Risk Adjustment Vice President

PAUL DONALD APUSEN CPC, CCS, CHONC, CIRCC, CPMA, CRC 2251 E. 21st St. # C

Signal Hill Ca. 90755

Cell phone : 562-***-****

E-mail: ****.******@*****.***

Education/ Certifications

Certified Coding Specialist (CCS)

Certified Professional Coder (CPC)

Certified Risk Adjustment Coder (CRC) Certified Interventional Radiology Cardiovascular Coder (CIRCC)

Certi

fied Hematology and Oncology Coder (CHONC)

Certified Professional Medical Auditor (CPMA)

Ahima Approved ICD-10 CM/PCS Trainer(2012-2015)

Doctor Of Medicine – Fatima College Of Medicine, Manila Philippines – Graduated 1990

Professional Affiliations

2015- President AAPC Corona Chapter

2014 –Vice President AAPC Corona Chapter

Work Experience

October 2021- May 2023 Kaiser Permanente (contractual)

Revenue Management Compliance – Risk Adjustment Coding

Compliance Consultant

Review and Audit Medical records Inpatient/Outpatient that were previously coded by the

different Kaiser Regions based on Coding Guidelines and Coding Clinic

Jan 2021- May 2021 St Mary Medical Center

Coder 4- Inpatient

Code charts using ICD-10 CM PCS, applicable modifiers, MSDRGs

Query Providers if necessary

August 2020 -March 2021 OPTUM HEALTH (Contractual)- Remote

Risk Adjustment Coder/ HCC Coder

Audit & Validate HCC & Rx HCC Codes

EPIC/3M

June 2020-Sept 12,2020 AE & Associatess LLC - Remote

Risk Adjustment / HCC Coder

*Audit /Validate HCC & Rx HCC Codes

EPIC/3M

Jan 2019- Sept 2019 Pop Health Care - Remote

HCC Coder / Risk Adjustment

* Audit and validate HCC & RX codes in accordance with coding convention

(Coding Clinic) and local HCC & Neoplasm guidelines.

Jan 2018- Dec 2018 AE & Associates LLC, Corona Ca (Staffing Company) - Remote

Victor Valley Global Medical Center

Inpatient Coder – Remote (Contractual)

* To accurately assign appropriate and complete ICD9,& ICD 10 CPT-

and/or HCPCS codes and any applicable modifiers supported by

documentation of professional services, MSDRG’s

*Query providers if necessary

EPIC/3M

Sept 2017-April 2018 AE & Associates LLC, Corona Ca (Staffing Company )

Alta Med

Inpatient Coder (Contractual)

* To accurately assign appropriate and complete ICD9,& ICD 10 CPT-

and/or HCPCS codes and any applicable modifiers supported by

documentation of professional services, MSDRGs

* Query providers if necessary

EPIC/ 3M

May 2015 – 2017 AE & Associates LLC, Corona Ca (Staffing Company )

Arrowhead Regional Medical Center ( Trauma Hospital)

Inpatient Coder (Contractual)

* To accurately assign appropriate and complete ICD9,& ICD 10 CPT-

and/or HCPCS codes and any applicable modifiers supported by

documentation of professional services MSDRGs

* Query providers if necessary

* Coding in accordance with CDI requirements

EPIC/3M

Dec 2014 – 2016 AE & Associates LLC, Corona Ca

HCC Project Auditor / QA

*Audit HCC/Rx HCC

. *QA auditors charts to ensure that no HCC codes are missed

May 2016- Nov 2016 AE Associates LLC, Corona Ca (Staffing Company)

Kaiser Permanente (Pasadena)

Medical Fraud Prevention Department

Compliance Auditor (Contractual)

* NLP Project Inpatient / Outpatient

* Audit external Providers

March 2014 – Nov. 2014 AE Associates LLC, Corona Ca (staffing Company)

Kaiser Permanente (Pasadena)

Medical Fraud Prevention Department

Compliance Auditor (Contractual)

