Medical Coding Resume Samples

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JL
J Leannon
Jeanie
Leannon
788 Mayert Burgs
Chicago
IL
+1 (555) 266 5848
788 Mayert Burgs
Chicago
IL
Phone
p +1 (555) 266 5848
Experience Experience
Boston, MA
Medical Coding Quality Consultant
Boston, MA
Welch, Mohr and Renner
Boston, MA
Medical Coding Quality Consultant
  • Collaborating with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment education efforts
  • Training providers on our Risk Adjustment methods and tools, and working toward their compliance with our programs
  • Targeting local providers who would benefit from our Medical Risk Adjustment training
  • Developing comprehensive, provider - specific plans to increase their RAF performance
  • Reaching out to physicians, medical groups, IPAs and hospitals, and building positive, consultative relationships
  • Educating providers on how to improve their Risk Adjustment Factor (RAF) scores, which measure their patients' health status
  • Finalizing documentation and providing feedback to team members based on findings
New York, NY
Medical Coding / Audit Supp Specialist
New York, NY
McKenzie, Marvin and Terry
New York, NY
Medical Coding / Audit Supp Specialist
  • Coordinate and process medical record requests while maintaining strict adherence to Policies and Procedures and Corporate Compliance Program Guidelines
  • Process medical record requests flagged for coding review for all Anesthsia and Pain Mgmt. related facilities
  • Assemble all Anesthesia and Pain Mgmt related documentation for coding audits and special request projects
  • Conducts follow-up on outstanding medical record requests
  • Maintains audit workflow spreadsheet
  • Updates and maintains audit workflow and outcome in an Excel spreadsheet
  • Ensures accurate data input received from the Coding Auditors
present
Houston, TX
Medical Coding Team Lead
Houston, TX
Rice-Treutel
present
Houston, TX
Medical Coding Team Lead
present
  • Recommends new approaches, policies, and procedures to influence continuous improvements in department’s efficiency and services performed
  • Performs duties and job functions in accordance with the policies and procedures established for the department
  • Assist Medical Coding Manager in training new employees
  • Assists in evaluation of reports, decisions, and results of department in relation to established goals
  • Reports to work, meetings and professional obligations on time. Good attendance is paramount to the success of this position and the department
  • Works in conjunction with the Reimbursement and A/R Claims Follow Up staff to answer all inquiries regarding coding and billing for physicians’ services
  • Contacts physicians through management regarding procedures and other services billed to ensure proper coding
Education Education
Bachelor’s Degree in Coding
Bachelor’s Degree in Coding
The University of Alabama
Bachelor’s Degree in Coding
Skills Skills
  • Knowledge of Health Information Portability and Accountability Act (HIPAA)
  • Good customer service skills and the ability to demonstrate professionalism and compassion
  • Analytical skills and the ability to be detail oriented
  • Good communication skills and the ability to communicate effectively verbally and in writing accurate information
  • Problem solving skills and the ability to apply analytical skills
  • Organizational skills and the ability to plan work based on priorities
  • Multitasking skills and the ability to manage more than one patient simultaneously
  • Time management skills and the ability to plan and prioritize task
  • General office skills and the ability to function comfortably in a high pace office setting
  • Interpersonal skills and the ability to interface with physicians, patients, and coworkers effectively
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14 Medical Coding resume templates

1

Medical Coding Team Leader, Continucare Resume Examples & Samples

  • Certified Medical Coder with an active CPC certification and high degree of competency
  • Strong experience in ICD-9 and CPT coding
  • Prior Management or Supervisory experience
  • Prior coding experience in a medical office environment
  • Must be able to travel to various offices in the Tampa Bay market regularly
  • This role is considered to be in a patient facing environment and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
  • Prior leadership experience in a health care/managed care environment
  • MRA and HEDIS knowledge
2

Medical Coding & Education Trainer Resume Examples & Samples

  • Minimum of 3 years certified coding experience or college degree in lieu of experience
  • Team building skills
  • One to three years of coding experience and ICD-9 knowledge
  • ICD-10 proficient
  • Knowledge of Medicare Risk Adjustment
3

Medical Coding Education Specialist Resume Examples & Samples

  • 3+ years coding experience required
  • Associates or Bachelors degree
  • CPC
  • MRA background
  • Working knowlege of Webex
4

Certified Medical Coding Front Line Leader Resume Examples & Samples

  • Execute MRA initiatives within the local market
  • Coordinate and deploy MRA training policies/objectives to the local team
  • Plan and direct MRA training techniques and suggests enhancements to existing training programs
  • Medicare Risk Adjustment, Documentation and Medicare Advantage experience
  • Experience partnering with senior leadership
  • Ability to travel throughout designated georgraphicarea 2-3 days weekly with occasional overnight travel
  • Bachelor's degree strongly preferred
5

Medical Coding Liaison Resume Examples & Samples

  • Will provide direction and give guidance on coding best practices
  • Responsible for identify the impact diagnosis coding has on risk adjustment models
  • Evaluate the element of the medical record for diagnosis code selection
  • CPC (Certified Professional Coder) Certification required
  • Effective Communication and Professionalism
  • Self- Management, Responsibility and Accountability
  • Problem Solving & Team building skills
  • Proficient in the use of Microsoft Office
  • ICD-10 knowledge
  • Experience in a provider setting
6

Medical Coding & Documentation Educator Resume Examples & Samples

  • CPC Certification from AAPC
  • Must be willing to obtain CPC-I if you do not have this certification
  • Ability to travel up to 75% of the time (primarily within the region, however, there may be occasional overnight travel)
  • Experience teaching, training providers is strongly preferred
  • CPC-I
  • CPMA (Certified Professional Medical Auditor)
7

Medical Coding / Billing Faculty Resume Examples & Samples

  • Minimum of a Master's Degree in Healthcare Administration or MBA with Healthcare Emphasis and Medical Billing and Coding experience required
  • Zero to two years experience in instruction or formalized education process, preferably in a post-secondary or college institution
  • Excellent verbal and written communication skills including the ability to build successful relationships with student populations
  • Demonstrated time management and detail-oriented skills
  • Computer based skills (i.e., software, analytical, and report writing skills )
  • Ability to work effectively under pressure and to meet frequently occurring deadlines
  • Ability to develop a professional rapport with diverse school/campus constituents
8

Medical Coding Liaison Resume Examples & Samples

  • This position can be located in Kansas city or Tulsa, OK
  • At least 1 year experience with in a provider setting
  • Must have 3+ years of coding experience
9

