Coding Consultant Resume Samples

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J Runolfsson

Julia

Runolfsson

584 Abernathy Terrace

Chicago

+1 (555) 279 2397

584 Abernathy Terrace

Chicago

Phone

p +1 (555) 279 2397

Experience Experience

San Francisco, CA

Provider Coding Consultant

San Francisco, CA

O'Conner Inc

San Francisco, CA

Provider Coding Consultant

Contributes to a robust pipeline of new product ideas working closely with product management
Working as primary contact to manage client and sales expectations
Produce final report according to Product Management specifications and assist Product Sales Consultants with presentation of report to client
Works with less structured, more complex issues
Providing comparative analysis of industry data
Working with prospective clients to understand their business and how their claim data will be analyzed
Identifying erroneous coding rules and working to resolve these in our system

Phoenix, AZ

Medicare Risk Adjustment & Coding Consultant

Phoenix, AZ

Walsh, McClure and Cassin

Phoenix, AZ

Medicare Risk Adjustment & Coding Consultant

Collaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts
Performs analysis and provides formal feedback to providers on a regularly scheduled basis
Ensures member encounter data (services and disease conditions) is being accurately documented and relevant procedural codes and all relevant diagnosis codes are captured
Educates providers and staff on coding regulations and changes as it relates to Quality and Risk Adjustment to ensure compliance with state and federal regulations
Refers inconsistent or incomplete patient treatment information/documentation to coding quality analyst, provider, supervisor or individual department for clarification / additional information for accurate code assignment
Refers inconsistent or incomplete patient treatment information/documentation to coding quality analyst, provider, supervisor or individual department for clarification/additional information for accurate code assignment
Refers inconsistent or incomplete patient treatment information / documentation to coding quality analyst, provider, supervisor or individual department for clarification/additional information for accurate code assignment

present

New York, NY

RN Coding Consultant, K Sign-on Bonus

New York, NY

Jacobson, Grimes and Fahey

present

New York, NY

RN Coding Consultant, K Sign-on Bonus

present

Work with corporate operations to develop program success metrics and ongoing performance metrics
Provides educational tools which may include presentations as assigned by management
Educate practitioners / clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process
Performs all other related duties as assigned
Perform Quality Audits to ensure error rate remains within industry standard; maintain compliance with Optum coding standards and CMS Risk Adjustment guidelines
Perform Quality Audits to ensure error rate remains within industry standard
Provide strong leadership and judgment; effectively build and deepen relationships across assigned market

Education Education

Bachelor’s Degree in Integrity

Georgetown University

Bachelor’s Degree in Integrity

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RN Coding Consultant, K Sign-on Bonus Resume Examples & Samples

Educate practitioners / clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process
Ensure all Market Leaders are utilizing established tools and are able to downstream this education in their prospective markets
Bachelor’s Degree in Nursing required (Associate’s Degree or Nursing Diploma from accredited nursing school with 2 or more years of additional experience may be substituted in lieu of a bachelor’s degree)
RN license in good standing
CPC certification or proof that certification has been obtained within 9 months from the American Academy of Professional Coders required
4 years of General Clinical experience required
2 years of clinical coding experience with strong attention to detail and a high level of accuracy
Ability and willingness to travel (locally and non-locally) as determined by business need
Demonstrates effective interpersonal, influence, collaboration and listening skills to address complex situations or issues with a high degree of integrity

RN Coding Consultant, K Sign-on Bonus Resume Examples & Samples

Educate practitioners/clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process. Ensure all Market Leaders are utilizing established tools and are able to downstream this education in their prospective markets
Perform Quality Audits to ensure error rate remains within industry standard; maintain compliance with Optum coding standards and CMS Risk Adjustment guidelines
Ability to work a flexible work schedule and travel to markets requiring overnight stay

RN Coding Consultant K Sign-on Bonus Resume Examples & Samples

Partner with business owners to identify methods to execute upon the key strategic visions and lead the initiative to completion
Work with corporate operations to develop program success metrics and ongoing performance metrics Provide strong leadership and judgment; effectively build and deepen relationships across assigned market
Perform Clinical Chart Audits as business needs dictate
CPC certification or proof that certification has been obtained within 9 months from the American Academy of Professional Coders 4-5 years of General Clinical experience required
Two years of clinical coding experience with strong attention to detail and a high level of accuracy
Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities and make changes to work as the project needs dictate

