DENISE M. GARCIA, CPC

**** ******** ***** **** #** • Clearwater, Florida 33763-3412 • Cell 813-***-**** • adpk7m@r.postjobfree.com

PROFESSIONAL PROFILE

Accomplished specialist with professional integrity and a solid understanding of the medical billing and coding industry. Solutions-driven with refined communication skills and comprehensive problem-solving abilities. Repeatedly promoted to leadership positions. Recognized for ability to excel as both a leader and key contributor. Demonstrates a positive, upbeat and can-do attitude.

SKILLS SUMMARY

ICD-10-CM Certified

Demonstrated history of producing accurate, timely, compliant documentation meeting customer and management satisfaction.

Keenly recognizes, investigate and resolve discrepancies leveraging extensive experience going through appropriate channels to facilitate medical claims review and appeal processes.

Ability to operate with high degree of sensitivity and confidentiality.

Strong decision-making abilities and analytical thinking skills.

Hands-on, deadline-oriented self-starter, who handles pressure well and possesses excellent prioritization and time management abilities.

Proven multitasker known for attention to detail, organization and professional knowledge.

10 years’ experience as a Technical Writer for a large communications company.

QUALIFICATIONS

Medical Terminology • Windows 10 • MS Word, Excel, PowerPoint, Access • XP • Publisher • Technical Writing • Chart Navigator • Cisco • Cerner Power Chart • Care Cloud EHR • EPIC Medical Records • Auditing • Patient Services • Accounts Receivable • Payment Posting • Modifiers • Workman’s Compensation • Claims Review and Processing • HIPPA • CPR • Medical Transcription • Office Management • Office Systems Specialist • Training • Instruction • Insurance Verification • Computer Skills • Key 13560 KSPH • EPIC • Chartview • Citrix • 3M • Power Trak •Citrix Power Charts • BR4 Medical Manager • Surgicource • IDX • HALO • Greenway Connect EHR • Claim Gear EHR • Military Coding • 3M Coding • Moodle

• Optum Medical Record Manager • Optum Encoder Pro • ICD-10-CM Certification

• Compliance 360 • Excelys • STARS

PROFESSIONAL EXPERIENCE

Medicaid Done Right (MDR)

Processor

Process Medicaid applications for patients who have entered a skilled nursing facility (SNF) and requesting for Medicaid assistance from the state. The facilities hire MDR to take on the task of completing the process for the patient and patient’s family. This process is as follows:

1.Initiate a Welcome Call to the contact given – request any documents that are required by the state. Welcome the family to MDR and at this time answer any questions the person of contact may have.

2.Submit the application with the documents on hand. After the submission the primary goal is to get all the necessary remaining documents i.e., bank statements, income verifications, assets verification, etc. and submit to the state for their review to obtain approval for Medicaid.

3.After five days contact is made to the State verifying they have received the application and status of the application. Make any calls necessary to push the case for approval.

4.If any documents are pending, contacting the facilities, i.e., Life Insurance/annuity companies, banks, funeral homes, etc. to get the case quickly approved.

5.Processing of one application may take 35-90 days depending on the situation.

Mr. Tax Financial Services

Office Manager Dec 2021 to Present

Run the operation of this organization – duties include:

Manage an office of three people:

Research for new employees; office and tax preparers

Maintain/Approve employee’s timesheets

Ensure employees are compliant with the organization’s process and procedures

Implement procedures to ensure tax preparers meet productivity.

Train employees on company’s process and procedures.

Maintain security for all employees: by assigning/terminating security codes.

Handle phone calls from clients.

Assist clients with their questions and ensure they sign and pay for their refund in a timely manner.

Handle client’s payments and maintain a log of monthly revenue.

Maintain client files - created a new filing system.

Purchase office supplies and all miscellaneous supplies.

Ensure the office is clean and tidy.

Handle all vendors: pest control, communication companies, utilities, etc.

Handle corporate client’s employee payroll.

Handle the company banking – preparing for deposit and keep track of payments [e.g., checks, cash, credit cards].

SNI Companies / Greenway Health

Certified Professional Coder (CPC) / Technical Writer July 2019 to July 2020

Technical Writer for EHR and Practice Management for Product Development, Greenway Revenue Services (GRS), and Intergy system.

