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Work Background
CALMED (California Medical Detachment )Medical Records Technician
Aug. 2023- Responsible for the assignment of accurate E&M, ICD, CPT, and HCPCS codes and modifiers from medical record documentation.
- Identifies and abstracts information from medical records (paper or electronic) for special studies and audits, internal and external.
- Interact with MTF staff to ensure documentation is clear and supports coding assignments.
- Educate MTF staff through individual or group in-services and training sessions.
Maintains a delinquency report of missing records in order to facilitate the completion of work within the required thresholds.
- Show excellent computer/communication skills for provider and staff interactions.
- Knowledge of anatomy/physiology and disease process, medical terminology, coding guidelines (outpatient), documentation requirements, familiarity with medications and reimbursement guidelines; and encoder experience.
- Ability to handle multiple projects and appropriately prioritize tasks to meet deadlines.
UnitedHealth GroupSr. Risk Adjustment Coder
Oct. 2021 - Aug. 2023California, United States- Provide Hierarchical Condition Category (HCC) coding services for outpatient and inpatient charts
- Analysis and translation of medical diagnoses with the ultimate goal of improvement in coding accuracy across the network
- Evaluate clinical coding from medical records to ensure accurate coding of encounter data and recommends processes to ensure accurate and efficient coding practices
- Maintain high level (96%) coding accuracy and complete work within assigned queue in established timeframe
- Process physician attestation forms and PCP visits at a minimum of 6 charts per hour
- Perform inpatient chart reviews for Medical Management (MM)
- Build and sustain effective relationships while working closely with manager, coding supervisor, coding team, coding educators and network managers
- Leverage understanding of disease process to identify and extract relevant details and data within clinical documentation and make determination or identify appropriate ICD-10 &/or CPT codes following CMS guidelines
- Identify suspect / unreported HCC codes in the notes / records to reflect the severity of the patient's condition
- Perform level one concurrent or retrospective coding quality reviews
- Perform the minimum number of coding quality reviews consistent with established departmental goals
- Maintain a 96% quality audit accuracy rate
- Attend internal meetings via WebEx as requested
HealthCare Resolution Services, Inc.Medical Records Technician
Nov. 2019 - Oct. 2021Army Health Clinic - Presidio of Monterey, Monterey, CaliforniaContracted to the US Army at the Presidio of Monterey and the US Navy at Twentynine Palms
- Responsible for the assignment of accurate E&M, ICD, CPT, and HCPCS codes and modifiers from medical record documentation.
- Identifies and abstracts information from medical records (paper or electronic) for special studies and audits, internal and external.
- Interact with MTF staff to ensure documentation is clear and supports coding assignments.
- Educate MTF staff through individual or group in-services and training sessions.
Maintains a delinquency report of missing records in order to facilitate the completion of work within the required thresholds.
- Show excellent computer/communication skills for provider and staff interactions.
- Knowledge of anatomy/physiology and disease process, medical terminology, coding guidelines (outpatient), documentation requirements, familiarity with medications and reimbursement guidelines; and encoder experience.
- Ability to handle multiple projects and appropriately prioritize tasks to meet deadlines.
Monterey Peninsula Surgery Centers, LLCCertified Professional Coder
May. 2019 - Nov. 2019Monterey, California- Accountable for understanding and coding all procedures within regulatory mandates
- Responsible for verifying and notifying patient of any outstanding deductible and co-insurance, prior to upcoming procedure/surgery
- Review and allocate the appropriate payments per payor contract and make necessary adjustment to patient accounts
- Follow up on outstanding insurance claims, submit appeals and perform miscellaneous office duties as needed
- Communicate effectively and professionally with patients, visitors, physicians, and coworkers
- Interact with others in a positive, respectful, and considerate manner
- Accountable for reviewing daily schedules for estimates, authorization and 3rd party billing
- Enter patients demographics and insurance information for upcoming procedures/surgeries
- Verify patients eligibility and benefits for upfront collection on unmet deductibles and co-insurance
- Contact physician/anesthesia billing personnel regarding Global Cases
- Responsible for reviewing operative reports and assigning appropriate CPT, HCPS, modifiers and ICD-10 within three (3) business days of procedure/surgery
- Enter charges accurately according to insurance payors/contracts
Cypress Healthcare PartnersMedical Coder
Feb. 2016 - Apr. 2019Monterey, CA- Responsible for abstracting provider services accurately into billable codes from the medical documentation
- Responsible for posting and reconciling charges and communicating with provider/staff of medical necessity of services, unspecified, truncated, and lack of supporting diagnoses along with incomplete or missing documentation
- Post and reconcile hospital setting (IP/OP/OBS) charges daily
- Communicate inefficiencies to the coding supervisor such as the medical necessity of services; unspecified truncated and lack of supporting diagnoses; incomplete or missing documentation along with any inappropriate coding and documentation trends
- Reference coding and payer resources to accurately code and bill the provider documented services
- Assist the AR Specialist with a complicated coding denial
- Assist with creating an appeal letter regarding the coding denial along with any supporting documentation
- Continue education with coding and billing via Encoder Pro, coding subscriptions and resources
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