RN Clinical Coding Consultant Resume Examples & Samples

Educate practitioners / clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process. Ensure all Market Leaders are utilizing established tools and are able to downstream this education in their prospective markets
Perform Quality Audits to ensure error rate remains within industry standard
Knowledge of CMS-HCC model and guidelines along with ICD-9 / 10 and guidelines
Ability and willingness to travel (locally and non-locally) as determined by business nee
Effectively communicates complex ideas clearly and concisely to internal and external customer
Additional Quality Assurance auditing experience

Clinical Coding Consultant Rn-k Sign-on Bonus Resume Examples & Samples

Work with corporate operations to develop program success metrics and ongoing performance metrics
Bachelor’s Degree in Nursing required (Associate’s Degree or Nursing Diploma from accredited nursing school with 2 or more years of additional experience may be substituted in lieu of a bachelor’s degree) and current RN license in good standing required
CPC certification or proof that certification has been obtained within 9 months from the American Academy of Professional Coders

Senior Documentation & Coding Consultant Resume Examples & Samples

Sets the strategic direction of projects. Determines goals and priorities with management team sponsors. Establishes team membership and negotiates time commitments and resources. Develops proposals for clients outlining proposed project structure, approach and work plan. Provides staff leadership to project teams, as well as manages work of outside consultants when needed
Designs research plans for data gathering and analysis; participates significantly in interpreting analysis and developing action plans accordingly
Produces or oversees development of written materials for senior executives and other key clients. Plans and facilitates meetings. Makes formal presentations to various senior level audiences

Financial & SAS Coding Consultant Resume Examples & Samples

Develop, perform and manage the analyses of business and financial metrics as well as performance measures
Develop and maintain financial reports to clearly communicate actual results, forecasted performance and variances to plan, forecast and budget
Understand and incorporate industry specific metrics into reports to highlight relevant trends and support fact-based business decisions
Develop, perform and manage all aspects of financial planning, budgeting and forecasting
Work closely with the business to develop, recommend and establish strategies, plans and processes to improve profitability and cost efficiencies
Bachelors degree or equivalent work experience in Accounting and Finance
4+ years of financial and / or accounting experience
Basic level of proficiency in MS Office products
SAS coding experience
Advanced Excel skills and intermediate Essbase / Smartview user
MBA or CPA
Hyperion Essbase, Planning and PeopleSoft Financials

Medicare Risk Adjustment & Coding Consultant Resume Examples & Samples

Utilizes analytics and identifies and targets providers
Utilizes analytics and identifies and target providers for Medicare Risk Adjustment training and documentation/coding resources
Routinely consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes
Refers inconsistent or incomplete patient treatment information/documentation to coding quality analyst, provider, supervisor or individual department for clarification / additional information for accurate code assignment
ProvidesICD10 - HCC coding training to providers and appropriate staff
Develops and delivers diagnosis coding tools to providers
Trains physicians and other staff regarding documentation, billing and coding and provides feedback to physicians regarding documentation practices
Reviews selected medical documentation to determine if assigned diagnosis, procedures codes and ICD-10 codes are appropriately assigned
Collaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts
Knowledge of ICD10

Medicare Risk Adjustment & Coding Consultant Telecommute Resume Examples & Samples

Assists providers in understanding the Medicare quality program as well as CMS-HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
The Medicare Risk Adjustment Coding Consultant will be responsible for facilitating and/or performing an audit of the providers’ medical chart to ensure appropriate documentation exists to support the diagnoses submitted appropriately
Ensures member encounter data (services and disease conditions) is being accurately documented and relevant procedural codes and all relevant diagnosis codes are captured
Provides thorough, timely and accurate consultation on ICD-10 and/or CPT 2 codes by providers or practice clinical consultants
Refers inconsistent or incomplete patient treatment information / documentation to coding quality analyst, provider, supervisor or individual department for clarification/additional information for accurate code assignment
Provides ICD10-HCC coding training to providers and appropriate staff
Develops and presents coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs
Educates providers and staff on coding regulations and changes as it relates to Quality and Risk Adjustment to ensure compliance with state and federal regulations
Assesses adequacy of documentation and queries providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding
Bachelor’s degree (preferably in Healthcare or relevant field) or equivalent work experience
Previous experience in Risk Adjustment and/or HEDIS / Stars
Minimum 4-6 years of clinic or hospital experience and/or managed care experience
Certified Professional Coder / CPC-A or willingness to obtain required certification within first year in position; equivalent certifications acceptable
Demonstrated knowledge and understanding of ICD and CPT coding principles as recommended by the American Health Information Management Association coding competencies, and as normally demonstrated by certification by the American Academy of Professional Coders
Master's degree
Minimum of one year of coding performed at a health care facility
Knowledge of billing/claims submission and other related actions