Created workflows for the above systems

Worked with the development team

Attended meetings with the development team to keep apprised of deadlines

Attended daily meetings with manager and technical writing team.

Created current CDC Guidelines that were expired in the system and posted them into the system for the medical billers to be able to research guidelines.

Gave recommendations after shadowing the medical billing team that the medical billers needed to see in their billing system to increase the productivity.

Took training in the Intergy billing system to be better equipped on how the system works.

WellCare Health Plans Tampa, FL March-2016 to Nov 2018

Certified Professional Coder (CPC)

Medical Coding Auditor – Special Investigations Unit (SIU)

Conducted comprehensive reviews of medical records and documents supporting claims for providers, suppliers, and pharmacies to include, but not limited to physicians, inpatient, outpatient, ancillary, behavioral health care, laboratory, etc.

Verified and validated authorization of services, written clinical documentation of services received through health services and health utilization management departments, and information contained in health care claim systems against claims, medical records and other documentation submitted by the provider, and identified coding errors, inconsistencies, anomalies, abnormal billing patterns, and other indicators (e.g., services not rendered, up-coding, unbundling, etc.) of suspected fraud and abuse.

Verify authorization for services and written documentation of services provided against claim information, ensuring the appropriateness and accuracy of diagnosis and procedure codes supporting such claims coordinate medical necessity and appropriate level of care determinations with medical directors, and validate services against CMS, State-specific coverage limitations and exclusion guidelines, and researching Federal Regulations.

Coordinates individual work activities with SIU investigators, develops and present findings and recommendations regarding the appropriateness of diagnosis and procedure codes submitted on provider service claims, and submits overpayment recovery during discussions/meetings.

Created a “Summary of Findings” to present to the investigator on each case, giving recommendations on the findings after extensive research of State/Federal Guidelines and review of the provider’s documentation ensuring the documentation met compliance regulations. The Summary format consisted of the findings of each claim, the reason for the denial, if any, Provider Education, and References used to justify the findings.

Supported and participated in process and quality improvement initiatives.

Attended educational seminars/workshops on fraud and abuse awareness, detection and reporting to areas and departments as required.

Performs other duties as assigned.

Change Healthcare Tampa, FL October 2018-Present

Certified Professional Coder (CPC)

Mostly responsible for HCC coding for commercial risk adjustment

Note: Presently studying for the CRC certification, and plan to sit for the CRC exam.

Starus Healthcare Tampa, FL Feb-2016 to March-2016

Certified Professional Coder (CPC)

Responsible for coding outpatient visits

Insight Global Tampa June-2015 to Feb-2016

Certified Professional Coder (CPC) – HCC Coding / Remote position

Responsible for coding Inpatient and Outpatient Risk Adjustment (HCC coding) - utilizing

ICD-10-CM codes for chronic conditions for all specialties.

Everest University Tampa & Largo Campus Jan-2014 to June-2015

Certified Professional Coder (CPC) - Lead Instructor for Medical Billing & Coding Department

Responsible to teach Intermediate and advanced coding on all chapters of the CPT and diagnosis coding.

Instruct how to abstract operative/progress notes, fundamentals of E/M coding, inpatient and outpatient hospital coding.

Create collaborative structures for the classroom to enhance learning.

Input student attendance in company database portal

Vastec Feb-2014 to July 2014

Certified Professional Coder (CPC) – with Security Clearance

Coding Ambulatory Provider Visits (APV) for Walter Reed Military Hospital – responsible for coding all phases/specialties and adhering to Military Guidelines as well as CMS Guidelines for the outpatient setting

Coding for Inpatient Provider Services (IPS) – for Walter Reed Military Hospital responsible for coding all specialties in this setting, adhering to Military Guidelines as well as CMS Guidelines.

