Grady Lewis, CPC
Manteca, CA 95337
Telephone Number: 209-***-****
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
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
Grady Lewis, ASB, CNA, CPC
1256 Felsina Court
Manteca, CA 95337
Telephone Number: 209-***-****
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
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.
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.
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
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
11/95 to 09/1996
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 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:
Customer Service Representative