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Coder Safety Health

Location:
Acworth, GA
Posted:
April 11, 2022

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Resume:

Bertha Okpareke, CPC

Acworth, GA

SKILLS

•CPC with 15 years coding experience including Profee and HCC coding / Auditing

•Profee: Audits, E & M Levels – 95 Guidelines, E & M Levels – 97 Guidelines, 2021 Guideline Updates, Emergency Services, HCC, Hospitalist, Ophthalmology/Optometry, Pain Management, Pediatrics, Podiatry, Primary Care, Telehealth Medicine, Urgent Care, Urology, Wound Care, Family Practice, Observation, Ancillary

•ED Case Mix: Asthma, Burns, Fracture, GWS, Head Injuries, Infectious Disease, Intoxication, Lacerations, MVA, Peds cases, Traumas and Wound Care, Behavioral Health, Hospitalists, Internal Medicine, OB/GYN, Oncology, Sports Medicine, Physical Therapy

•System Experience: Epic, 3M, 3M 360, 3M HDM, Allscripts, Athena, Cerner, Chartmaxx, Clintergrity/Quantum (Nuance), ClinTrac, HPF, Optum 360, Sorian, Trucode

WORK EXPERIENCE

AMN Healthcare (University Health System)

Profee Hospitalist Coder

11/2021 - Present

Researched, reviewed, and coded missed encounters from report. Assigned E/M levels, diagnosis codes and modifiers.

Remotely coded telehealth encounters for Multi-Specialties: Psych, ENT, Ortho, Neurology, Family Practice, Internal Medicine, Gastro, Cardio, Behavioral, Urgent Care and Peds.

Reviewed and coded edit encounters. Made corrections and resubmitted for payments.

Communicated to managers, coders, attended meetings for updates and changes in department.

Remote Profee Auditor

July 2021-October 2021

•Remotely audited patient encounters for 32 Providers from 14 specialties, average of 30 charts per provider.

•Utilized new 2021 Guideline updates.

•Reports and recommendations are written based on audit findings.

•Managers, providers, coding and billing staff are communicated to, regarding deficiencies of Under coding, under documented, use of modifiers and E/M leveling based on documentation.

Memorial Hermann Health

Profee Remote Coder / Auditor

April 2020-May 2021

•Presently coding remotely for urology, Family/internal medicine, Covid-19, Urgent Care, Pediatrics, Orthopedics, Telehealth and Hospitalist specialties.

•Assigned E/M Levels, diagnosis codes and appended modifiers for outpatient encounters.

•Audited, reviewed claims for correct coding and completeness before submission for payment.

•Managed edits, duplicate claims, corrected errors and resubmitted to billing for timely filling/payment.

•Communicated with billing staff, coding staff, clinicians and Physicians.

Change Healthcare

HCC Coder

November 2020-March 2021

•Managed Project based on Hierarchical Condition Categories (HCC) to determine severity of illness and reimbursement levels of enrollees in Medicare Advantage plans.

•Performed outpatient coding for medical centers located in New York and Ohio state networks. Coded 40-60 charts daily while maintaining 97% accuracy and achieving productivity goals.

•Validate provider, vendor and internal diagnosis coding for accuracy by reviewing and analyzing claims, abstract diagnosis codes from medical records. Audited charts.

•Determine coding issues and discrepancies and update as necessary.

•Identify coding issues, determine impact to risk adjustment models and reports for various products and services.

•Participated in HCC and HEDIS (Healthcare Effectiveness Data and Information Set) project, which included Payment Integrity, Health Outcomes Improvement, Quality, Safety Health and Wellness Programs.

Ixoop Tech, Inc.

HCC Coder

June 2020-August 2020

•Managed Project based on Hierarchical Condition Categories (HCC) to determine severity of illness and reimbursement levels of enrollees in Medicare Advantage plans.

•Performed outpatient coding for medical centers located in New York and Ohio state networks. Coded 40-60 charts daily while maintaining 97% accuracy and achieving productivity goals.

•Validate provider, vendor and internal diagnosis coding for accuracy by reviewing and analyzing claims, abstract diagnosis codes from medical records. Audited charts.

•Determine coding issues and discrepancies and update as necessary.

•Identify coding issues, determine impact to risk adjustment models and reports for various products and services.

•Participated in HCC and HEDIS (Healthcare Effectiveness Data and Information Set) project, which included Payment Integrity, Health Outcomes Improvement, Quality, Safety Health and Wellness Programs.

Berkshire Health

Profee Remote Coder

January 2020-April 2020

•Coded Telehealth encounters for Family Practice, Internal Medicine and Pediatrics.

•Assigned E/M levels adhering to telehealth guidelines, time spent with patient via phone and real time audio.

