Krystal Henry,CPC

***** ***** *** ******* *****, CA 91406

Phone 818-***-****

• Over 10 years healthcare experience working for multidisciplinary medical clinic, major health plan and a MSO.

• 7+ years experience configuring benefits in both EZCAP Legacy and Benefit Matrix modules.

• Able to interpret benefit coverage for all lines of business, Medicare, Medi-Cal and commercial HMO POS and PPO Plans.

• Able to apply standard coding conventions and rules established by the American Medical Association (AMA) and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes, i.e. CPT, HCPCS, ICD-9, and modifiers.

• Prior experience processing claims

• Knowledge of Medicare payment methodologies including IPPS/DRG, OPPS, and RBRVS.

• Knowledge of HIPPA requirements and laws governing the protection of PHI.

• 10+ years reviewing and coding medical records, and Coding Professional services on the

• healthplan schedule of benefit summaries using ICD9cm for DX’s and CPT for PX’s.

• Certified CPC medical coder.

• Knowledge of medical terminology and human anatomy and physiology.

• Working knowledge of EZCAP, Medicode, Macess and Imax, ABS and Medisoft software.

Work History

Benefits Coordinator

Medical Coder 11-2004 to current

MedPoint Management

Responsible for configuring benefit records in EZCAP, an automated claim processing system to reflect covered and non covered healthcare services, copayments and coinsurance, out-of-pocket maximum, deductibles, and benefit limits. Created and periodically updated benefit tables for commercial, Medicare Advantage, and Medi-Cal plans in accordance with standard coding convention utilizing the appropriate CPT/HCPCS and diagnosis codes to ensure automated adjudication of claims and authorizations. Coordinate the response to all requests for benefit verifications and financial responsibility determination for Providers, members, and internal staff, i.e. Authorizations, Claims, Customer Services, Case Management and Provider Service. In addition I apply E/M codes to the office visits, specialist visit, preventive care and periodic care health visits daily, as well as vision, hearing exams, immunizations, self-injected drugs, DME, nuclear medicine, complex radiology, prosthetics, orthotics, outpatient surgery ER services, and whatever else comes across my desk that requires a CPT, HCPCS, Modifier or ICD9cm Code.

Seniority Plus Claims Examiner 04-2002 to 10-2004

Health Net of California

Process professional and facilities claims for Medicare members based on contractual agreements, health plan division of financial responsibility, applicable regulatory stature, claims processing guidelines and company policies and procedures. Processed Medicare Indemnity (Flexnet) and Medi-Cal supplement, Catch all 1 and 2, Ensured claims was submitted with the proper documentation and the services authorized in accordance with the health plan requirements.

Health Information Coder IV 10-2000 to 03-2002

UCLA Medical Center

Responsible for coding medical records for various department at UCLA multidisciplinary medical clinics. Reviewed charge sheets and applied appropriate procedural coding in accordance with the diagnosis and treatment services. Additional duties included providing administrative support that included preparing insurance billing in accordance with contracts terms and conditions, arranging appointments for patients, printing super bills for same day and emergency appointments, assisting with data entry and collections for guarantors.

Additional Work Experience

Medical Coder 08-2007 to 12-2007

K Force Staffing and Solutions

Contracted to assist a large health plan with a major backlog project involving the coding of medical records for their emergency room department. The project included reviewing medical charts and pertinent documentation to verify and abstract medical data to assign appropriate codes based on the symptoms, treatment, diagnosis, and procedure utilizing established CPT/HCPCS coding and ICD 9-CM coding systems.

Education and Training

Omega Career College 04-2002 – to 09-2004

Completed the training in hospital and professional based coding, emergency room and clinical chart review and coding, medical terminology, anatomy and physiology, basic through advanced ICD 9 and HCPCS coding

Professional Training

Attended training course for Medicare based products and claims processing, HCFA-1500, UB92, HCPCS coding, and HIPPA rules and regulations.

Certifications

Certified Professional Coder 08-2005

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