NLP Project Inpatient / Outpatient

* Audit External Providers= providers who render services to KP members

are being audited on proper billing/claims reporting (UB-04 & HCFA 1500)

and ICD-9 /CPT codes reported

*QA = NLP SCAL/NCAL/NW/HI/COLORADO ; Involved in the review of NLP

Audits conducted by GEBBS facility in Mumbai, India and SCAL FTE and

Contractual auditors

*QA –NLP SCAL Inpatient: Review audits done by FTE and Contractual

auditors

May 2012 – Dec 2017 Tri County Allied Health School Corona Ca

Medical Coding Instructor

*Teach ICD-9 volumes 1,2,3 to medical coding students

*Train students in CPT and HCPCS coding

*Provide education on ICD- 10 CM and PCS coding

*Supervise student externships and provide instruction on coding for

Various types of medical charts such as inpatient, outpatient,

Ancillary, ER, and HCC

Jan 2010 – April 2012 AE and Associates LLC Corona Ca(Staffing Company)

Kaiser Permanente Pasadena Regional Offices

Compliance Auditor (Contractual)

* QA- HCC Project; Query Providers; QA- NLP Project

* Review E/M levels of external Providers

* Hedis Project

* Interventional Radiology Coder

Aug 2011 – October 2011 AE and Associates LLC Corona Ca (Staffing Company)

Los Angeles Metropolitan Medical Center

Inpatient Coding – Psychiatry

*Coded charts according to ICD-9/CPT/Coding clinic guidelines

Aug 2009 – Dec 2009 AE and Associates LLC Corona Ca (Staffing Company)

Kaiser Permanente Southbay

Compliance Auditor (Contractual)

* HCC Validation –validate HCC & Rx HCC using ICD-9

* E/M Level Validation- using the 1997 guidelines

* Provider Education on Chart Documentation – visit providers offices,

answer questions with regards to the specificity of the submitted

diagnoses and also to educate them on the effects of their

documentation E/M levels

Feb 2009 – July 2009 AE and Associates LLC, Corona Ca (Staffing Company)

Kaiser Permanente Pasadena

* QA – HCC Project

*QA – NLP Project

* E/M Validation

June 2008 – Jan 2009 AE and Associates LLC Corona Ca(Staffing Company)

Arrowhead Regional Medical Center ( Trauma Hospital)

Clinical Coder (Contractual)

Inpatient; Outpatient ; ER coding; MSDRGs, APDRGs

*Coded charts using ICD-9/CPT/HCPCS/ CMS Guidelines /coding

Clinic guidelines/ query providers if necessary

April 2008 – May 2008 AE and Associates LLC Corona Ca (Staffing Company)

Kaiser Permanente Fontana

Charge Capture Project

*Gather all charge documents

*Ensure no lost or missed charges

* Make sure all services rendered are billed

May 2007- April 2008 AE and Associates LLC Corona Ca (Staffing Company)

Kaiser Permanente Anaheim

Charge Capture Project

*Gather all charge documents

*Ensure no lost or missed charges

* Make sure all services rendered are billed

July 2007- Sept 2007 AE and Associates LLC Corona Ca (staffing Company)

Kaiser Permanente ( Sunset)

Coder (Contractual)

Mega Charge Capture Project

*Gather all charge documents

*Ensure no lost or missed charges

* Make sure all services rendered are billed

Dec 2006 – April 2007 AE and Associates LLC Corona Ca (Staffing Company)

Kaiser Permanente Pasadena/ San Diego

Compliance Auditor (Contractual)

HCC Project / E/M project

*Validate HCC codes using ICD-9/ coding clinic guidelines/CMS

Guidelines

Nov 2006 – Dec 2006 AE and Associates LLC Corona Ca ( Staffing Company )

Kaiser Permanente Baldwin Park

Coder (Contractual)

Mini Charge Capture Project/ Revenue cycle project

*Gather all charge documents

*Ensure no lost or missed charges

* Make sure all services rendered are billed

Feb 2005 – Oct 2006 Family Dentistry Granada Hills Ca

Floor Supervisor

* Make sure that the flow of patient is well

*Make sure that all patients will have a schedule for a

follow – up appointment before they leave

* Patients are given a reminder call

*Supervise employees in their work; proper attire

March 2001 – Jan 2005 El Pueblo Medical Clinic Huntington Park Ca (Closed)

Clinic Manager

*Make sure that employees report on time

* Supervise so that patients will be satisfied of the service

* Make sure that all laboratory results should be in before patients

Appointment

* Make sure that employees are polite and cordial to all patients

Make sure that the clinic is compliant to all government policies &

Regulations

* Takes care of all grievances and issues of patient and emplyee

SKILLS

Ability to code Diagnoses and Procedures

Computer Literate and Familiarity with 3M

Well versed in Medical Terminologies

Managerial and supervisory skills

Proficient in written business communications

Contact this candidate