Medicare Risk Adjustment & Coding Consultant Resume Examples & Samples

Assists providers in understanding the Medicare Stars quality program as well as CMS -HCC Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
Monitors Stars quality performance data for providers and promotes improved healthcare outcomes
Assist providers in understanding the Medicare Stars quality and CMS -HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
Performs analysis and provides formal feedback of to providers on a regularly scheduling basis

RN Coding Consultant, K Sign on Bonus Resume Examples & Samples

Educate practitioners/clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process; ensure all Market Leaders are utilizing established tools and are able to downstream this education in their prospective markets
Work collaboratively with market physician leadership in the development and management, project governance and detailed project plans as it relates to assigned market
Provide strong leadership and judgment; effectively build and deepen relationships across assigned market
Provides educational tools which may include presentations as assigned by management
Ability to speak and provide presentations and education to small and large groups alike
Effectively communicates complex ideas clearly and concisely to internal and external customers
Possess a high tolerance to stress and the ability to handle difficult situations in a confident and diplomatic manner
Provide leadership, organization and methodology to a project / operations team

Division Coding Consultant Resume Examples & Samples

3 + years of progressively responsible revenue cycle and/or practice management experience to ensure familiarity with coding, third-party reimbursement and billing systems required
Thorough knowledge of coding practices and official guidelines, HCPCS, ICD-9/ICD-10 and CPT codes
Preferred auditing skills for coding quality and compliance
Requires proficiency in Microsoft applications, including Outlook, Word, Excel and Power Point
Proactively prioritize initiatives and have ability to multi-task

RN Coding Consultant Resume Examples & Samples

Partner with corporate leadership to identify the most beneficial options and assist in driving the completion of the selected option
Create a team-oriented work climate that enables professional development and encourages creative solutions and strategies, establishes collaboration and emphasizes quality and cost
Maintain compliance with Optum coding standards and CMS Risk Adjustment guidelines
Knowledge of CMS-HCC model and guidelines along with ICD-9/10 and guidelines
Able to create, build and maintain relationships in order to improve performance and establish trust and maintain creditability throughout the organization

Coding Consultant Resume Examples & Samples

Associate degree in healthcare related field of study or equivalent years of healthcare experience
RHIT,CPC, COC, CCS, or CCS-P
Prior experience in an acute care facility
Excel spreadsheet, Access database & PowerPoint experience a plus
Price file Maintenance experience a plus
Evaluation & Management experience a plus
Must be familiar with PC's and able to work with multiple technical systems simultaneously
Must be familiar with JCAHO, State and Medicare Standards
Ability to work in a multi-disciplinary environment
Very strong communication skills, written and oral, for communication with Medical Staff and other healthcare professionals are a must for this role
Ability to perform well in a fast-paced, team environment and to manage time effectively. Prior report writing is a plus for this role
Ability to define problems, collect data, establish facts and draw valid conclusions
Ability to interpret and deal with several abstract and concrete variables
Ability to effectively present information and respond to questions for groups of clients, physicians, and customers

Healthcare Coding Consultant Resume Examples & Samples

Conduct coding reviews to assess the overall effectiveness of clients’ coding systems
Educate and mentor clients on effective and accurate coding practices and principles
Research complex coding and reimbursement issues
Educate physicians and coders to improve the connection between coding and documentation
Be a technical resource in coding and reimbursement systems to other health care practice professionals
Maintain a detailed level of knowledge of Medicare guidelines, other payer rules, ICD-10, CPT, and HCPCS coding
Requires an Associate Degree in business or health related field
Certification is required
Requires 3-5 years of previous experience. Our immediate need is for physician coding reviews but experience with hospital outpatient coding is also preferred
Requires experience in training professionals in coding practices
Experience with a variety of EHRs is a plus
Ability to plan, prioritize, and organize work effectively
Ability to balance many projects simultaneously
Ability to work under pressure and time deadlines
Ability to analyze data and recommend solutions
Requires strong oral and written communication skills
Requires excellent professional presentation skills
Proficient in Word, Excel, and Outlook
Requires a valid driver’s license

