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Work Background
S7 Insurance LLCIndependent Insurance Agent
Sep. 2023Omaha Metropolitan AreaProviding property and casualty insurance to residents of NE and IA.
CloudmedLead Auditor, DRG-V
Nov. 2019 - Aug. 2023Phoenix, Arizona, United StatesManages 4-7 clients from the auditing perspective. Responsibilities include but are not limited to Participates in client implementation and training Assist in ensuring all assigned auditors have proper EMR access Communicate client needs with managers and auditors Oversee client questions and concerns in Cloudmed tool Manage/troubleshoot denials Monitor client actions to identify any trends or education opportunities Communicate with other DRG-V depts Participate in Periodic Business Reviews and providing content when needed Production auditing
Revint SolutionsDRG-V Auditor II
Apr. 2019 - Nov. 2019Phoenix, Arizona AreaReview inpatient medical records for proper DRG assignment. Provide educational and industry recognized references to clients for reimbursement or educational purposes.
himagine solutions inc.DRG Validator
Feb. 2018 - Apr. 2019Greater Omaha AreaReviews DRG downgrades and denials from insurance companies. Files an appeal when appropriate or downgrades account in accordance with appropriate CMS, coding or clinical guidelines. Ensure compliance with all DRG mandates and reporting requirements to assure appropriate assignment of ICD-10 codes and DRG assignment according to official coding guidelines. Perform a quantitative and qualitative review and analysis of health records and physician queries, both concurrently and retrospectively, to ensure documentation is accurate, consistent, complete and assigned codes can be supported by documentation. Conduct chart reviews based on DRGs. Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC & CC) and procedures. Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by SOW. Assists departments with billing edit resolutions,
nThriveCoder II
May. 2015 - Feb. 2018Gwinnett Medical Center, Trauma II Facility Lawrenceville, GA Coding: Applies ICD-9/ICD 10 codes for diagnoses and procedures for inpatient stays including but not limited to trauma patients, OB delivery, NICU, Cardiac and Spinal surgeries. Works with various client systems (HPF, Optum CAC, Open Vista), including applicable coding compliance editor software and ensure records are accurately coded. Followed established query process to clarify documentation to support coding assignments. Maintains productivity and accuracy requirements as outlined for each client. Worked closely with the coding and or QA manager during QA audit process. Ensured all required component parts of the medical record that pertain to coding are present, accurate and comply with CMS, JCAHO and client requirements.
Inpatient Coder, SA Solutions INCContracted Worker
Jun. 2014 - Oct. 2015Kern Medical Center, Trauma II Facility Applied ICD-9/ICD 10 codes for diagnoses and procedures for inpatient stays including but not limited to trauma patients, OB delivery, NICU and Psychiatry. Works with various client systems (HPF, Star navigator, Open Vista), including applicable coding compliance editor software and ensure records are accurately coded. Followed established query process to clarify documentation to support coding assignments. Maintained productivity and accuracy requirements as outlined for each client. Worked closely with the coding and or QA manager during QA audit process. Ensured all required component parts of the medical record that pertain to coding are present, accurate and comply with CMS, JCAHO and CA MediCAL requirements.
Verisk Health IncRemote Clinical Coding Specialist
Jul. 2013 - Feb. 2014HCC Coding: Chart review for proper diagnosis coding form various chart types (physician, hospital outpatient, hospital inpatient). Insure that the highest level of diagnosis code was utilized in each date of service reviewed and documentation of findings in company data storage program.
Inpatient Coder, Walter Reed National Military Medical CenterIP coder
May. 2013 - Dec. 2014Assigned codes for diagnoses, treatments and procedures according to ICD-9 Reviews appropriate provider documentation to determine principal diagnosis, co-morbidities and complications, secondary conditions and surgical procedures. Utilized technical coding principals and MS-DRG reimbursement expertise to assign appropriate ICD-9 diagnosis codes and procedure codes. Assign present on admission (POA) value for Inpatient diagnosis. Review medical records for documentation of procedures performed, coexisting chronic conditions that have been exacerbated or required treatment with medications or monitoring, or are a risk factor for the patient treatment. Training/Compliance: Resolved medical record documentation deficiencies through health care provider queries; provided routine feedback to healthcare providers to correct deficiencies.
AmeritoxAccounts Receivable Follow up Specialist
Jan. 2012 - Oct. 2012Audited medical bills for verification of proper diagnosis and procedure codes in accordance with State and Federal workers compensation laws and regulations. Prepared and submitted clean claims to various insurance companies both electronically or by paper. Customer Service: Contacted Insurance companies and verified patient claim information via telephone. Obtained and completed necessary documentation for payment authorization. Accounts Receivable: Mailed out and verified receipt of medical bills; documented expected payment dated and amounts. Training: Coach and mentor new employees on workers compensation policies and procedures for medical bills/claims.
Kaiser PermanenteRevenue Integrity Coding Analyst
Oct. 2011 - Jan. 2012Coding Operations: Audited outpatient medical bills with the use of medical records for CPC/ ICD 9 coding accuracy for the OB/GYN, preventive medicine and radiology physicians. Production: Achieved individual production and quality assurance performance within established expectations and standards.
AHC/ ConvergentUSAWorkers Compensation Supervisor
May. 2008 - Aug. 2011Manage: Coached, mentored and responsible for the work of 5 to 10 members. Drafted quarterly and yearly evaluations for assigned staff members and submitted to Managing Attorney/ Director of Operations for review and approval. Training: Organized meetings to keep team members, staff attorneys, account specialists up to date on CA laws and regulations in accordance with Workers Compensation laws. Recruiting/ Resource Management: Processed payroll for assigned team members, reviewed applicants resumes for hiring process. Tested and interviewed candidates for potential hiring. Client Services: Conducted monthly meetings with clients to overview teams’ performance and append any policies to meet with clients standards. Worked in conjunction with Director of Operations, Vice President of Operations and Financial Directors of Hospitals to achieve financial goals in a timely and effective manner.
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