JOAN M. ZOELLER, CPC

**** ******** ****** **** ***** 502-***-****

Louisville, KY 40222 Cell 502-***-****

PROFESSIONAL EXPERIENCE

COMFORCE HEALTH 3/21 – 7/22

CSI/OPTUM HEALTHCARE 4/19-9/19

COMFORCEHALTH/AIXIO 11/19-1/20

PEAK HEALTHCARE for Apixio 11/18 - 1/19

Contract Medicare Risk Adjustment -Medical Coder

Perform reviews of medical records verifying accuracy, completeness and specificity of diagnosis codes (ICD-9) and (ICD-10) based on CMS Hierarchal Condition Categories

Complete appropriate documentation and computer system entry regarding claim encounter information coordinating and making proper adjustments

Demonstrate problem solving ability to interpret and validate accurate coding

HUMANA, INC. 12/12 - 1/18

Medicare Risk Adjustment/Audit -Medical Coder

Awarded Humana’s Star Award for exceeding expectations and working overtime on special projects

Perform concurrent and prospective reviews and audits of medical records verifying accuracy, completeness and specificity of diagnosis codes (ICD-9) and (ICD-10) based on CMS Hierarchal Condition Categories

Complete appropriate documentation and computer system entry regarding claim encounter information including coordinating with markets and making proper adjustments

Actively participate in Quality Improvement process

UNIVERSITY OF LOUISVILLE 9/11 - 6/12

Coding Specialist I

Assigned appropriate CPT Evaluation and Management codes, procedural codes, modifiers and the ICD-9 CM diagnosis codes for each patient in OB/GYN with specialties in Maternal Fetal Medicine, IVF and URO GYN

Entered all charges into Centricity

Maintained optimal reimbursement within federal, state and private documentation guidelines

Read and comprehended medical record documentation

HUMANA, INC. 7/6 - 10/9

Medicare Risk Adjustment/Medical Coder

Reviewed and coded medical records to verify accuracy, completeness and specificity of diagnosis codes (ICD-9) based on CMS Hierarchal Condition Categories

Claims Specialist – Coordination of Benefits

Quality Service Award for 4th Quarter 2006

Utilized Metavance Claims System to process Medicare and commercial claims, including inpatient and outpatient surgery (Medicare Part A and B), medical, psychiatric, durable medical equipment and estimation of benefits

Interpreted explanation of benefits from Medicare and commercial insurance carriers

Verified and entered primary and secondary insurance into Metavance for members

EDUCATION

B.S. degree in Agriculture, University of Kentucky, 1979

Medical Coding Certificate, Spencerian College, 2004

A.S.C. degree in Data Processing Technology, University of Louisville, 1984

Certified Professional Coder Certificate, American Academy of Professional Coders

TECHNICAL SKILLS

Microsoft Word and Excel, Verisk, EPIC, CAS, MTV, 3M Coding Software, CCP2, Estar and Carebook

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