NIEVE GARCIA

CPMA, CCS, CPC, CGIC

*** ***** **** *********, ** 07631 646-***-**** adxik4@r.postjobfree.com

PROFESSIONAL QUALIFICATIONS

Analytical, focused, and detail-oriented multi-specialty Medical Coder with 8+ years of experience. Proficient in CPT-4,

ICD-9-CM, ICD-10-CM diagnostic/procedural and E/M levels coding, Electronic Medical Records (EMR); Documentation, Computerizing Billing; MS Word, Excel; Provation, Healthmatics ED and Encoder Pro, ClinTrac, Crown, 3M and Healthcare Information System.

• Specialize in coding for cancer, GI, injections and infusions.

• Thoroughly familiar with anatomy, physiology and medical terminology.

• Knowledgeable in 1995/1997 Evaluation and Management documentation guidelines.

• Bilingual–Fluent and literate in Spanish and English.

CREDENTIALS & EDUCATION

AAPC Certified Professional Medical Auditor (CPMA) 9/2020

AHIMA Certified Coding Specialist (CCS) 8/2018

AAPC Certified Gastroenterology Coder (CGIC) 1/2016

AAPC Certificate - ICD-10-CM Proficiency 7/2015

AAPC Certified Professional Coder (CPC) 7/2011

The Healthcare Network Fort Lee, NJ

CPMA Auditing Certificate Course 9/2020

Principles of medical auditing, compliance and regulatory guidelines, CIAs, medical record documentation, evaluation and management coding, coding and reimbursement, chart abstraction, risk analysis, validation and communication.

The Roxbury Institute for Medical Management Jamaica, NY

Certificate, Outpatient & Ambulatory Surgery Coding/Billing 6/2011

Bronx Community College Bronx, NY

A.A., Health and Human Services 6/2001

PROFESSIONAL EXPERIENCE

Memorial Sloan Kettering Cancer Center New York, NY

Clinical Data Specialist II - Inpatient/Outpatient 3/2016-Present

• Code for facility and physician’s initial visit and follow-up as well as emergency department evaluation and management, hospital admission and follow-up.

• Analyze medical records, extracting clinical, pathological, therapeutic and epidemiologic data in accordance with established ICD-10-CM coding principles and guidelines.

• Complete audit summaries to identify discrepancies, advise physicians, document audit findings in accordance with ICD-10 and Medicare Risk Adjustment Payment Systems guidelines.

• Maintain strong relations with providers and communicate guidelines to ensure correct coding.

• Identify issues and trends in coding and documentation that affect provider risk adjustment factor scores.

• Assign and code all ICD-10 diagnoses, as well as applicable CPT procedures.

• Ensure data/coding quality to optimize allowable reimbursement pursuant to federal and state payment systems.

• Perform all other related functions as outlined below.

Columbia University Medical Center/61st Street Service Corporation New York, NY

Medical Coder - Gastroenterology Department 7/2015-2/2016

• Reviewed patient medical records assigning appropriate evaluation/management levels and codes for diagnoses, treatments, procedures and professional services. Ensured all services documented in the patient’s chart are coded with proper diagnoses and procedure codes.

• Maintained a working knowledge of the current CPT professional edition and ICD-9-CM coding principle, governmental regulations, protocols and third-party requirements pertaining to billing and documentation.

• Reviewed and submitted clean electronic (CROWN) and paper encounters.

• Reconciled and corrected encounters by using CROWN reporting, GE/IDX/ TES and claim edits.

• Informed clinicians and practice managers about procedures for securing account in order to submit a clean and accurate claim.

Revenue Cycle Representative II - Medicine Department 2/2015-7/2015

• Performed functions similar to those listed above.

Mount Sinai Health System New York, NY

Coding Coordinator - ER Department 11/2013-1/2015

• Performed outpatient coding for SUNY Downstate at LICH ER and Roosevelt ER for Physicians Services.

• Reviewed and abstracted data from the patients’ emergency medical records to apply appropriate professional Evaluation and Management levels, ICD-9 and CPT-4 codes.

• Adhered to coding guideline regulations and requirements.

• Coded and double-checked assigned codes to expedite billing and prevent denials due to incorrect coding.

• Accurately processed 100+ charts daily while maintaining productivity goals.

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