Associate Director, Medical Coding Duhs Resume Examples & Samples

  • Extensive Knowledge of ICD-9-CM and CPT coding principles and guidelines
  • Extensive knowledge of hospital/technical and professional services reimbursement systems (DRGs, APCs, RBRVUs)
  • Extensive knowledge of federal, state, and payer specific regulations and policies pertaining to documentation, coding and billing for professional and technical services
  • Strong managerial, leadership and interpersonal skills
10

M HIS NLP Medical Coding Expert Resume Examples & Samples

  • You will participate in large scale agile teams using Scrum to organize their work, and coordinate your teams’ work with other groups
  • Apply your knowledge of medical coding systems to help build systems that code automatically
  • Communicate with product owners, scrum masters, subject matter experts, and developers
  • Test changes against data, validate improvements to the products, and support the release of changes to customers
  • High School education or higher from an accredited learning institution
  • Minimum of one (1) of the following Coding Certifications: AHIMA, AAPC, RHIA, RHIT, CCS, CCS-P OR CPC
  • Minimum of two or more (2+) years of Medical Coding experience
  • Working knowledge of ICD-10, CPT, and SNOMED-CT
  • Experience with revenue cycle applications
  • Experience with automated medical coding products
  • Comfortable working with knowledge resources: lexicon/ontology understanding, editing of vocabularies
  • Excellent analytical skills, being able to detect patterns and predict behavior for coding rules in medical documentation
  • Comfortable working with technical editing resources, XML/CSV editing, regular expressions, etc
  • A commitment to team oriented approaches and consensus building
11

L&I Medical Coding Compliance Auditor Resume Examples & Samples

  • Objectively review medical documentation for appropriate procedural coding
  • Understand and apply various healthcare coding structures (including both CPT® and HCPCS Level II)
  • Understand general medical terminology
  • Interpret and apply laws, rules and policies related to the payment of healthcare services
  • Apply critical thinking and analytical skills
  • Effectively and professionally communicate complex information in both oral and written format in a way that is understandable to the audience
  • Build rapport and partner with others
  • Independently analyze and weigh the risks verses benefits in decisions and recommendations related to provider billing and bill audit issues
  • Apply organization and time management skills with minimal supervision
  • Manage multiple projects and assignments at one time
  • Apply negotiation and conflict resolution skills
  • Maintain confidentiality in the performance of this role
  • Effectively use various computer applications (including: internet, Microsoft Word and Excel) to conduct research, create reports and detailed spreadsheets
12

Manager, Professional Services Medical Coding Resume Examples & Samples

  • Develop action plans as necessary to resolve knowledge gaps with employees or to address the implementation of new service offerings or code changes. Provide feedback to physicians through the consultants on work performance to ensure consistency and accuracy with all professional coding. Advise the Region and staff on professional coding and documentation guidelines to ensure regulatory compliance. Provide education to support Medicare Risk requirements and organization goals. Provide staff with training and resources on coding procedures and system workflow/functionality
  • Demonstrate positive human relations skills, utilizing effective leadership, written and oral communication skills. Ensure staff capabilities through established Kaiser Permanente policies and procedures along with prescribed management and personnel practices. Coordinate recruitment, development, appraisal and retention of competent professional coding services staff
  • Monitor efficiency and productivity to ensure compliance to national metrics and departmental performance standards. Provide leadership and staff supervision to accomplish timely and qualitative response to professional services documentation/coding requests, issues, and responsibilities
  • Executes problem identification, data gathering, and implementation of strategy actions that are in the best interest of the department and its mission, values, and philosophy. Provide staff with information about the Program's mission, strategic direction, values and the external environment to increase their effectiveness
  • Determine and assure the proper utilization of human resources necessary for the effective and efficient operation of the department. Develop, administer, and maintain a comprehensive annual budget that reflects department needs and the application of cost-effective management
  • Minimum three (3) years of supervisory work experience in Health Information Management/Medical Records or equivalent experience
  • Minimum two (2) years of combined experience in professional fee coding experience in a multispecialty provider setting including Medicare and business management
  • Minimum one (1) year of experience conducting coaching/training of coding staff
  • Minimum four (4) years of supervisory work experience in Health Information Management/Medical Records
  • Minimum four (4) years of professional fee coding experience in a multispecialty provider setting coding including Medicare
  • Minimum two (2) years of experience coaching/training of coding staff
  • Experience with data systems and reporting for health record coding, abstracting, and performance metrics
  • Strong communication skills, ability to deal tactually and assertively with physicians and nursing staff
  • Bachelor's degree in health care administration or health information management
  • Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA)
  • Excellent command of the ICD-9-CM and CPT-4 classification systems with thorough understanding of the effect of data quality on prospective payment, utilization, and reimbursement
  • Knowledge of Medicare Risk Adjusted coding and reimbursement methodologies
  • Thorough knowledge of state, federal, and TJC licensing and accrediting requirements/standards related to documentation for coding purposes
13

Manager Medical Coding Resume Examples & Samples

  • Perform medical coding activities from CRF review of codable pages to system coding approval and final sign off of a Clinical Study and manages the synonym-lists to ensure accuracy and consistency of the coded data
  • Manage and review coding listings using MedDRA and WHODD or any other company dictionary
  • Performs approval of terms, oversees coding query and coding listings for review to study directors
  • Manage requests for grouping of terms for Adverse Events of Interest or Medications of Interest and Interacts with Clinical Safety Data Review team in review of the AESI data
  • Provide Coding guidance to medical coders in first pass coding, and to project data managers in reconciliation of adverse event between clinical and pharmacovigilance database
  • Manages Oncology coding convention, dictionary upversioning and and synonym list
  • Coordinates with Data Operations in Study Start up of coding in clinical database and Coding set –up in Coding Environment. Identify and coordinates technical issues regarding coding
  • Participate in the development and implementation of department standards and documents as needed
14

