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I am currently certified through AAPC and obtain my CPC certification. I have 12 years of coding experience. I have worked in a small 25 bed critical access hospital as well as a level 5 trauma and teaching hospital. I am able to code inpatient, outpatient, ER, OB, newborns, radiology, clinic, PT, infusions and cardiac surgeries, as well as many minor and serious procedures.
PACT Social Worker
I am a Licensed Masters Social Worker with 15 years of Federal Government service/ experience in the healthcare field. I obtained my Doctorate in Social Work, and it has afforded me the opportunity for advanced practice in a clinical setting. As a social worker I have a wealth of knowledge with the DRG classification system and coding, as well as the ICD-10 diagnosing coding system. I work well independently, have excellent communication and documentation skills. I am timely with all of my required reporting and documentation standards in accordance with Joint Commission on Accreditation of Healthcare Organizations. In addition to my current duties as a social worker for the PACT team, I have taken on collateral duties as a peer reviewer and acute medical auditor.
Dallas TX 75227 (469)-531-5910
To secure a position within a stable work environment that will allow advancement and growth as well utilizing the ability to contribute towards a stable company. I work well with diversity whether it is on an individual basis or within a team environment. I know that I would be a great asset to your company as I am very committed, focused, and a hard worker. Highly motivated, ambitious professional with extensive experience, excels at leadership, communication, problem solving, and interpersonal skills. Known for producing results, project management, problem solving, motivating others, and multi-tasking.
Aetna-Arlington, TX (Client Benefits Specialist) Nov 2015-Apr 2019
Responsibilities including analyzing and approving routine claims that cannot be auto adjudicated. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process. Routes and triages of complex claims to Senior Claim Benefits Specialist. Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements. Reviews and adjudicates routine claims in accordance with claim processing guidelines. Critical success factors – Ability to work independently – Ability to think logically and problem solve – Strong oral communication skills.
•Experiences in a production environment.
•Claim processing experience.
CVS Health-Irving, TX (Client Operations Consultant) Oct 2004-June 2015
Responsibilities include, but are not limited to meeting and exceeding turnaround time and quality standards as well as researching client benefit requests/issues and recommend alternative solutions to internal partners in meeting client needs. Additional responsibilities include analyzing client benefit requests, to determine the best operational approach and perform coding and testing for Medicare and/or Medicaid business. Assist to manage the resolution and status of routine to complex client requests with Account Management through effective and timely communication to ensure client expectations are met. Work closely with internal departments to coordinate timely resolution of requests. Trending analysis, and supporting and mentoring staff. Interface with internal and external clients via conference calls and written communication. Cross training with Account Management Team. I also analyze projects and/or day to day rework for root cause errors, and work collaboratively with various functions to reduce those errors. In addition to analysis, I reprocess rework claims while maintaining stellar quality results while convey a positive and professional image and the ability to demonstrate tact and diplomacy in communications with both internal and external customers
• Proficiency in compiling data, creating reports and presenting information, including expertise with Crystal Reports (or similar reporting tool), SQL Query, MS Access and MS Excel.
• Identify process improvement opportunities to make the processing of plan design requests more efficient.
• Research client benefit requests/issues and recommend alternative solutions to internal partners in meeting client needs.
• Support urgent issues including but not limited to research and analysis of benefit setup issues in support of Employer issue tracking.
• Support the team of benefit coders, testers and QA through mentoring, providing in depth quality reviews and distributing information relevant to Employer plan setups.
• Ability to maintain attendance to support required quality and quantity of the workload, yet is flexible enough to work off-hours to meet deadlines.
• Ability to quickly assimilate knowledge of processes and systems to develop and deliver necessary training to departmental staff and internal customers.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
• Perform coding, testing and QA functions, such as moving all plan design implementations and/or changes into a Production status upon completion of a review within tight timelines.
