoses. Analyzed and interpreted

patient medical and surgical records to determine billable services.

Interpreted medical reports to apply appropriate ICD-9, ICD-10, and CPT-4

Codes. Recently train and evaluate providers on Hierarchical Condition

Category (HCC) coding. Evaluated the accuracy of provider charges,

Including dates of service, procedures, level of care, locations, diagnoses,

patient identification and provider signature. In doing so then reported the

accuracy to the provider via face to face meetings on a scorecard

timeline, in addition to reporting these results to administration on a timely

basis.

Remained up-to-date with all insurance requirements, including the details of

patient financial responsibilities, fee-for-service and managed care plans.

Actively maintained up-to-date knowledge of applicable state and Federal

laws and regulations. Revised policies and procedures in accordance with

changes in local, state and federal laws and regulations. Developed and

conducted physician documentation review process. Effectively served as an

advisory resource for coders, providers, nursing staff by providing coding

education and updates. Planned, organized and performed all coding training

for new coder orientation. Planned, organized and performed all coding

training for new provider and nurse orientations. Responsible for gathering and

researching agenda items for monthly Compliance meetings.

07/2000 to 07/2010 Coding Specialist

Decorah Clinic-Mayo Health System Decorah, IA

Appropriately and correctly identified errors and re-filed denied/rejected

claims as they were received from the Patient Account Representative. Added

modifiers as appropriate, coded narrative diagnoses and verified diagnoses.

Analyzed and interpreted patient medical and surgical records to determine

billable services. Interpreted medical reports to apply appropriate ICD-9 and ICD-10CM, CPT-4 and HCPCS codes. Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.

Completed appeals and filed and submitted claims.

Posted charges, payments and adjustments. Ensured timely and accurate

charge submission through electronic charge capture, including the billing and

account receivables (BAR) system and clearing house. Remained up-to-date

with all insurance requirements, including the details of patient financial

responsibilities, fee-for-service and managed care plans. Observed strict

confidentiality and safeguarded all patient-related information. Carefully

reviewed medical records for accuracy and completion as required by

insurance companies. Assigned additional diagnosis codes based on specific

clinical findings (laboratory, radiology and, pathology reports as well as clinical

studies) in support of existing diagnoses. Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services

rendered.

Coded professional charges for outpatient and inpatient, clinic and nursing

home encounters. Accurately entered procedure codes, diagnosis codes and

patient information into billing software. Reviewed diagnostic and procedural

terminology for consistency with acceptable medical nomenclature.

Consistently ensured proper coding, sequencing of diagnoses and procedures.

Quickly responded to staff and client inquiries regarding CPT codes. Acted as a

liaison between the business department, billers and third party payers in

resolving billing and reimbursement accuracy. Demonstrated knowledge of

HIPAA Privacy and Security Regulations by appropriately handling patient

information. Received, organized and maintained all coding and

reimbursement periodicals and updates.

08/1995 to 07/2000 Lab Secretary & Billing Specialist

Decorah Clinic-Mayo Health System Decorah, IA

Performed standard laboratory procedures which included clerical duties,

performed venipunctures and finger sticks, blood collection, central receiving,

highly skilled in preparing and labeling tubes and specimen containers,

in-depth knowledge of collecting specimens, proper recognition of patients

and registration/check-in of patients, quickly and professionally obtained

specimens for laboratory analysis, interviewed and verified physician requests,

maintained files of patient orders and other records, entered patient

Information into the computer and produced and delivered reports.

Remained up-to-date with all insurance requirements, including the details of

patient financial responsibilities, fee-for-service and managed care plans.

Consistently informed patients of their financial responsibilities prior to

services being rendered. Carefully prepared, reviewed and submitted patient

statements. Submitted refund requests for claims paid in error. Applied

payments, adjustments and denials into medical manager system. Posted

charges, payments and adjustments. Completed appeals and filed and

submitted claims. Thoroughly reviewed remittance codes from EOBS/AR's.

Appropriately and correctly identified errors and re-filed denied/rejected claims

as they were received from the Patient Account Representative.

Demonstrated knowledge of HIPAA Privacy and Security Regulations by

appropriately handling patient information. Acted as a liaison between the

business department, billers and third party payers in resolving billing and

reimbursement accuracy. Accurately entered procedure codes, diagnosis

codes and patient information into billing software. Carefully reviewed medical

records for accuracy and completion as required by insurance companies.

Thoroughly investigated past due invoices and minimized number of unpaid

accounts. Efficiently performed insurance verification and pre-certification and

pre-authorization functions. Performed full-cycle medical billing.

08/1985 to 08/1995 Desk Attendant & Blood Pressure Monitoring Technician for the Department of

Hypertension

Mayo Clinic Rochester, MN

Read and recorded temperature, pulse and respiration. Prepared patient rooms

prior to their arrival. Recorded patients' medical history, vital statistics and test

results in medical records. Escorted patients to examination rooms and

prepared them for physician exams. Ensured HIPAA compliance. Maintained

patient privacy and confidential patient information. Utilized strong

assessment skills to determine necessary patient care. Measured urine

specimens and delivered them to the laboratory. Recorded patient histories

and filed supporting clinical data and diagnosis. Instructed patients on blood

pressure monitoring equipment. Monitored patient stability by checking vital

signs and weight. Answered appointment calls. Acted as a liaison between

physician and patient. Communicated with patients by phone and via

written correspondence.

EDUCATION AND TRAINING

1985 Associate of Applied Science: Medical Secretary

Rochester Community College Rochester, MN, United States

2002 Certified Coding Specialist-Physician-based, CCS-P

American Health Information Management

AHIMA Chicago, IL, United States

2016 Compliance Bootcamp-Critical Access Hospital Version:

Health Care Compliance Association

HCCA – Minneapolis, MN, United States

2017 Certified Evaluation & Management Auditor, CEMA

Medical Auditing Bootcamp: Chicago, IL

National Alliance of Medical Auditing Specialist

NAMAS Association

REFERENCES

Lisa J Thomas, CPC

Coding Supervisor

Baylor, Scott & White Health

2401 South 31st Street

Temple, TX 76508

512-***-****

Email: adjxjd@r.postjobfree.com

William Remington, MD

ENT Surgeon

Winneshiek Medical Center-Mayo Clinic Health System Providers

Decorah, IA 52101

Office: 563-***-****

email: adjxjd@r.postjobfree.com

Sarah Caddell, RHIT

HIM Supervisor

Winneshiek Medical Center-Mayo Clinic Health System Providers

Decorah, IA 52101

Office: 563-***-****

email: adjxjd@r.postjobfree.com

COMMITTEES/BOARD/ORGANIZATIONS

·Currrent AHIMA member

·Current AAPC member

·Current member of National Alliance of Medical Auditing Specialist

·Past member of WPS Medicare POEG (Physician Outreach Education

Group)

·Past advisory board member for HIT program at Northeast Iowa

Community College (NICC)

·Past member of Mayo Health System Coding Advisory Board

·Past member of Mayo Health System Provider Education Resource

·Group

·Past member of the Mayo Health System Compliance & Medicare

·Strategy Committee

·Past member of the Compliance Committee at Winneshiek Medical Center-Mayo Health System Providers

·Past member of the Revenue Cycle Committee at Winneshiek

Medical Center-Mayo Health System Providers

·Past core team member and Applications Champ for Electronic Health Record at Winneshiek Medical Center-Mayo Health System Providers

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