Director, Medical Coding Services Resume Examples & Samples

  • Leadership - Provides strategic guidance and direction for the provision of coding services by planning and executing short and long term startegic actions throughout the region supporting the Program's mission, goals, policies and procedures. Creates and manages a strong culture that understands and supports the Program's vision and philosophy. Active leader in the Region's revenue cycle processes to meet defined goals and objectives. Maintains comprehensive knowledge of contemporary coding practices and emerging technology (clinical information systems) to ensure that KPNW coding services and infrastructure are progressive and effective. Works closely with other business support departments to coordinate efforts, share best practices and promote consistency in processes. One key area of focus will be in generating the appropriate Risk Adjustment score for the region for Medicare, Medicaid and ACA members
  • Communication - Develops communication strategies and processes for communicating to coding team members as well as senior leadership. Communication needs to include success metrics, project updates, policy changes, system ehancements, etc. Will also need strong communication with national coding leaders for involvement with national initiatives and training
  • Operations - Implements and evaluates organizational structures, policies and personnel management practices to achieve effective leadership and supervision of coding staff for the Region. Ensures the recruitment, training and retention of motivated, competent managers/supervisors. Directs operational activities to improve processes, ensure adequate staffing, with a focus on customer satisfaction. Develops and communicates accountabilities for managers/supervisors and support staff. Provides coaching, counseling, leadership to management to address human resource issues. Meets quality and throughput standards as developed through internal processes. Develops, measures and manages a high performance culture, effectively maintaining a high performing team
  • Quality Management - Establishes, manages and evaluates KPNW coding quality. Required to develop a robust quality management program. Achieves compliance with state and federal laws, regulatory agencies, administrative and medical/legal risk assessments and accepted professional practice standards. Evaluates and plans for advanced technology to enhance the quality of coding. Develop vision and strategy for completeness and accuracy of documentation for accurate code capture of diagnoses, procedures and professional services. Leads the organization through changes to meet new industry or governmental requirements
  • Expense/Budget Control - Organizes, manages, assesses, reports and monitors cost effective coding. Manages area of responsibility within budget authority. Maintains an ongoing process to identify, evaluate and implement cost restructuring activities to meet KPNW mission and goals
  • Internal Controls-Ensures effective internal controls and SOX compliance for coding management functions
  • Partnering with Labor - Activity participate in labor negotiations, compilation of contract interpretation manual, and provide written or oral documentation of dialogue during labor negotiations. This includes sponsorship of Unit Based Teams (UBTs) and facilitation of process improvement (including issue resolution and grievances)
  • Minimum three (3) years plus experience at middle management or director level position within Kaiser Permanente, large hospital system or large Managed Care Organization (MCO)
  • Minimum six (6) years in Coding Management including: compliance, operations, and systems
  • Minimum five (5) years experience at director level position within Kaiser Permanente, large hospital system or large Managed Care Organization (MCO)
  • Minimum ten (10) years in Coding Management including: compliance, operations, and systems
  • Master's degree in Health Care Administration, business or related field OR six (6) years of experience in a directly related field
  • Current/active Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) credential
  • Current working knowledge of KP HealthConnect
  • Comprehensive knowledge of managed health care setting, medical and legal, coding compliance
  • Technical knowledge of professional and hospital (technical) coding disciplines
15

Director Medical Coding Services Resume Examples & Samples

  • Provides direction and oversight while coordinating the efforts of the department’s certified coders in supporting their assigned clinics, specialties, and providers. Maintains consistent communications with each clinic/department Site Manager and CMD to ensure their needs are being met. Performs scheduled and random visits of each clinic at least quarterly to observe each coder’s interactions and relationship with clinic provider’s and staff, and to provide coder’s any clinic-specific assistance that may be needed
  • Presides over the coders weekly team meeting, ensuring that the time is used productively for updating the coders on important, relevant information gathered since the last meeting, sharing best practices they’ve observed, resolving or creating plans to resolve coding issues and initiate accurate and consistent corrective action, ensuring all ongoing assignments (i.e. Etm and Tes edits) are being completed timely and accurately. Identifies and addresses other issues that may be impacting the coders ability to provide their clinics/providers with quality, value-added services
  • Maintains appropriate, consistent communications with operating/other department management, and serves on and/or ensures departmental participation in appropriate committees and work groups to help ensure that compliance/coding considerations are included and that the department is aware of situations and/or changes that may impact its operations
  • Monitors and works closely with Revenue Operations to ensure the integrity, accuracy, and appropriate application of all edits built and operating via the Flowcast Ingenix coding scrubber software. Facilitates determination of the need for new edits, as well as their design and implementation, helping ensure compliance while appropriately maximizing reimbursement
  • Prepares and monitors the department’s Operating & Capital budgets. Addresses variances in a timely manner
  • Mentors and coaches coding staff to help ensure accomplishment of organizational, departmental, and personal goals. Assists coders in enhancing their coding expertise by ensuring they have opportunities for further education and experience
  • Four (4) years of related experience of which two (2) years must have been in a supervisory capacity
  • Ability to communicate effectively; Ability to direct and manage projects and/or programs; Ability to prepare technical reports; Advanced computer skills
16

Medical Coding Instructor Resume Examples & Samples

  • Demonstrate and apply a thorough and accurate knowledge of the teaching field and discipline
  • Organize instruction in ways which maximize student learning. Practice excellence in teaching and instruction
  • Modify instructional methods and strategies to meet diverse students’ needs
  • Encourage the development of communication skills and higher order thinking skills through appropriate assignments
  • Minimum of 7 years of experience in the medical coding field with a strong background in training and/or classroom teaching experience
  • AAPC CPC or CPC-H certification required
  • Expertise in the skills needed to solve insurance billing problems, how to manually file claims (using the CPT and ICD-10 manual), complete common insurance forms, trace delinquent claims (EOB’s) and use generic forms (CMS 1500) to streamline billing procedures
  • Expert knowledge in the following Outpatient coding topics
  • Healthcare Basics
  • Hospital Revenue Cycle
  • The concept of a HER
  • Medical Terminology in relation to ICD-10-CM
  • Anatomy and Physiology in relation to ICD-10-CM
  • Coding Ethics, Medical Necessity, and Ancillary (outpatient) coding
  • ICD-10-CM coding classification and guidelines
  • Encoder Logic, MPI and medical record abstraction
  • Proficiency in medical coding in an ancillary hospital coding role
17