Proficient in CISCO, Recap, Rx Claim/AS400, People Safe, Rx Navigator, Salesforce, Citrix, Microsoft Office, Microsoft Excel, Word, Power Point, Access and Billing / Running Macros, SFDC, ACAS, Rumba, Burgess.
Pinecrest High School Diploma
Six Sigma White Belt
Six Sigma Yellow Belt
I am an International Medical Graduate and studied medicine in Zagreb, Croatia. I graduated from medical school in July 2013. In 2014, after becoming a licensed physician, I began working in family medicine offices in the Dubrovnik region substituting for local general practitioners. After six months, I got a full-time position working in a clinic in the village of Ston, near Dubrovnik, Croatia. There I ran a Family Medicine office with 1000 patients. In May 2015, I got a residency position in Infectious Diseases at the General Hospital Dubrovnik where I worked for two years. I recently moved back to the U.S. and have been working as a medical scribe in the General Pediatrics department at the University of Michigan Health Center in Ann Arbor, Michigan.
I also have over six years of writing experience, and have a bachelors degree in English from Wayne State University, in Detroit. Since 2012, I have been a contributing writer for Croatia in Your Pocket Guides, a European based travel guide. Since 2017, I have also been a freelance writer for Textbroker International and have written many health related and wellness articles.
My background in medicine and writing makes me an ideal candidate for writing on medically related topics. As well, my experience in primary healthcare have contributed to my passion for health promotion and prevention.
Close to 30 years of clinical and administrative medicine experience as a primary care physician and medical director/consultant for health plans, state and governmental agencies and pharmacuetical companies. I have extensive background in quality assurance and utilization review as well as fraud and abuse. I also have over 5 years of experience doing formulary development/management.
CCS, RHIT CDI coder
TONY WACHIRA, RHIT, CCS 941-350-2954
7560 Aguila Dr, Sarasota FL,
Currently, I hold my RHIT degree and CCS license through AHIMA and I am looking for a full-time/part-time position.
I am passionate about my work and always strive to be the best in every contract/position I undertake.
CDI inpatient coder @ Acusis (Current)
Accurately reflect and report the patient’s severity of illness equating to intensity of service
Review inpatient medical records for identified payer populations (i.e., Medicare, Medicaid, etc.)
Maintain up to date working DRG and has clear strategies to effectuate improved quality of clinical documentation for all the select cases
Attend training seminars weekly
Query providers for Diagnosis with DRG impact
Find missing CCs and MCCs missing from diagnosis notes
Effectively demonstrate physician clinical judgment and medical decision making in support of medical necessity
Facilitate complete discharge summaries in promotion of post-acute care and facilitation of orderly handoff to patient’s primary care physician
HCC remote coder @Matrix medical network (current)
Review medical charts electronically using a computer
Assign HCC codes
Handle documentation mismatches
Assign ICD-10 and CPT codes for provider home visits.
Query provider for clarification
Research and resolution of coding projects as assigned
Document requested information from the medical record
Determine valid encounters including legibility and valid signature requirements
Remote Outpatient medical coding @MEDICAL PRACTICE SUCCESS (December 2018- April 2019) contract
SUPERVISOR: TANIS RODRIGUEZ
Assign correct ICD-10Cm and CPT codes
Send queries for clarification
Establish relationships with medical/dental staff.
Follow-up with providers to ensure documentation supports the diagnoses and E/M level in question.
Audit Completed charts for corrections
Ensure correct ndc units have been displayed
Thorough knowledge of Medicare Fraud and Abuse regulations.
Document patient charts on a excel spreadsheet.
Full knowledge of HIPAA regulations.
File monthly reports
Establish evidence to correspond with Codes.
Edit CPT codes for billing.
Remote imaging coder/Auditor @MEDICAL PRACTICE (December 2018- April 2019) contract
SUPERVISOR: TANIS RODRIGUEZ
Receive assigned medical charts to code.
Review medical charts electronically using a computer.
Abstract and code diagnosis and documentation information.
Research and resolution of coding projects as assigned.
