Amber Howard

adt2fc@r.postjobfree.com

Newton Falls, OH

adt2fc@r.postjobfree.com

+1-330-***-****

I’m a detail oriented & motivated professional with impeccable customer service. I take pride in mastering new career skills & look forward to sharing my strengths in my next role. Work Experience

Medical Coding Auditor, Fraud Prevention

Insight Global/Optum Healthcare - Remote

October 2021 to Present

This was a temp position investigating flagged claims for fraudulent billing & coding practices. Requirements were as follows:

• Audit for misrepresentation of services

• Assure CMS compliance

• Utilize various means & software to conclude claim integrity vs fraud

• Maintain >96.6% accuracy as well as #claim lines/ hr requirements

• Maintain access & a working knowledge of EMR systems from variety of provider types Bartender/ Server

The Gargoyle - Geneva-on-the-Lake, OH

July 2011 to April 2020

At this Geneva on the Lake Steakhouse and bar I bartended and served seasonally. After Covid they closed down permanently.

• bartended in an extremely fast paced environment being on the main strip and part of the “bar crawl” yearly.

• served primarily when i first started then trained and served as needed while bartending Reimbursement Consultant Special Projects - QA auditor Laurie Ann Nursing Services - Newton Falls, OH

February 2017 to February 2020

This was a contract/prn position during a company buy out and management change over to ensure operations remained profitable and credible. Duties included:

• Ensuring adherence to CMS guidelines

• Audit denials/ potential denials, follow through with appeals

• Ensure coding and billing accuracy through documentation reviews

• Maintain active authorization for payment

• Staff education

Medical Coding & Reimbursement Consultant, Clinical Documentation Specialist

Guardian Elder Care - Boardman, OH

April 2016 to February 2020

Acting first a Lead Medical Coding Specialist and later as Reimbursement Coordinator with responsibilities surrounding all stages of the revenue cycle such as:

• Maximizing revenue for services of all levels (pre-auth, skilled nursing, PT, OT, etc.) utilizing a planned, strategic approach

• Maintaining guidelines per Centers for Medicare & Medicaid Services

• Managing & meeting case mix index benchmarks

• Auditing of coding & billing practices, supervision of ancillary staff

• Ensure payment of claims, follow formal appeals process as needed

• Collaborate with nursing admin to raise quality measures set forth by CMS Medical Transcriptionist, Scribe, Independent Contractor American Scribe - Remote

January 2009 to February 2017

• Transcribed dictated medical reports of various disciplines into chart formatted documents

• Functioned in roles of Scribe, Transcriptionist, Proofreader/QA, Supervisory roles

• Maintained an accuracy rate of >98.8% which at the time was the standard requirement

• Maintained other production based metrics in this contracted position

• Supervisory and editing experience

Education

Associate in Science (AS) in Nursing

Mercy College of Ohio

Skills

• EMR Systems & billing databases (various)

• Clinical documentation review and Auditing

• Medical Coding (ICD10, CPT, HCPCS), acute & nonacute settings

• Expert navigation of Managed Care, Medicaid, Medicare & Private insurance contracts

• Microsoft Office and Google Suite Proficient

• Strong Clinical/ Nursing Foundation

• CMS guidelines & policies

• Remote Office Enabled, HIPPA compliant

• Medical billing

• Outstanding Professionalism

• Medical Transcription

• Medical Office Management

Certifications and Licenses

Certified Medical Office Management & Billing Specialist Certified Risk Adjustment Coding Specialist

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