Medical Coder

Professional Summary:

Certified Professional Coder (CPC) with over 10 yrs experience within in healthcare industry. Currently audits and codes ICD-9, ICD-10 and CPT on inbound Claims/EMR to ensure they are correct. I have a thorough knowledge of medical coding guidelines and coding techniques (ICD-9, ICD-10, CPT-4 and HCPCS) as well as of Anatomy, Physiology and Advanced Medical Terminology. Possess excellent communication and group interaction skills.

Technical Summary

Cerner, Amicus, Allscripts, CCS, Windows 2003 and XP: Word, Excel, Outlook, Essentris, AHLTA, CHCS, CCE

Education Summary:

B2B Medical Coding Solutions- Aug 2010

AAPC- ICD-10 Certificate: March 2015

American Academy of Professional Coders (AAPC) - (CPC) Certified Professional Coder: Dec 2010

Luther Burbank High School – Graduated: June 1999

Professional Work Experiences

Field reviewer Change Healthcare January 2018 – Current

Healthcare Effectiveness Data Information Set to ensure they are providing the quality care and services to the members they ensure.

Payment Integrity Audit ensures that Health Plans are billing correctly through the Centers for Medicare Medicaid, scan/review patient charts for personal info, audit Diagnosis and Procedure codes

Outpatient Medical Coder Altegra Health June 2016 – November 2016

Code ICD-9

Audit charts for missing Date of Services and Doctor Signature page number and patients information

Out Patient Medical Magnificus Corp (David Grant Medical Center) 06-01-2014- July 29, 2015

Code/audit EMR's (13-14 assigned clinics) for documentation accuracy, physician education, ER, data entry.

Enter CPT codes and ICD-10 / ICD-9 codes into database system accurately into 3M/AHLTA/CHCS/CCE

Review and read ER Charts- Doctor Notes from (Essentris) and assigned appropriate CPT codes and ICD-10 / ICD-9 codes

Enter Inpatient Rounds

Out Patient Medical Coder Doma Technologies (David Grant Medical Center) 01-2013- 11-2013

Code/audit EMR's (13-14 assigned clinics) for documentation accuracy, physician education, ER, data entry.

Enter CPT codes and ICD-10 / ICD-9 codes into database system accurately into 3M/AHLTA/CHCS/CCE

Review and read ER Charts- Doctor Notes from (Essentris) and assigned appropriate CPT codes and ICD-10 / ICD-9 codes

Enter Inpatient Rounds

Clerk CHW (Dignity Healthcare) 10-2009 – 12-2011

Audits ICD-9 and CPT coding on inbound Claims to ensure they are correct and to ensure timely reimbursement. If error exists, responsible for researching and sending Claim to the Coding Department for edits.

Review and organize claims that are received electronically

Process referrals and authorization form into database (IDX- Reflection for Regis Graphic Session)

Post Rejections for Appeal Acknowledgements and Appeal Approved received via correspondence

Pull and print medical records for Workers Compensation Claims from database (Cerner, Amicus, and Allscripts)

Claims Clerk I Superior Staffing (HP-Hewlett-Packard Co) EDS. Aug. 2008 – Mar. 2009

Entered confidential data into database system(Medical & Medicare)

Enter CPT codes and ICD-9 codes into database system accurately

Scan through EOBs for unpaid claims

Assisted others as needed

Intake Representative Health Net, Inc Nov 2004 – Jun. 2007

Entered CPT codes and ICD-9 codes into database system accurately

Researched diagnosis and procedure for correct ICD-9 and CPT

Processed HMO and PPO insurance, referrals and authorization forms into Care Coordination system (CCS)

Medical transcription

Office Clerk Kyle Reporting, Inc., Jan. 2004 – Apr. 2004

Responsible for filing confidential documents, photocopied and scanned documents

Answered incoming calls

Coordinated with other departments to assist with projects

Reliable for general office administrative responsibilities

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