Medical Coding Quality Analyst Resume Examples & Samples

  • Conducts reviews on records that have been identified as suspicious and/or potentially fraudulent, utilizing most current reference materials to include, but not limited to: Current Procedural Terminology (CPT), Internal Classification of Disease (ICD-9/ICD-10) and Healthcare Common Procedure Coding System (HCPCs) guidelines
  • Documents Decisions on reviews through notations and enters notes in appropriate company systems
  • Ability to discuss and present on decisions made to appropriate internal and external individuals/groups
  • Coordinate with team members to understand trends and schemes related to billing issues/coding trends
  • 2+ years of experience in coding and medical billing
  • Associates degree or related field experience
  • Clinical and/or coding expertise in a Physician office, SNF, ALF, Hospital setting, and/or billing/office
  • Strong organizational/time management skills and be able to work independently or as a team
  • Strong knowledge of CMS 1500 and UB04 data elements
  • Strong knowledge of ICD, CPT, HCPC and Revenue Codes
  • Ability to support heavy work load volume and meet unit standards while engaging multiple priorities
  • Current CPC or CCS-P Certification
  • Serves as a resource on moderately complex issues related to coding / billing
18

Medical Coding / QA Manager Resume Examples & Samples

  • Maintain working knowledge and demonstrate understanding of CMS and insurance payor claim filing requirements associated with coding, modifier usage and concurrency compliance
  • Must maintain knowledge, apply and promote compliance to company policies and operating procedures in place for Account Origination, Coding, Charge Entry and Batch Reconciliation
  • Must maintain specific staff productivity measures for account originators, batch reconciliations representatives and coders ensure productivity
  • Must ensure to meet weekly and monthly work flow deadlines in accordance with identified performance goals and measures
  • Must be able to communicate clearly and comfortably with providers (MDs or CRNAs) regarding medical record documentation or concurrency issues that require clarification
  • Must be able to communicate with practice/hospital/facility staff regarding patient insurance and demographic information, electronic demographic needs/issues or patient medical records needs
  • Must be able to communicate effectively with internal and external auditors, provide the documentation required for audit purposes and/or document and modify existing procedural documentation based on the outcome from the audit
  • Calculates and prepares department staff time and attendance records for each payroll period
  • Interacts with company Coding Education and Auditing leaders
  • Responsible for reviewing patient logs and other report of clinical activity to ensure billing is captured for all patients
  • Works in conjunction with the Patient Accounting team to answer all inquiries regarding coding and billing for physician services and assists with resolving coding related payer denials
  • Works in coordination with other members of the Central Business Office as necessary
  • Coaches and assists assigned personnel to maximize productivity and teamwork which includes providing work direction, managing performance, supporting training and development, administering company policies and fostering positive employee relations
  • Adheres to MEDNAX Services, Inc., Department and HR policies and procedures. Advises staff within and outside the department of changes. Supports and promotes adherence of all policies
  • Participates in administrative staff meetings and attends other meetings and seminars. Assists in evaluation of reports, decisions, and results of department in relation to established goals and requirements
  • Serves as a member of the Business Services Team and other project teams
  • Prepare and maintain functional work area operational procedures and training manual standards
  • Prepares monthly productivity reports for areas of responsibility and uses to assist in the preparation of annual employee evaluations and/or with achieving monthly Business Services performance goals
  • Maintains a high level of confidentiality, ethical, and professional standards
  • Certified Professional Coder (CPC or CCS-P) designation required with current active status, clinical background; and a minimum of four years related experience and/or training; or equivalent combination of education and experience
  • Level of educational degree and years of experience in hospital administration and/or multi-specialty physician practice, with full exposure to managing the accounts receivables, physician billing, and CPT-4/ICD-10 coding with medical terminology will identify the appropriate candidate
  • Direct experience with anesthesia, critical care and pain coding preferred. This individual must have a strong working knowledge of medical terminology and anatomy
  • Ability to read, analyze, and interpret common and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to write speeches and articles for publication that conforms to prescribed style and format. Ability to effectively present information to top management, public groups, and/or boards of directors
19

Medical Coding Team Lead Resume Examples & Samples

  • Responsible for leading team and ensuring the success of daily coding workflow and assignments in accordance with weekly and monthly deadlines using FIFO methodology
  • Reviews code check/errors for claims being processed by Clearing House for resubmission
  • Assists with periodic coder and compliance audits, including but not limited to the CBO Quarterly QA Audits
  • Maintains a high level of confidentiality, as well as promotes ethical and professional standards in compliance with Corporate Policies
  • May require overtime or schedule change flexibility to accommodate work flow
  • Performs initial charge coding review to determine appropriate ICD-10 and CPT codes to be used to report physician services to third party payers
  • Monitors and follows up to ensure all services that can be billed are captured and coded for billing accurately and timely in accordance to CBO billing guidelines, deadlines and goals
  • Works in conjunction with the Reimbursement and A/R Claims Follow Up staff to answer all inquiries regarding coding and billing for physicians’ services
  • Assist Accounts Receivable Department staff with coding related payer denials
  • Works in coordination with other members of the Physicians’ Billing Office as necessary
  • Meets and exceeds short and long term goals as established for the department
  • Performs duties and job functions in accordance with the policies and procedures established for the department
  • Is a member of the CBO Front End and Back End Enhancements Task Force as well as actively participates in Coding Committees
  • Assists in evaluation of reports, decisions, and results of department in relation to established goals
  • Takes ownership of special projects, researches data and follows through with detailed action plans
  • Adheres to MEDNAX Services, Inc., Department and HR policies and procedures
  • High school diploma or GED completion is required. Certified Professional Coder (CPC or CCS Certification) with a minimum of two years’ experience with CPT/ICD-10 coding of physician services preferred. Good working knowledge of medical terminology and anatomy required
  • Ability to gather and interpret clinical data
20

Medical Coding Spec Resume Examples & Samples

  • Provide guidance on documentation requirements, queries, and documentation improvement processes
  • Research, analyze, and respond to inquiries regarding compliance, inappropriate coding, denials, and billable services
  • Provide technical support to medical providers, as appropriate, regarding coding compliance documentation, regulatory provisions and third-party payer requirements
  • Evaluate the quality of clinical documentation to identify incomplete or inconsistent documentation that could impact the quality of data being reported
  • Audit codes and professional fee services performed by providers from medical records according to ICD-10, CPT, ASA, and CMS guidelines
  • Maintain up-to-date knowledge of coding such as appropriate documentation, accurate coding, coding trend found during chart reviews, third-party audit findings, and annual coding updates
  • Serve as a resource to the office staff, providers, and billing department
  • Conduct all business in a professional manner maintaining respect for individuals at all times
  • Associate's degree (A.A.) or equivalent from a two-year college or technical school Coding Certification preferred (CPC or AHIMA)
  • Coding Experience Required: 1 – 2 years minimum
  • Ability to adapt, modify and prioritize audit functions as required
  • Ability to ensure the confidentiality and rights of patients, the confidentiality of health system and patient documents required
  • Ability to identify problems, develop course of action and follow through to resolution required
  • Ability to analyze and identify opportunities in documentation improvement
  • Excellent written communication, and analytical skills
21