Change Healthcare Tampa, FL (Remote position) Oct-2018 to Present

Certified Professional Coder (CPC)

Coding Risk Adjustment for Medicare/Medicaid

Coding of all specialties

Insight Global, Inc. Oct-2013 to Feb-2014

Certified Professional Coder HCC Coding / Remote Position

Responsible for coding Inpatient and Outpatient Risk Adjustment (HCC coding) for Optum Healthcare utilizing ICD-10-CM codes for chronic conditions for all specialties: Orthopedics, Adolescent Medicine, Immunology, Gastroenterology, Endocrinology, Psychiatric, Immunology, Cardiology, Genetics, Neurology, ENT.

Tactical Management, Inc., Tampa, FL Feb-2013 to Oct 2013

Professional Coder Remote Position – Pediatric Care

Responsible for coding in pediatric care for Miami Children’s Hospital project in all specialties: Orthopedics, Adolescent Medicine, Immunology, Gastroenterology, Endocrinology, Psychiatric, Immunology, Cardiology, Genetics, Neurology, ENT, Pediatric Medicine.

Main coding responsibilities were coding ICD-9-CM, E/Ms, consultations.

Strength is in ICD-10-CM coding.

Ultimate Medical Academy, Tampa, FL 4/2010-2/2013

Certified Professional Coder – Lead Instructor for Medical Billing & Coding Department

Responsible to teach advanced coding on all chapters of the CPT and diagnosis coding.

Instruct how to abstract operative/progress notes, fundamentals of E/M coding, inpatient and outpatient hospital coding.

Maintain records of student attendance, student progress, and grade distributions.

Participate in special staff development activities for faculty.

Create collaborative structures for the classroom to enhance learning.

Assume other responsibilities as assigned by the appropriate instructional administrator.

Input student attendance in company database portal; ensure other instructors are update with reporting and adhering to company policies and compliance.

Assist program director with student issues, student academic progress

Assist in maintaining student retention - give reports to program director.

Peak Healthcare, San Diego, CA 2009-2010

Certified Professional Coder / Remote Position

Abstract physician’s progress/procedure notes in the clinic setting by assigning the appropriate procedural and diagnosis codes for the following projects:

Emergency Department/Observations (Jan. 2010 – Aug 2010)

Observation care services, Subsequent hospital care visits, Observation/Inpatient care services, Observation care discharge services, Observation consults, Radiology, Procedures, ICD-10-CM codes.

Abstract Coding in the clinic setting (Aug. 2009 – Jan 2010)

Evaluation and Management, Emergency Department, Radiology/Laboratory, Pathology, Surgery (all sections within surgery), Vascular Injections, Medicine/Vaccines/Immunizations/Acupuncture, OB/GYN, Respiratory, Cardiology, Ophthalmology, Neurology & Neuromuscular Procedures, Physical Therapy, Dermatology, Orthopaedic.

Coventry Health, Tampa, FL 2008-2010

Certified Professional Coder

Reviewed “Evaluation and Management” that were electronically submitted through Powertrak and BR4 systems for the workman’s compensation setting.

Abstracted progress notes and evaluated the appropriate CPT code or denial of claim.

Gave recommendations by adhering to the CPT Guidelines for determining the correct level to be billed.

Reviewed consultations, hospital visits, emergency department, injection codes, prolonged visits, physical therapy, radiology, and medical team conferences.

Verified that diagnosis codes matched and were in conjunction with procedure codes.

Made certain that body parts matched physician billing.

Florida Orthopaedic Institute – Surgery Center, Temple Terrace, FL 9/2007-10/2008

Certified Professional Coder

Handled abstract coding for pain patients and patients having orthopaedic surgery.

Ensured correct CPT and ICD-9-CM codes and proper modifier codes were assigned.

Medical Records Coordinator

Handled break down of charts in correct order.

Obtained the operative notes and physician signatures.

Made certain the operative notes were concise and accurate to coding and that they were complete and ready for billing.

Handled training of support personnel.

Tracked patient charts daily in preparation for coding and billing.

Screened healthcare records to verify they were complete and contained all required data.

Maintained confidentiality of medical records and supervised the release of medical information.

Ensured retrieval and storage of records were compliant with legal requirements.

Made certain records were accessible to authorized health care practitioners anytime facility was open to patients and that records were filed for easy retrieval.

Provided backup billing support as needed.

