Medical Supervisor
Resume:
Tina L. Lors ms, ccp
Willoughby, Ohio 44094
Primary Phone (Mobile): 440-***-****
Secondary Phone (Work): 440-***-****
Email: ****.****@**********.***
Experience:
Company: Ashtabula Medical Center
Title: Reimbursement Specialist / RAC coordinator
Start Date: 08/2007
End Date: Present
Address: 2440 Lake Ave
Ashtabula, Ohio 40004
Phone: 440-***-****
Job Description: . Oversee the Charge Master, working closely with the ancillary departments of the facility to assure that the CPT codes used in the CDM are current and compliant. Work with external vendors and auditor on CDM reviews and CDM pricing levels to ensure that ACMC is appropriately charging for services rendered. Coordinates efforts with other departments (PFS, Finance, Ancillary Departments, etc.) to facilitate the coding / management of unbilled accounts. Monitors the number of claim denials, and will be responsible for tracking reimbursement amount by payer for services. Participate in development of process changes and improvements to accomplish coding turnaround times and maintaining goals for the unbilled accounts. Communicates issues and concerns to the Coding Supervisor and the H.I.S. Director.
Assign accurate codes and resulting DRG/APC classifications. Review patient records for the purpose of accurately assigning ICD-9-CM and CPT-4 codes related to diagnosis and procedure. Utilize coding software and other coding resources to accurately assign and/or verify the DRG or APC. Maintain established coding accuracy levels. Comply with coding guidelines and conventions as well as governmental rules and regulations and report suspected misconduct to the next level of authority. Communicate with physicians and others in a timely and professional manner in order to clarify documentation. Daily, weekly and monthly reports provided to the Coding Supervisor and the H.I.S. Director.
Maintain productivity standards and abstracting quality. Accurately abstract patient records into the ACMC abstracting system. Maintain established productivity levels for a Reimbursement Specialist. Contribute to the goals of the department and ACMC. Complete tasks in a timely, manner being aware of the level of unbilled records. Assist Patient Financial Services personnel with needs related to correct coding for billing purposes. Participates in special projects as assigned. Attend department meetings and contribute to the overall needs of the department as a whole.
Stay current with coding rules and regulations by reading publications and doing self-study related to my job. Be aware of changing trends in the industry. Attend education sessions and meetings as requested. Assist with special projects as assigned by the Coding Supervisor or Director. Contribute ideas and suggestions for the development of the coding area. Maintain current credentials or strive for earning credentials. I over see all RAC audits.
Company: Cleveland Clinic
Title: Financial Coordinator
Start Date: 02/2004
End Date: 08/2007
Address: Euclid Ave
Job Description: Prepare price quotes/package pricing for upcoming visits.
Responsible for actively pursuing collection of self-pay and past-due patient accounts at point of service. Responsible for collection of deposits, deductibles and co-pays as they may apply. Responsible for entering referrals/authorizations on patients not supported by Outpatient Referral Management. Performs financial and insurance pre-screening to make appropriate recommendation for point-of-service patients. Resolves financial/billing related issues that are presented patients during the in-person interview. Performs other related duties as assigned. Identifies uninsured patients and identifies programs for which they may be eligible. Secures correct payer information, verification and pre-certification as necessary. Excellent verbal and written communication skills communicate effectively with patients, physicians and support personnel. Strong problem-solving skills required coordinating multiple resources.
Company: Medical Mutual Of Ohio
Title: Coding Auditor
Start Date: 01/2001
End Date: 02/2004
Address: Eucild Ave
Review patient charts for diagnoses, procedures, and medical necessity. Review DRG Claims for Standards for Ethical Coding provide by all coders, physicians and other providers in making decisions related to selecting and sequencing codes. The standards are intended to emphasize the importance of applying accurate and complete codes consistent with standard practice. The standards also provide physicians, health care professionals, and health care administrators with assistance in understanding the ethical obligations of all which assign codes for statistical and reimbursement purposes.
Standards: Diagnoses that are present on admission or diagnoses/procedures that occur during the encounter must be supported by the documentation in the medical record. Those diagnoses not applicable to the current encounter should not be abstracted and selected unless they meet local, state and national coding guidelines and regulations.
Select the principal diagnosis and principal procedure, and other diagnoses and procedures based upon the definitions of the Uniform Hospital Discharge Data Set (UHDDS), Coding Clinic guidelines, AMA/CPT Assistant guidelines. When not established reviewed with physicians to change codes and return of payments. Standards for Ethical Coding - American Health Information Management Association (AHIMA) to insure claims are accurate. I work very closely with a team of Physicians to insure audits and appeals are processed on a timely matter
Education:
High School: South High
Willoughby
Date Graduated: 05/1981
Major: Billing/coding DRG and out patient
College: Tric
Cleveland
Date Graduated: 02/2004
Major: Billing /Coding
College: Cleveland Inst
Mentor
Date Graduated: 02/2002
DRG boot camp
HCPro
2003
3M DRG auditor
2010
Contact this candidate