Resume

Sign in

Service Representative, Claims Processor, Certified coder

Location:
Manteca, CA
Posted:
October 31, 2022

Contact this candidate

Resume:

Grady Lewis, CPC

**** ******* *****

Manteca, CA 95337

Telephone Number: 209-***-****

Email: ads92v@r.postjobfree.com

Enclosed please find a recently updated copy of my resume for your review and

consideration of a position with your organization.

As the resume will indicate, my background involves progressively responsible

positions in Health Care Insurance and marketing operation, involving personnel

supervision, purchasing, research, bookkeeping, computer operations and public

relations.

I’m a highly-motivated, enthusiastic, and conscientious individual, with excellent

interpersonal and communication skills. I am seeking a challenging position

where my knowledge and experience will have valuable application.

I would welcome the opportunity to discuss my qualifications in further detail in

a personal interview. I look forward to hearing from you at your earliest

convenience.

Sincerely,

Grady Lewis

Grady Lewis, ASB, CNA, CPC

1256 Felsina Court

Manteca, CA 95337

Telephone Number: 209-***-****

E-mail: ads92v@r.postjobfree.com

PROFILE: 40 years successful background in Health Insurance and public

contact responsibilities: 21 years with Kaiser Permanente and 2 years with

Lifeguard, HMO and 17 years with Blue Cross of California and 2 years teaching

part-time at Corinthian College and 25 years part-time with JC Penny and areas

of knowledge and attributes include:

Personnel management…….supervising, training, and motivation

Employee.

I have extended experiences in reimbursement, billing and coding.

Marketing, sales and retain merchandising

Financial Activities business accounting/bookkeeping, accounts

payable/receivable, payroll, auditing, and collections.

Written and telephone communication skills recommendation and

reports to management, procedures and business correspondence (Legal,

Department of Insurance, Medicare and Medical)

Medical insurance terminology and procedures…..contracts, benefits,

claims clinical chart extraction for inpatient UB92 and UB04 and 1500 for

outpatient claims and services, coding (ICD-10 and ICD-9 and CPT and

HCPCS), workers compensations, third party liability, pharmacy, medicare,

medical, and coordination of benefits etc.

CNA Certified Nurse Assistant

CPC Certified Professional Coder

AA Degree in Business Administration

East Bay Skills Center—Professional Skills Development Certificate

Decision making…….exercising informed independent judgment.

Computer literate….Microsoft Word, Excel, Access and PowerPoint.

Efficient organizer detail minded, skilled planner and prioritize.

Client/public relations skills, interpersonal communication.

System: EPIC

Medical Records Chart Extraction for---E&M coding auditing, and Risk

Adjusted HCC auditing for all cancer, heart disease, diabetes, etc

I’m a highly motivated and conscientious individual, with the ability to work well

in a high pressure, creative environment and an excellent individual worker as

well as an outstanding team member.

EMPLOYMENT EXPERIENCE:

09/26/20 to 8/26/2022 JC Penney in Manteca, CA home department and online pick-up

10-1-2019 to 3/13/20: JC Penney in Hayward, CA work online pickup and returned

04-19 to 9-18-19: The CSI Companies, JACKSONVILLE, FL

Contract Coder work from home

10-25-17 to 04-06-19: JC Penney- I sold furniture and appliance. Previously, I had worked 23 years part-time for JC Penney.

08-03 TO 12-30-2016: KAISER PERMANENTE, OAKLAND, CA

Medical Documentation Auditor /Project Manager

Lead, monitor and audit outpatient physician documentation

for Risk Adjusted HCC on an electronic health recorders

system call EPIC. Then, I provided consultation and support

to all 15 facility providers and administrative staff with

accountability to regional Encounter Information Operations

Department.

Act as a consultant for the HBS physician’s inpatient E/M

coding and documentation, intern visits and for all other

physicians providing inpatient and outpatient services.

Assist in the development and delivery of specialized

education tools, policy and training to providers, on coding

conventions, documentation. However, perform concurrent

and retrospective audits of the documentation of outpatient

encounters against services and diagnoses reported by

individual clinical providers.

11-95 to 8-03: KAISER FOUNDATION HEALTH PLAN,

11/2000 to 8/2003

Quality Services Liaison/Patient Billing Services/Revenue Cycle

Trained biller to read documented charges in the medical recorder and

bill the for payment and, monitor, consult, educate, and audit the billing

trends for front end and back end for patient billing system for Kaiser

Foundation Health Plan 17 billing site. Also help the collections

department respond to inquiry regarding under- payment as well as

over-payment and work with clinical personnel to correct documentation

and make coding decision.

Assist in development and implementation of education materials and

training materials and provides information regarding documentation for

coding, billing, collections and the billing systems.

Provides audits and reports on the accuracy and consistency of billing

procedures in accordance with accepted standards for Medicare and

Medical and commercial insurance company. However, provides

expertise training in ICD-9, CPT, and E&M coding to business office and

clinical staff and collection department to ensure that revenue,

documentation, and compliance were met.

09/1998 to 11/2000

Provider Reimbursement Coordinator

Coordinated the review for non-plan physician bills and work with Health

Plan physicians to determine reimbursements based on fee schedule,

after CCI edit had denied services. Work with Regulatory Department

for Health Plan interpretation of those fees.

However, I was accountable for making decisions regarding payment

and appropriate case review. In addition, negotiates payment with nonplan physicians for services render to members and maintained a

department records for annual savings for the negotiated amount.

09/1996 to 09/1998

Appeals Reimbursement Coordinator

Set-up and Manage the inflow and outflow of significant numbers of

appeals for Northern and Southern Kaiser Appeal Departments from the

physicians, members, and lawyers and department of insurance and

other regulatory agencies. Also, setup packages and help trained the

nurses and clerical staff who were hired into the department to help with

the review of medical records from all the regulatory agencies; however,

attended the appeal monthly meeting. In addition, help with medical

records review in 1997-1999 for Kaiser Foundation Health Plan NCQA

approval status.

11/95 to 09/1996

Claims Examiner

Completed online all medical claims type for payment; however, these

members were seen at non-plan emergency facility (Medicare, Med-ical,

TPL and Workers Comp, foreign and COB).

04/06- 01/08: Corinthian Colleges, Inc.

Instructor

Instructor at Everest College Campus located in Hayward;

however, instructed students on coding, billing and

insurance to a classroom size of 15 to 30 adult students.

10/93 – 11/95: LIFEGUARD HMO INC., MILPITAS, CA

Lead Analyst for Pharmacy

Complete online telephone inquiries from pharmacies, providers,

subscriber, third-party administrator and instruct other pharmacy

representatives on benefits and guidelines for pharmacy reimbursement.

1976 – 1993: BLUE CROSS OF CALIFORNIA, OAKLAND, CA

Held the following positions:

Supervisor

Assistant Supervisor

Claims Processor

Customer Service Representative

Clerk Typist



Contact this candidate