•Appended modifiers required by respective insurance policy to facilitate reimbursement.

•Responsible for team coding Covid-19 pandemic ER encounters with updated specific codes and guidelines.

•Reviewed charts for accuracy before submission.

Paulse8 Health Solutions

HCC Coder

October 2018-April 2019

•Managed Project based on Hierarchical Condition Categories (HCC) to determine severity of illness and reimbursement levels of enrollees in Medicare Advantage plans.

•Performed outpatient coding for medical centers located in New York and Ohio state networks. Coded 40-60 charts daily while maintaining 97% accuracy and achieving productivity goals.

•Validate provider, vendor and internal diagnosis coding for accuracy by reviewing and analyzing claims, abstract diagnosis codes from medical records. Audited charts.

•Determine coding issues and discrepancies and update as necessary.

•Identify coding issues, determine impact to risk adjustment models and reports for various products and services.

•Participated in HCC and HEDIS (Healthcare Effectiveness Data and Information Set) project, which included Payment Integrity, Health Outcomes Improvement, Quality, Safety Health and Wellness Programs.

•Performed HCC, ICD-10 coding targeting selected measures of several specialties.

•Collected data, reviewed medical records, abstracted charts, performed reporting and analysis.

•Created and managed functional database and spreadsheet for better organization of project. paying attention to detail and accuracy level.

•Maintained compliance and coding guidelines according to CMS and OIG.

•Adhered to strict deadlines for coding to avoid untimely filing.

•Payment Integrity Audit-PIA (project) Project was based on Medicare Advantage Risk Adjustment payment method, created by Medicare to reimburse private plans for providing health maintenance to Medicare patients.

South Maine Health Care

Profee Travel Coder / Auditor

March 2019-January 2020

•Coded Family Medicine, Adult Medicine, Pediatrics and Emergency Room charts.

•Coded Orthopedics, trigger point injections, Podiatry and Ancillary.

•Assigned E/M levels for office visits, ER and Facility with point system.

•Performed CCI edits to ensure clean claims were submitted for payment.

•Audited physicians’ E/M leveling to ensure correct components were met for the level assigned.

Penn State Health

Profee Remote Coder

October 2018-March 2019

•Coded Professional side of emergency charts, ICD-10-CM, including infusions and injections.

•Assigned facility and professional E/M levels.

•Coded emergency Procedures and appended modifiers.

•Coded EMR charts from outpatient clinics that includes Orthopedics, Pathology, Oncology, Family Practice, Urology, Gastroenterology.

Franciscan Alliance Health Systems

Profee Contract Remote Coder / Auditor

January 2018-October 2018

•Coded EMR charts for professional side of ER with ICD-10-CM, CPT including infusion and injections.

•Assigned and coded E/M levels, for outpatient and facility encounters.

•Assigned diagnosis codes, procedures and appended relevant modifiers.

•Audited and reviewed charts for accuracy and completeness.

•Worked denials and submitted to meet deadlines for respective health insurance companies.

Gundersen Health System

Contract Remote Coder

September 2018-December 2018

•Coded and assigned E/M level for hospitalist encounters for different specialties, Gastroenterology, orthopedics, Urology and endocrinology and other specialties. All physician charges.

•Assigned E/M level for Observation encounters, appended relevant modifiers.

•Worked and cleared edits and resubmitted charts for payment to meet timely filling.

•Coded urgent care charts and procedures.

Theda Care Health System

Profee Contract Travel Coder / Auditor

June 2017- October 2018

•Coded EMR charts for Family Practice, Internal Medicine Ortho and Ancillary.

•Audited charts to ensure correct E/M Level is coded.

•Reviewed Insurance denials, made corrections and resubmitted to meet deadlines for timely filling.

•Assigned E/M levels for outpatient charts, appended modifiers.

Hilo Medical Center

Profee Contract Remote Coder / Auditor

April 2017-June 2017

•Coded Professional side of emergency charts, ICD-10-CM, including infusions and injections.

•Assigned facility and professional E/M levels.

•Coded emergency Procedures and appended modifiers.

•Coded EMR charts from outpatient clinics that includes Pathology, Oncology, Family Practice, Urology, Gastroenterology.

•Audited and review charts for accuracy before submission.

•Communicated with physicians, managers and billers.

Lakeland Regional Health

Profee Contract Remote Coder / Auditor

January 2017-March 2017

•Remotely coded charts for Orthopedics, Urology, Pediatrics ancillary and family practice.

•Audited and reviewed charts for accuracy and completeness.

•Coded E/M levels, procedures and appended modifiers for each specialty.

•Coded and audited EMR charts for Orthopedics specialty that included, ambulatory surgery, Injections and castings.