Review Services Lead-medical Coding Resume Examples & Samples

  • Review the following
  • Certified as a Registered Health Information Technician, Coding Specialists, or Coding Specialists- Physician based
  • At least 3 years’ experience in medical coding
  • Correct use of medical terminology, grammar and punctuation
  • Computer experience
  • Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
  • Experience with Medicare and TriCare DRGs
  • Supervisory/Management Experience
22

Senior Manager Medical Coding Services Resume Examples & Samples

  • Manages the Medical Coding Team on coding, auditing activities and overall education and general support of the coding functions
  • Interprets, provides feedback and acts as the subject matter expert of CMS regulations, documentation guidelines, and HCC reimbursement methodologies
  • Provides management, training. Mentoring and coaching for the coding staff to help ensure accomplishment of organizational and departmental goals. Provides feedback and suggestions to improve coding accuracy and documentation
  • Maintains appropriate, consistent communications with department management, medical staff, and physicians as required to successfully resolve coding issues
  • Works closely with Revenue Operations to ensure the integrity, accuracy, and appropriate application of all edits built and operating via the Flowcast Ingenix coding scrubber software. Facilitates determination of the need for new edits, as well as their design and implementation, helping ensure compliance while appropriately maximizing reimbursement
  • Assists in the preparation and monitors the department’s Operating & Capital budgets. Addresses variances in a timely manner
  • Assists in the development policies, processes, strategies and goals that support the department and the organization’s direction
  • Over 3-5 years and up to and including 5 years of management experience
23

Manager, HCC Medical Coding Resume Examples & Samples

  • Plan, organize, staff, direct, and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority
  • Provide day-to-day managerial oversight for staff responsible for HEDIS, Quality and Coding activities. Ensure continuous improvement of processes and delivery of results within assigned area. Encourage innovation and focus resources, including staff not under direct managerial control, to ensure successful delivery of desired results. Optimize the use of resources in assigned area using proven resource management techniques
  • Contribute to the department’s strategic planning efforts by identifying both strategic and tactical opportunities for improvement and recommending solutions, especially directed at HEDIS, Quality and Medical Coding/Medical Record Documentation projects related to Revenue Program Management and overseeing the development and implementation of educational opportunities related to HEDIS, Quality, Medical Record Coding, and medical record documentation to appropriate departments and network provider office sites
  • Oversee development and execution of processes that will support the capture of complete and accurate diagnosis coding. Oversee Revenue Program Management medical record reviews to ensure medical coding and medical record documentation is complete and accurate. Oversee the development and implementation of QA standards for all medical coders
  • Oversee the processes to conduct annual audits, identify gaps, repeating issues and communicate results in provider office sites with data analysis from office site and/or medical record reviews to (a) continually improve the care, service to members and patient satisfaction; (b) coordination with the credentialing and quality improvement programs to achieve and maintain accreditation, and (c) ensure medical records meet regulatory requirements. Consults with providers as needed to ensure identified gaps, or chart deficiency trends are outlined, communicated, discussed and provider staff trained on correct procedures
  • Participate in initiatives requiring cross-functional, matrix relationships. These initiatives may involve staff in different departments or business units within the organization, or vendors and/or strategic business partners
  • Assess the impact of potential or actual regulatory changes impacting the assigned area. Ensure ongoing compliance in all activities within the assigned area
  • Oversee the development and manage process improvement initiatives to include detailed data analysis, process analysis, report generation and documentation
  • Bachelor's Degree in a health-related field or 6 years of experience as a registered nurse with managerial, process improvement, healthcare insurance and/or medical coding experience
  • 5-7 years of HCC Coding experience
  • 3-5 years of Coding experience with a ICD-10 Coding Certification (CPC, CCS, or RHIA)
  • 3-5 years of experience working with government markets and working within all Compliance and Coding Guidelines
  • 3-5 years of leading and/or supervising employees
  • 1-3 years of prior project management experience
  • ICD-10 Coding Certification
  • Excellent verbal communication skills and professional manner, excellent written communication skills and a familiarity with a variety of writing styles. Must be able to communicate with medical administrators, including Medical Directors and Physician Advisors related to problem identification, action plan implementation, ongoing monitoring and problem resolution
  • Demonstrated computer literacy and knowledge of information systems and comparative data bases. Working knowledge of Microsoft Office software (Word, Excel, Access, PowerPoint, etc.)
  • Well-developed, analytical and problem solving skills with the ability to understand and interpret clinical data
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Medical Coding Technician Resume Examples & Samples

  • Responsible for identifying, compiling, abstracting patient date, and coding patient data using the current standard classification systems
  • Reviewing patient records for completeness and accuracy to insure that the overall management of patient health information is of the highest quality and maintained in accordance with HIPAA, HITECH, and other regulatory standards
  • Abstracts clinical information from documents in a patient record and assigns appropriate ICD-10 codes according to established procedures, when necessary queries physicians for documentation clarification, utilizes coding databases and confirms DRG assignments
  • Assists H.I.M. Director in department functions as needed
  • AHIMA Certification preferred (CCS, RHIT, or RHIA)
  • Three years minimum coding experience
  • Minimum of five years' experience in Health Information Management
  • Knowledge of psychiatric and medical terminology
  • Coding and auditing skills
  • Good communication skills, computer skills helpful, ability to work with others as a team
  • Basic experience with office equipment (telephone, copy machine, fax, etc.)
  • Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization
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Analyst Medical Coding Resume Examples & Samples

  • Develops preventive measures in response to patterns identified through analysis of claims denial data and HCC reviews; prepares periodic reports for the HCC findings, trends and clinical staff identifying corrective measures necessary to resolve denial problems
  • Advises and instructs providers regarding billing and documentation policies, procedures, and regulations; interacts with provider staff regarding conflicting, ambiguous or non-specific medical documentation, obtaining clarification of same; and educates providers regarding changes and measuring compliance
  • Compiles and reports HCC statistical data
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Field Based Medical Coding Quality Consultant Resume Examples & Samples