Florida Gulf-to-Bay Anesthesiology, Tampa, FL 1/2006-9/2007

Certified Medical Coder – Anesthesia Coding

Reviewed physician’s procedure notes and applied the appropriate procedural and diagnosis codes including abstract coding for the following medical facilities:

Critical Care for Tampa General Hospital, Surgicare for St. Mary’s Hospital, Florida Orthopaedic Institute-Surgery Center, Largo Medical, St. Pete Medical, Southbay Memorial Hospital, Riverwalk Medical, Pasco Medical, Tampa General Hospital (Anesthesia for all procedures) and Physician’s Health Center in Naples, Florida.

Florida Orthopaedic Institute Surgery Center, Temple Terrace, FL 2005-2006

Patient Services/Collection Specialist

Checked in patients, ensured proper forms were completed, collected co-payments and answered questions regarding insurance.

Pursued outstanding late accounts with patients in accordance with facility policy and procedures.

Updated accounts receivable aging accounts, monitored aging report, updated insurance data and assisted front desk personnel as needed.

Custom Staffing, Tampa, FL 2005

Medical Bill Claims Reviewer

Reviewed and process 60-90 medical bills daily for rehabilitation and health insurance facilities.

Entered all bills and determined proper allowance based on State provisions and established guidelines.

Concentra Integrated Services, Tampa, FL 2004-2005

Medical Bill Review Auditor

Reviewed medical bills for Worker’s Compensation and resolved errors.

Used PowerTrak to manually price procedure codes that had not been processed correctly in system.

Knowledge of physical therapy, chiropractic care, surgeries, anesthesia, home health care and prescription drugs.

Processed and resolved invalid exception codes, reviewed CPT and ICD-9 codes for linkage, and managed employee sensitive claims.

Entered all bills and determined proper allowance, ensured accurate modifiers, and sent payment recommendations to insurance carrier.

Handled 150-200 bills daily; assisted in job training and developed documentation for training.

ADDITIONAL PROFESSIONAL EXPERIENCE

GTE Data Services, Tampa, FL – Technical Writer 1986-1996

oWas responsible for creating/maintaining the documentation on the

software that the database administrators created – solely responsible for the Medicare

project which was on new releases every six weeks.

Ensured the accuracy and made grammatical errors. State-of-the-art computer system, Interleaf, was utilized in maintaining these manuals.

oEnsured that the software and the documentation coincided – if any discrepancies in the documentation informed the project manager/project lead.

oWorked closely with the project managers to ensure budgets and deadlines

were met.

oResponsible for the manuals being printed and delivered to the project within the deadline.

Great American Paper, Inc., Tampa, FL – Executive Administrative Assistant,

Human Resources Director, and Safety Director, Purchasing Manager 1996-1999

Aero Simulation, Inc., Tampa, FL – Assistant Purchasing Agent 1999-2001

Teleradiology Association, Tampa, FL – Radiology Assistant (Part-time) 2001-2002

Brandon Regional Hospital, Brandon, FL – Radiology Assistant (Part-time) 2002-2003

EDUCATION

Hillsborough Community College, Tampa, FL

Medical Billing and Coding, 2005 (GPA 3.50)

Internship: H. Lee Moffitt Cancer Center in Tampa, Florida from May 2005 to July 2005 in the DIO Coding Support Department.

A.A. Liberal Arts, 1978

ASSOCIATIONS

Member of the American Academy of Professional Coders (AAPC)

Member & former Secretary for Tampa Bay Florida Chapter (AAPC)

COMMUNITY INVOLVEMENT

‘2018-2019 Vice President of HOA Community

AAPC – Acted as Secretary for Tampa Bay Professional Coders and assisted with negotiations to have local chapter regional conference to be held in November 2010.

H. Lee Moffitt Cancer Center – Offered time and talent in DIO Coding Support Department as the medical coder for Oncology physicians (research of Melanoma).

Volunteer for “Feeding American

Volunteer for Metropolitan Ministries

Volunteer for Habitat for Humanity

AWARDS

Teach Beyond Z – education achievement award for collaborative structuring at “2011 UMA Education Summit.”

President’s Award while at GTE Data Services for excellence on the job and was given a 7-day paid vacation to Marco Island. Also received numerous smaller awards for recognition and dedication on the job.

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