Medical Records Internal Medicine
Resume:
Ethel A. Sinkler, CPC
Columbia, SC
******.****@*****.***
Ambulatory Coder Professional Billing (Remote)
Prisma Health - Columbia, SC
May 2018 to November 2024
•Front-end claim edits, audit medical records to ensure documentation supports ICD-10, CPT and HCPCS codes being billed are accurate, primarily for outpatient/Profee services Family Medicine, Urology, Pediatric Urology, Hospitalist, Pulmonology, and Internal Medicine.
•Review EMR for pre-billed rejections and update the diagnoses, modifiers, and procedures as necessary.· Track trends in order to make the coding department more efficient and productive and report to management. Maintain productivity standards.
•Through close attention to detail, ensure that all ICD-10 coding is to the highest level of specificity and all documented CPT procedures have been captured and coded correctly.
•Query physicians for clarification of documentation when needed and educate them on coding guidelines. Contact management, education, or compliance when necessary for coding questions.
•Use encoder software and other search engines to verify accuracy of diagnosis, CPT and HCPCS codes.
•Responsible for EPIC work queues claim review, claim edit, and charge corrections.
CPC certification 2016-Present.
Business Office Associate
Lexington Medical Center - West Columbia, SC
(May 2015 to May 2018)
•Reviewed denials and determined if a corrected claim or an appeal was needed.
•Reviewed medical records and applied appropriate missing ICD-10, CPT and HCPCS codes for hospitalist and intensivist.
•Followed up on denied claims with insurance companies and resubmitted corrected claims and appeals as needed.
•Updated patient accounts by entering complete notes so any follow-up that was done on the account was clear.
•Used multiple databases daily to complete job.
•Understanding and use of the NCCI and LCD edits.
Education
Certificate in Medical Billing and Coding Specialist
Southeastern Institute - Columbia, SC
August 2014 to July 2015
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