Clinical Coding Consultant Resume Examples & Samples

Feedback any coding queries or issues with source documentation to the onsite hospital lead or other nominated person
Liaise with CHKS clinical coding professional lead for any coding queries
To ensure completion of coding; continually striving to maintain timeliness, accuracy, completeness and consistency of clinical coding when on a client site
To adhere to the clinical coding conventions and procedures, as defined by the World Health Organisation (WHO) and National Classifications Service
To follow locally defined variations to coding rules where defined in each of the organisations clinical coding policy
To organise and prioritise workload as appropriate to meet the agreed weekly/monthly clinical coding deadlines as set by the client, ensuring the number of episodes are completed as outlined in individual contracts, without comprising data quality
To act as an ambassador for CHKS Coding and Financial Assurance by providing a professional coding service
To promote CHKS Coding and Financial Assurance as an expert and professional coding, audit and consultancy services provider and recognise potential opportunities to obtain further work with clients
ACC – Accredited Clinical Coding
Knowledge of coding all specialties
Knowledge of coding complex specialties
Knowledge of the Data Protection Act, confidentiality and information security requirements
Ability to work independently or as part of a team

Clinical Coding Consultant Rn-port St Lucie Resume Examples & Samples

Review and update educational materials as approved by Leadership
4-5 years of General Clinical experience
90% travel

RN Clinical Coding Consultant Resume Examples & Samples

4 - 5 years of General Clinical experience
Knowledge of CMS - HCC model and guidelines along with ICD - 9 / 10 and guidelines
Ability and willingness to travel (locally and non - locally) as determined by business nee

Medicare Risk Adjustment & Coding Consultant Resume Examples & Samples

* Candidate must reside in the Colorado area ***
Minimum of 3 years experience in Risk Adjustment and HEDIS / Stars
Minimum of 4 years experience in managed care
Advanced proficiency in MS Office: Excel (Pivot tables, excel functions), PowerPoint, and Word

Coding Consultant Resume Examples & Samples

Certified Coding Specialist (CCS) approved by the American Health Information Management Association (AHIMA) for inpatient or hospital outpatient coding
Bachelor or Associate degree and successful completion of the examination for Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) approved by AHIMA for inpatient or hospital outpatient coding
Certified Procedural Coder- Hospital (CPC-H) approved by AAPC for hospital outpatient coding
Certified Coding Specialist- Physician (CCS-P) approved by AHIMA for physician services coding
Certified Procedural Coder (CPC) approved by the American Academy of Professional Coders (AAPC) for physician services coding
Inpatient
Outpatient
Physician services

Provider Coding Consultant Resume Examples & Samples

Working with prospective clients to understand their business and how their claim data will be analyzed
Create client reports in conjunction with the sales with occasional custom projects
Creates all required client documentation required for the study
Ensures accuracy, consistency and quality of deliverables regardless of client data challenges
Acts as Lead for specific client data management projects and interacts with technical staff assigned to work on project. Entails serving as primary contact to manage client expectations and noting and responding to scope or work
Working as primary contact to manage client and sales expectations
Produce final report according to Product Management specifications and assist Product Sales Consultants with presentation of report to client
Contributes to a robust pipeline of new product ideas working closely with product management
Researching, sourcing and editing using the collection of industry standards
Responding to client questions and inquiries about correct coding and reimbursement
Reviewing documented industry standards to verify client specific editing results
Identifying erroneous coding rules and working to resolve these in our system
Document any editing defects and next steps for internal reporting
Providing comparative analysis of industry data
B.A./B.S. Degree and/or relevant and applicable work experience
Strong Excel experience
3-5 years of healthcare claims experience
CPC/CCS certified, or the ability to obtain upon hire
RN, RHIT, RHIA experience
1-3 years of reimbursement policy experience
Claims editing and fraud experience
Experience working with large claims data sets
Experience interacting with telecommuting team and/or offshore resources
Thorough knowledge of applicable regulatory rules and guidelines; e.g. CCI, OCE, MCE
Excellent interpersonal and communication skills (written and verbal). Task oriented and ability to manage multiple projects

Clinical Coding Consultant Resume Examples & Samples

The ideal candidate will undertake a clinical coding service on behalf of CHKS Coding and Financial Assurance (CFA) to their private healthcare providers and clinically code their patient episodes from the medical records provided
Have previous experience in clinical coding within a healthcare environment and be confident in the use of software packages, including PAS systems, word and excel
Must be an ACC – Accredited Clinical coder, with at least 3 years coding experience
Have the ability to competently code multiple specialties to include, Orthopaedics, Spinal Surgery, General Surgery, ENT, Ophthalmology, Gynaecology, Urology, Endoscopy and Pain
Have a good sound understanding of anatomy, physiology and medical terminology
Ensure completeness of coding, to maintain timeliness, accuracy and consistency when on the client site
Build up good effective working relations with onsite staff, to include the hospital NHS Team, consultants, finance and medical records staff
Provide feedback on any coding queries or issues with source documentation to the onsite hospital NHS lead or other nominated person
Liaise with the CHKS clinical coding professional leads for any coding queries when on site
Act as an ambassador for CHKS CFA by providing a professional coding service
Promote CHKS (CFA) as an expert and professional coding, audit and consultancy services provider and recognise potential opportunities to obtain further work with clients