Document requested information from the medical record.
Determine valid encounters including legibility and valid signature requirements.
Knowledge of the Medicare and Medicaid Programs particularly as it relates to CPT procedures and ICD-10 diagnostic coding.
Identify valid face to face encounters.
Perform ongoing analysis of medical record charts for the appropriate coding compliance.
File monthly reports
Establish evidence to correspond with Codes.
Edit CPT codes for billing.
Track and report findings of chart audits and opportunities to improve documentation and coding back to providers and staff
CDI/MEDICAL CODING Mentorship @Veteran allied services (April 2017- December-2018)
@Veteran medical services
Certified Coding Specialist (CCS)
Proficient in extracting correct information from source documents and typing them accurately into the encoder system
Appropriate assignment of CPT, ICD-10CM/PCS and E/M Codes while adhering to the official coding guidelines and established client policies.
Ensure coding compliance within medical record policies and procedures
Formal training in anatomy and physiology, medical terminology, pathology, and disease processes
Review patients’ documentation to determine diagnosis, co-morbidities, and Complication
Computer proficiency, able to research coding questions
Able to effectively utilize ICD, CPT/HCPCS and related materials to investigate coding issues and produce accurate results.
Conduct a Query Process
3m encoder trained
CALL REPRESENTATIVE/SALES AGENT, @ALORICA/DUKE-ENERGY (Jun 2018-september 2018)
Verify customer information
Help customers handle personal accounts
Sell electrical insurance products to homeowners
Take payments for electrical bills
Resolving customer disputes
ADMINISTRATIVE ASSISTANT, @ASALISOLUTIONS (Jan 2015-Jan 2016)
Review customer information file for health insurance policies
Record accurate data for the manager to follow up
Data entry of customer information
Outbound calls to clients
Manage client information on Microsoft Excel
Order & manage Office supplies
COOK/CASHIER, @SMACK’S (April 2017-May 2018)
Minimize loss through the efficient use of resources
Ensured proper food presentation and storage
Inventory check for supplies
Maintained a clean kitchen and restaurant setting
Handle customer payment options
Customer Service Excellence
Store Closing Procedures
CCS certified through AHIMA
ICD-10 CM coding, ICD-10 PCS coding, CPT coding
3M encoder experience
Recording accurate information
Sales and customer service excellence
Billing, CPT coding, clients, Data entry,
ICD-10, notes, medical terminology, policies, coding
Ability to work in a continuously changing environment, flexible
I am an Osteopathic physician board certified in Internal Medicine and Pain Medicine with extensive clinical practice experience in both. My main areas of subject matter expertise are in Pain Medicine, Interventional Pain procedures, Orthopedics, Regenerative Medicine, Internal Medicine, and the Internal Medicine subspecialties. In addition to clinical practice experience, I have served roles in medical consulting, medical writing, medical education, medical administration, and as a medical science liaison.
Medical Coder/Billing Specialist
Accomplished Medical Coding & Billing Specialist with experience in EHR integration and practice health administration and expertise in ICD-9/10-CM and CPT coding looking to integrate past IT education, medical coding, and healthcare experience into Health Info Management and Informatics. Resourceful and strategic planner who analyzes critical data to ensure accurate coding, recording, and documentation of patient information while optimizing IT networks to ensure the confidentiality of patient data and HIPAA privacy laws. Articulate communicator and respected leader who partners with industry professionals, physicians, and clients in order to ensure timely payment of copays and deductibles and determine the best course of action on appeals for claims denials.
I have 6 years coding experience with a 19 physician Orthopedic Group which includes: Orthopedic doctors, a pain management doctor and a podiatrist. We also have 11 Nurse practices. We review every office note that comes through our office. We reveiw the E&M levels and to make sure every axillary code is documented (x-rays, casting, casting supplies, DME, injections and injection medication). We also code minor procedures done in the office. We make sure the modifiers are right for the insurance companies. I look forward to hearing from you.
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