  • Developing comprehensive, provider-specific plans to increase their RAF performance
  • Collaborating with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment education efforts
  • Conducts physician chart audits (including research and presentation). Assesses and interprets whether the coding assigned by the provider was properly assigned based upon review of the medical documentation and application of the coding guidelines
  • Identify potential suspects through clinical documentation where diagnosis is clinically indicated but not documented, discuss findings with providers for validation
  • Able to field any questions or concerns and provide solutions that will mirror management’s guidelines
  • Implement education, and provide formal training to Client providers and staff as needed regarding coding compliance, documentation guidelines, HCC education and Medicare/Medicaid regulations by proactively providing solutions to meet the needs of the Client provider
  • Utilize management for escalation purposes
  • Available to assist other team members in coding, HCC opportunities and act as a resource to less experienced staff
  • Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10 CM knowledge
  • Reports to/works with the Associate Director of Clinical Quality & Coding
  • Provide feedback and present solutions, to the Associate Director of Clinical Coding and Quality, regarding trends or patterns noticed in provider coding
  • Finalizing documentation and providing feedback to team members based on findings
  • Must have completed coding certification course, AAPC/AHIMA, or other accredited certifying body, or completed college courses with degree in coding or currently enrolled in program for CPC, COC, CRC, CIMC, CFPC, CPMA, CCS, CCA, CDIP, or RHIT
  • Must have experience auditing charts and consulting with providers on improving documentation and coding
  • Complete Understanding of ICD - 10 - CM coding classification and guidelines
  • Must have Computer skills (i.e. MS Office)
  • Must be task oriented and able to meet designated deadlines, productivity standards and able to work independently
  • Must reside within a commutable distance (50 miles or 50 minutes) of Los Angeles, San Diego or Orange County areas
  • Previous consulting or sales experience
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Supervisor, Physician Medical Coding Resume Examples & Samples

  • Oversees the daily operations of the Physician Coding Department as directed by the Coding Manager
  • Monitors coding operations for compliance with established policies, regulations, procedures and standards
  • Supervises staff actions as related to coding, communication with practices and resolution of claim edits, denials, procedures and standards as related to Physician Coding
  • Assists management with the administration of education and training necessary, evaluating the effectiveness of the education plan or performance improvement plans, providing feedback to Coding Manager
  • Work collaboratively with Coding Manager and Practice Management staff to assess the strengths of practitioners and staff involved in the coding process and make recommendations for improvements
  • Serve as a resource to physician practices and staff for ongoing educational needs related to coding. Respond to practitioners and management questions regarding coding and reimbursement, researching as necessary to find answers and make recommendations
  • Assist in the development, implement and evaluate educational programs for Coding applications and processes
  • Provides input to Coding Management for employee evaluations
  • Maintains current working knowledge of all coding and reimbursement rules, regulations, trends and new developments. Responsible for providing knowledge to staff as related
  • Makes sound judgments; strong organizational, independent, problem solving and analytical skills
  • Performs other job related duties and assignments as requested
  • Associate or Bachelor degree in business, healthcare, or related field preferred
  • Minimum of three to five years' experience in Physician Coding, including experience in auditing and/or management
  • Requires CPC certification with the AAPC or Certified Coding Specialist- Physician-based (CCS-P) with AHIMA
  • Specialty in E&M (CEMC), Certified Evaluation and Management Coder through the AAPC, or CPMA, Certified Professional Medical Auditor through the AAPC preferred
  • Requires comprehensive understanding of Evaluation and Management Coding
  • Requires comprehensive understanding of ICD-10 coding
  • Ability to communicate effectively with a wide variety of individuals, both verbally and in writing
  • Demonstrated ability to assist in creating training materials and deliver training in area of expertise
  • Experience with software applications as they apply to the computerized patient record and billing system (ECW, Patient Keeper, Soarian Financials preferred)
  • Knowledge and expertise in the following areas: physician billing requirements, CPT/ICD-10 coding schemes and physician reimbursement methodologies
  • Demonstrated ability to create training materials and deliver training in area of expertise
  • Demonstrated ability to create strong working relations with physicians
  • Proficient PC skills; proficient use of Microsoft Excel, PowerPoint and Word desired
  • Capable of working independently as well as in a team environment
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Instructor Medical Coding Resume Examples & Samples

  • Present facilitative, well prepared, organized, and clear lectures and classroom activities consistent with the course syllabus (AAPC curriculum, medical terminology, anatomy & physiology, advanced medical coding, HCPCS coding, ICD-10 coding) and school policies
  • Continually promote students’ development and effective use of skills in areas such as critical and analytical thinking, evaluation, communication, professionalism, customer service, computation, problem solving, and decision-making
  • Provide the student with timely information and feedback on his/her academic progress relative to quizzes, tests, homework and projects
  • Maintain accurate, up-to-date records of student academic and attendance performance
  • Possess a thorough knowledge and understanding of all school policies, and actively participate in their implementation and enforcement
  • Follow all retention policies of the school to ensure students are in attendance
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Medical Coding Spec Senior Resume Examples & Samples

  • Review inpatient records and interpret documentation to identify all diagnoses and procedures; applying knowledge of medical terminology, disease processes and pharmacology. Assigns proper ICD-9-CM/ICD-10-CM and CPT diagnosis and procedure codes in accordance with Official Coding Guidelines
  • Code charts consistently according to the national gold standard utilizing 3M CRS grouper for proper Medicare Severity Diagnosis Related Group (MS-DRG) assignment
  • Apply appropriate discharge status disposition codes in a compliant manner and in accordance with established HIM guidelines and CMS mandates
  • Enter diagnoses and procedures 3M CRS grouper, analyze groupings, and observe for appropriate and optimal assignment of MS-DRGs and POAs for reimbursement
  • Contact the physician and/or clinical staff when necessary to gain additional information or clarify documentation discrepancies
  • Maintain the inpatient Discharged Not Final Billed (DNFB) report on a regular basis; ensure accounts do not go unresolved past payer specific billing guidelines
  • Assess the adequacy of medical record documentation to ensure it supports all reportable diagnoses and procedures; identify clinical documentation improvement opportunities and seek clarification when appropriate
  • Communicate daily to appropriate persons regarding any issues or concerns pertaining to coding, abstracting, or billing
  • Notify the appropriate manager if a medical chart is not available with forty-eight hours of discharge
  • Assist in the development, review, and assessment of departmental goals and objectives
  • Maintain an up-to-date knowledge and understanding of current trends and widely accepted practices related to Health Information Management; pursue professional growth and development opportunities
  • May lead the day-to-day activities of the assigned team. Provide leadership and direction to members of the department, performing those responsibilities in accordance with the Hospital's policies and applicable laws. May provide input during interviews, on hiring, planning, assigning or directing work, and assessing performance
  • Four (4) years of medical coding experience
  • Knowledge of medical terminology and hospital medicine
  • Time management skills and the ability to plan and prioritize task
  • General office skills and the ability to function comfortably in a high pace office setting
  • Interpersonal skills and the ability to interface with physicians, patients, and coworkers effectively
  • Analytical skills and the ability to be detail oriented
  • Good communication skills and the ability to communicate effectively verbally and in writing accurate information
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Senior Medical Coding & Quality Specialist Resume Examples & Samples