The Christ Hospital

Contract Remote Ancillary/ER Coder

November 2015-November 2016

•Coded Ancillary charts that included Pathology, Cath Scan, Duplex Scan, Echocardiogram, Epidural injections, Diagnostic and screening Testing.

•Assigned and sequenced ICD-10 CM, CPT codes and modifiers accurately base on medical documentation.

•Reviewed Physician orders from multiple specialties to ensure completeness and accuracy.

•Maintained productivity and 95% accuracy.

University of Chicago Medicine

Contract Remote Coder

June 2016-October 2016

•Coded emergency charts for children and adult ER departments, ICD-10-CM, CPT.

•Coded procedures including infusions and injections. Appended modifiers.

•Performed charging for all emergency charts from 3 different systems.

•Assigned facility and professional E/M levels.

Pocono Medical Center

Contract Remote Coder

November 2015-June 2016

•Coded Professional side of emergency charts, ICD-10-CM, including infusions and injections.

•Assigned facility and professional E/M levels.

•Coded emergency Procedures and appended modifiers.

•Coded EMR charts from outpatient clinics that includes Pathology, Oncology, Family Practice, Urology, Gastroenterology.

•Audited and review charts for accuracy before submission.

•Communicated with physicians, managers and billers.

Baylor Scott &White Health

Contract Coder/Auditor

March 2015-October 2015

•Coded emergency charts, ICD-10-CM including infusions and injections.

•Assigned E/M levels for patients’ visits.

•Coded emergency procedures and appended modifiers.

•Performed emergency charge capture.

•Communicated with physicians, billers and managers.

Centennial Medical Group

Contract Coder/Auditor

November 2014 – March 2015

•Auditing patient charts for 15 physicians from 6 specialties and an average of 20 charts per physician.

•Writing reports and recommendations on findings.

•Communicate with providers, coders and managers regarding deficiencies related to up coding, under coding and use of modifiers.

Fremont Area Hospital

Contract Coder/Auditor

June 2014 – December 2014

•Coded emergency charts, including injections and infusions.

•Reviewed and audited charts.

•Assigned E/M levels for patient visits.

•Communicated with physicians, billers and managers.

Sky Lake Medical

Contract Coder/Auditor

January 2014-June 2014

•Coded Family Medicine, Adult Medicine, Pediatrics and Emergency Room charts.

•Coded biopsies, trigger point injections, debridement and destruction of lesions.

•Assigned E/M levels for office visits, ER and Facility with point system.

•Prepared and sent queries to physicians for clarification of documentation.

•Performed CCI edits to ensure clean claims were submitted for payment.

•Audited physicians’ E/M leveling to ensure correct components were met for the level assigned.

•Audited patient charts for under or up coding.

Kaiser Permanente

Contract Coder/Auditor

August 2013-February 2014

•Coded Pathology, Labs, Internal Medicine, Family Practice and Pediatrics.

•Researched, corrected and resubmitted denied claims.

•Performed CCI edits on each claim to ensure CPT and ICD-9 codes supported documentation and charts were coded in compliance with correct coding initiative.

•Assigned E/M levels/ codes for outpatient office visits.

•Reviewed and confirmed physicians’ orders for Laboratory and Radiology.

•Maintained tumor registry.

Dignity Health

Contract Coder/Auditor

March 2013 – July 2013

•Performed compliance audits to ensure adherence to rules and guidelines for Medicare, Medicaid and third-party insurance.

•Performed audits of posted charges to determine whether services ordered and rendered were accurately billed and supported by proper documentation.

•Maintained current knowledge of charge master system, clinical charging, billing documentation policies and processes.

•Performed CCI edits on claims to ensure codes were not unbundled and appropriate modifiers were appended.

•Maintained thorough knowledge of CPT-4 and ICD-9 CM coding procedures and application.

•Ensured policies and procedures were compliant with correct coding initiative guidelines.

•Reviewed claims before submission for correct codes and modifiers to minimize denials.

Tuba City Regional Health

Contract Coder

May 2012 – March 2013

•Coded outpatient physician practices affiliated with Tuba City Regional Health Network.

•Coded Family Practice, Internal Medicine, Urology, Gastroenterology, Ortho, Pediatrics, Podiatry OBGYN, General/Outpatient Surgery, ENT and wound care.

•Researched, corrected and resubmitted denied claims.

•Assigned E/M levels for outpatient charts, appended modifiers as needed when coding patient charts.

Indiana University Health

Contract Coder

July 2012 – November 2012

•Remotely coded Emergency Room charts that included a wide range of specialties.

•Coded all emergency procedures including but not limited to Infusion, IV Hydration, Therapeutic/Diagnostic Injections, Immunization Administration, Chest Tube Placement, Blood Transfusion, Catheterization and Burn Dressings.