Certified Medical Coding Consultant Resume Examples & Samples

Perform DRG validations and provide outcomes management for decreasing denied claims
Will compose educational letters to provide information on coding guidelines and regulations support the medical record findings
Assist educators with their coding questions
Required to complete 12-15 DRG validations per week and provide 12-15 educational letters back to providers. Claims will be inappropriately denied if we don't assure a DRG validation process in place for the provider outreach team
Conduct chart audits to assure claims are paid accurately and contributes to the overall recoveries
2+ years of experience as a Certified Coder (inpatient and outpatient claims)
2+ years of CPT / HCPCS / ICD-9 / ICD-10 coding experience with a thorough knowledge of health insurance business, including knowledge of industry terminology, and regulatory guidelines
Microsoft Word (creating and editing documents) and Microsoft Excel (creating and editing spreadsheets, analyzing data, sorting, and filtering) experience
Healthcare Claims experience
Investigational and / or Auditing experience
Client service experience preferred
Healthcare and / or project management experience is preferred
2+ years of experience as a manager, supervisor and / or team lead
Ability to develop collaborative client relationships is required
Excellent negotiation / influence, collaboration, and listening skills
Ability to quickly assimilate new ideas and concepts and apply them in new situations
Effective presentation and writing skills

Him-remote Inpatient Coding Consultant Resume Examples & Samples

Minimum of 3 years experience coding or auditing
RHIA, RHIT, CCS, CPC or CCS-P credentials
Recent experience in academic/level 1 trauma centers
Experience coding or auditing inpatient records for various facilities
Track record of acceptable productivity standards
Maintain 95% accuracy rate for DRG assignment and 95% productivity rate
Experience with various software including EMR, Encoder and Auditing software

Him-remote Outpatient Coding Consultant Resume Examples & Samples

Reviews medical records and assigns appropriate CPT, ICD-10-CM, ICD-10 procedures, ICD-10-CM and ICD-10 PCS, HCPCS, DSMV codes as appropriate and required by client workflow
Communicates professionally with co-workers, management, and hospital staff regarding clinical and reimbursement issues
Communicates documentation improvement opportunities and coding issues to appropriate personnel for follow up and resolution
A minimum of 1-5 years of coding experience in a hospital and/or coding consulting role

Him-remote Provider Practice Coding Consultant Resume Examples & Samples

Conducts data quality reviews of records to assess compliance with official coding and documentation guidelines
Demonstrates excellent written and verbal communications skills
Associate or Bachelor’ degree from AHIMA certified HIM Program or Nursing Program or completion of certificate program with CCS, CCS-P, CPC, CPC-H, CIC or COC preferred
Ability to communicate effectively in the English language
Experience in computerized encoding and abstracting software
Required to take and pass annual Introductory HIPAA examination and other assigned testing to be given annually

Medicare Risk Adjustment & Coding Consultant Resume Examples & Samples

* Candidate must reside in Colorado or Idaho. The person in this role will be traveling up to 50% of the time through the Denver, CO airport ***
* Candidate must reside in either Colorado or Idaho ***
Minimum of 1 year experience in Risk Adjustment and HEDIS / Stars

Implementation & Coding Consultant Resume Examples & Samples

Conceptualizing approaches to utilization of integrated coding nomenclatures and data sources into deliverables that consider both the varied business issues and objectives across HealthCore. Standarized and detailed project specific applications of the coding strategies will be integrated as considerations for research, analytic and reporting systems.[HD1]
Collaborating in the development of solutions that include integration of clinical data elements obtained from medical record abstraction processes, data warehouse data, care management systems, and other data sources, including registries and clinical trial data elements
Communicating and monitoring the execution of standardized coding practices in collaboration with clinical and operations stakeholders throughout HealthCore
Maintaining the standardized coding library for use by HealthCore analysts and researchers
Collaborating in the development of a Wiki information sharing structure as a subject matter expert
Collaborating with project teams in developing and implementing customized coding algorithms for specified projects
Developing and managing the quality assurance process to ensure accurate code assignment on policies and within translation of research and analytic systems/tools
Collaborating to improve coding systems embedded within all processes, tools, and measures that standardize and improve performance related to implementation and demonstrates quantifiable value to business units. Facilitates identification and resolution of local coding implementation issues