  • Maintains departmental tracking logs/databases. Collaborates on various projects where coding expertise is required
  • Risk Adjustment
  • HCC coding
  • Inpatient coding
  • Prior experience developing Quality Improvement programs
  • Prior experience developing and administering educational programs with 2 years work experience directly applying codes in a health plan, hospital or physician's office
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Medical Coding & Quality Specialist Resume Examples & Samples

  • Interprets and assigns ICD-10-CM, ICD-10 PCS, CPT and HCPCS codes at the most precise level. Assigns and files medical policy/benefits system edits
  • Supports corporate audits where medical coding expertise is needed
  • Registered Nurse, or Licensed Practical Nurse with equivalent combination of experience, or Bachelors degree in health related field, or Registered Health Information Management Administrator (RHIA), or Registered Health Information Record Technician (RHIT) or Certified Coding Specialist (CCS) by the American Health Information Management Association with equivalent education, or Certified Professional Coder (CPC) with equivalent education
  • Minimum of 3 years experience in field and 3 years clinical coding experience using ICD (International Classification of Diseases and Procedures) and CPT (American Medical Association Current Procedural Terminology)coding systems
  • Demonstrated proficiency in ICD and CPT coding
  • Ability to read and interpret regulations and specifications
  • Intermediate proficiency with Microsoft Office Suite of products. Ability to learn/use DB2
  • Proficient in web-site research for coding changes
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Medical Coding Quality Consultant Resume Examples & Samples

  • Targeting local providers who would benefit from our Medical Risk Adjustment training
  • Reaching out to physicians, medical groups, IPAs and hospitals, and building positive, consultative relationships
  • Educating providers on how to improve their Risk Adjustment Factor (RAF) scores, which measure their patients' health status
  • Developing comprehensive, provider - specific plans to increase their RAF performance
  • Training providers on our Risk Adjustment methods and tools, and working toward their compliance with our programs
  • Rely upon independent judgment and decision making while at a provider site, whether conducting an audit or providing training/education, both from historical and/or real time data
  • Implement education, and provide formal training to Client providers and staff as needed regarding coding compliance, documentation guidelines, HCC education and Medicare / Medicaid regulations by proactively providing solutions to meet the needs of the Client provider
  • Enhance professional growth and development through in-service meetings, and educational programs
  • Work independently and rely on professional discretion and judgment; as well as a professional representation of Client/Optum
  • Maintain strictest confidentiality based on HIPPA privacy policy
  • Schedule audits and provide patient lists to practice managers to promote a smooth audit process
  • Performs related work and projects as required
  • Must possess a CCS, CPC or COC certification or will have it completed within next 90 days of employment
  • 3+ years of medical coding experience (after obtaining certification)
  • HCC coding experience
  • Must have working knowledge of billing systems to understand how to identify potential black holes in claims submissions that might be causing lower risk adjustment scores to be reported inaccurately
  • Must have an excellent understanding of medical terminology, disease process and anatomy and physiology
  • Ability to travel locally to provider practices, will be out in field 75% with rare overnight stay required
  • Must reside within a commutable distance (50 miles or 50 minutes) of Los Angeles County
  • Bilingual in Spanish, Vietnamese, Korean, and / or Farsi / Persian
  • Knowledge of Risk Adjustment HCCs
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Medical Coding Assurance Specialist Resume Examples & Samples

  • 5+ years of experience in a health care setting
  • Experience with MARS and Cerner
  • Knowledge of ICD-9 and 10, CPT classifications, and coding of diagnoses and procedures
  • Knowledge of medical terminology, human anatomy or physiology, pharmacology, and pathology
  • Graduate of a Health Record Administration or Accredited Medical Record Technician program, including RHIA, RHIT, or equivalent coding program
  • Ability to problem solve and communicate with staff and other health care professionals in a professional manner
  • Possession of excellent detail and organizational skills
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Medical Coding Program Compliance Analyst Resume Examples & Samples

  • 5+ years of experience with financial management, information systems, health information management, or medical coding
  • Knowledge of ICD10 transition and CPT coding and modifiers
  • Ability to interact directly with client
  • BA or BS degree in Health Administration or Business Administration
  • Risk Management or Healthcare Compliance Certification preferred
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Adjunct Medical Coding / Insurance Instructor Resume Examples & Samples

  • Minimum of Associates Degree in Medical Billing, Medical Coding, or related field, OR CMA (Certified Medical Assistant)/RMA (Registered Medical Assistant), OR credentialed as a CCA (Certified Coding Associate)
  • Must have three years work experience within the last five years in the area of Medical Coding/Billing/Insurance
  • Previous teaching experience in the postsecondary Health Science environment strongly preferred
  • Must be knowledgeable in course content, as evidenced by education/or experience, effective in directing and evaluating student learning and laboratory performance, and be prepared in educationaltheory and techniques
  • Must possess valid driver’s license and required insurability
  • Must possess skill in oral and written communication
  • Must possess basic computer skills including, but not limited to, Word; Excel; PowerPoint, and Outlook/email
  • Experience in the use of the Banner a plus
  • Must possess excellent organizational and customer service skills to deal professionally with Savannah Tech employees, students, and visitors
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Medical Coding Quality Assurance Associate Director Resume Examples & Samples

  • Manage a team of auditors that are contracted and full time employees remotely and onsite
  • Assign QA products to auditors
  • Ensure coders and auditors are meeting quality standards
  • Ensure coders and auditors are meeting production standards set by the department
  • Assist with vendor and client audits
  • Ensure the auditors and coding staff are adhering to the coding policies set forth by the department
  • Develop and perform ongoing coding training for coders and auditors
  • Quality reporting, analysis and audits and for developing plans and programs to support continuous quality improvement using applicable tools
  • Assist with management training programs for current and new hire coding and quality assurance staff
  • Generate monthly productivity, quality, and resource usage statistics; configured data and distribution files daily to promote right staffing
  • Develop coding policies, procedures, and best demonstrated practices as part of a collaborative continuing quality improvement task force
  • High School Diploma / GED or equivalent experience
  • 7 or more years of ICD-9 / ICD-10 Coding experience
  • 5 or more years of experience in Medicare Risk Adjustment Coding
  • Intermediate (or higher) MS Office (Word, Excel & Outlook) proficiency
  • 7 or more years of experience with Coding certification (CPC or CCS or RHIT or RHIA)
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Medical Coding / Audit Supp Specialist Resume Examples & Samples