•Coded 10 charts an hour while maintaining 97 percent accuracy.

•Performed E/M leveling of ER patients.

Alaska Native Medical Center

Contract Coder

March 2012 – May 2012

•Remotely performed outpatient and inpatient coding for hospital practices that included Urology, Podiatry, Ambulatory Surgery and Primary Care.

•Coded 10 charts an hour while maintaining 96% accuracy and achieving productivity goals.

•Coded medical records with ICD-9, CPT and HCPCS Level II.

•Reviewed charts for correct admit/discharge dates.

Adena Regional Hospital

Profee Contract Coder / Auditor

June 2011 – March 2012

•Coded outpatient physician practices affiliated with Adena Health System Network.

•Utilized ECW (E-Clinical Works), Meditech and Chartmax softwares to code, bill, review and audit charts.

•Coded Pathology, Oncology, Family Practice, Urology, Gastroenterology, Ortho, Pediatrics, Podiatry, Ambulatory surgery and wound care.

•Researched, corrected and resubmitted denied claims.

•Assigned E/M levels for outpatient charts, appended modifiers as needed when coding patient charts.

Georgia Lung Associates

Contract Medical Auditor

March 2011 – June 2011

•Performed thorough audit of the medical records of organization focusing on inefficiencies and discrepancies within the billing system.

•Made recommendations to redesign the coding procedures to simplify process and eliminate possibilities for mistakes.

•Reviewed the organization’s coding and billing systems for accuracy.

•Ensured consistency of the drafted bills with actual medical services provided and prescribed regulations.

•Performed monthly reviews to confirm implementation of recommendations.

Coffee Regional Hospital

Contract Coder

August 2010 – December 2010

•Performed outpatient coding for physician practices located in the Coffee Regional Healthcare Network.

•Coded medical records with ICD-9, CPT-4 and HCPCS Level II coding, processed 40 to 70 claims daily while maintaining 95% accuracy and achieving productivity goals.

•Utilized 3M software and input information into computerized patient record system.

•Coded ENT, Primary Care, Surgeries, OBGYN, Orthopedic, Pediatrics, Urology, Diagnostic testing, ER and E&M.

•Abstracted medical records with ICD-9-CM, CPT-4 and DRG coding.

•Reviewed charts for correct admit/discharge dates and entered proper surgery dates. Assigned E/M levels for outpatient and physician patient charts.

RAM - Risk Adjustment Management

Contract Coder / Auditor Risk Adjustment- HCC (project)

August 2009 – June 2010

•Project based on Hierarchical Condition Categories (HCC) to determine severity of illness and reimbursement levels of enrollees in Medicare Advantage plan.

•Performed outpatient coding for medical centers located in New York and Ohio state networks. Coded 40-60 charts daily while maintaining 97% accuracy and achieving productivity goals. Duties included wide range of medical specialties including ENT, Gastroenterology, Podiatry, Orthopedics, Internal Medicine, Pediatrics, OBGYN, General Surgery, Oncology and Ophthalmology.

•Audited charts.

•Assigned E/M levels for outpatient and physician charts.

Outcomes Health Information Solutions

Contract Coder/Chart Reviewer

July 2008 – September 2009

•Participated in HEDIS (Healthcare Effectiveness Data and Information Set) project, which included Payment Integrity, Health Outcomes Improvement, Quality, Safety Health and Wellness Programs.

•Performed HCC, ICD-9 coding targeting selected measures of several specialties, in Atlanta area. Coded average of 45 charts daily of Internal Medicine, ER, ENT, GI, Allergy, Orthopedics, Oncology and General Surgery.

•Collected data, reviewed medical records, abstracted charts, performed reporting and analyses. Managed and organized project by paying attention to detail and accuracy level. Adhered to strict deadlines, data entry of chart review findings into medical record. Reviewed project database. All coding was performed according to HIPAA and OIG.

•Payment Integrity Audit-PIA (project) Project was based on Medicare Advantage Risk Adjustment payment method, created by Medicare to reimburse private plans for providing health maintenance to Medicare patients.

Atlanta Medical Care

Coder

May 2006- July 2008

•Performed CPT-4 and ICD-9CM coding from outpatient medical record documentation.

•Coded all Evaluation and Management services provided by physician and NPs.

•Coded primary, secondary and sequenced diagnoses based on ICD-9 guidelines.

•Reviewed medical records for all appropriate secondary diagnoses.

•Utilized practice management database to audit office encounters to ensure accuracy of claims reimbursement.

EDUCATION

St Augustine’s College

Bachelor’s: Accounting

LICENSURE AND CERTIFICATIONS

•Certified Professional Coder



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