  • Coordinate and process medical record requests while maintaining strict adherence to Policies and Procedures and Corporate Compliance Program Guidelines
  • Process medical record requests flagged for coding review for all Anesthsia and Pain Mgmt. related facilities
  • Assemble all Anesthesia and Pain Mgmt related documentation for coding audits and special request projects
  • Conducts follow-up on outstanding medical record requests
  • Maintains audit workflow spreadsheet
  • Updates and maintains audit workflow and outcome in an Excel spreadsheet
  • Ensures accurate data input received from the Coding Auditors
  • Utilizes Excel and Word to complete numerous logs, spreadsheets, and data entry assignments
  • Communicates audit status frequently with the Coding Manager to ensure adherence to the audit timeline and schedules
  • Working with the Coding Manager prepares quarterly reports from the audit outcome worksheet. Reports are distributed to Senior Management and Corporate Officers
  • Develops and creates Excel worksheets for special projects and audit reviews
  • Assists the Coding Compliance Auditors and the Coding Manager with creating PowerPoint presentations
  • Performs a variety of other Audit Support duties
  • Consistently meets deadline dates and times on assigned projects
  • Works overtime in mandatory situations
  • Assists Department Administrative Assistant when needed with the scheduling and organization of audit related tasks
  • Maintain strict confidentiality in accordance with HIPAA regulations and Company policy
  • Performs other job-related duties within the job scope as requested by Management of Coding
  • Embodies the principles of the corporate Mission Statement and Philosophy at all times. Represents the corporation in a positive fashion and makes all individuals feel as comfortable as possible
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Medical Coding & Education Specialist Resume Examples & Samples

  • Reviews medical records for appropriate coding levels and reimbursement
  • Direct coding staff with education, chart reviews and works with Medical Records staff on random audits to assure coding accuracy
  • Design and run training sessions on a regular or as needed basis
  • Administer coding resources for all coding staff and physicians
  • Develop efficient coding processes for coding staff and physicians
  • Offer input to the Physician Billing Department on policies and procedures as they relate to coding and documentation
  • Maintain regular contact and clear communication with the physicians. Maintain current coding library for MHS clinics
  • Update encounter forms with new and deleted codes
  • Maintain CPC certification
  • Required to work weekends, holidays and reasonable amounts of overtime if necessary
  • Maintain patient confidentiality
  • Attend all mandatory in-service and department meetings
  • Maintain a professional appearance and encourage behavior appropriate for a healthcare setting
  • Actively participate in organization committees
  • Consistently demonstrate a self-directed, mature, disciplined and tactful approach to completing work duties
  • Keep updated on applicable regulations, laws and new procedures
39

Medical Coding Resume Examples & Samples

  • The purpose of this position is to assign ICD-10-CM diagnosis codes for Central Lab outpatient claims in order to ensure a valid data base to be used for research, reporting, quality improvement activities, management of days not final billed (DNFB) and appropriate reimbursement
  • Codes ancillary encounters utilizing ICD-10-CM diagnosis codes according to the official coding guidelines as published in Coding Clinic for ICD-10-CM
  • Abstracts data elements for ancillary encounters as required by the facility
  • Coordinates with Ancillary Departments relative to medical necessity issues
  • Utilizes official coding guidelines and resources as required including Coding Clinic for ICD-10-CM, Faye Brown Coding Handbook, UHDDS guidelines for sequencing, pharmacology reference, medical dictionary, CMS directives and bulletins, and Fiscal intermediary communications
  • Reports inaccuracies found in coding software to HIM coding supervisor, reports any potential unethical and/or fraudulent activity per compliance policy, adheres to all HIM coding and compliance policies, and reports inaccuracy or inconsistencies in coding practices to the HIM coding supervisor
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40

Senior Clinical Document Spclst Medical Coding Resume Examples & Samples

  • Communicates with physicians, case managers, coders and other healthcare team members to facilitate comprehensive medical record documentation to reflect clinical treatment, decisions, and diagnoses for inpatients
  • Utilizes the hospital’s designated clinical documentation system to identify opportunities for physician and hospital outcomes
  • Provides or coordinates education to all internal customers related to compliance, coding, and clinical documentation issues and acts as a consultant to coders when additional information or documentation is needed to assign the correct DRG
  • Responsible for the day-to-day evaluation of documentation by the medical staff and healthcare team in accordance with the hospital’s designated clinical documentation system
  • Gathers and analyze information pertinent to documentation findings and outcomes
  • Identifies patterns, trends variance and opportunity to improve documentation review and process
  • Contributes to a positive working environment and performs other duties as assigned or directed to enhance the overall efforts of the organization
  • Responsible for monitoring appropriate applications and creating reports relevant to the current clinical documentation workflow
  • Monitors productivity, query response rates, query rates and any other applicable performance metrics for the Clinical Documentation Improvement team
  • Daily and weekly reviews for Clinical Documentation Improvement Specialist queries and Retrospective Coding queries for appropriateness and feedback
  • Participation in the Coding and Clinical Documentation Oversight Committee
  • Performs retrospective reviews of medical record documentation to determine opportunities for improvement and education with Clinical Documentation Specialists, Coders and/or patient care teams. Acts as a resource to the Clinical Document Specialists and aids in training new staff (??)
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Medical Coding Quality Analyst Resume Examples & Samples

  • Conducts reviews on records that have been identified as suspicious and / or potentially fraudulent, utilizing most current reference materials to include, but not limited to: Current Procedural Terminology (CPT), Internal Classification of Disease (ICD - 9/ICD - 10) and Healthcare Common Procedure Coding System (HCPCs) guidelines
  • Ability to discuss and present on decisions made to appropriate internal and external individuals / groups
  • Coordinate with team members to understand trends and schemes related to billing issues / coding trends
  • Clinical and / or coding expertise in a Physician office, SNF, ALF, Hospital setting, and / or billing / office
  • Strong organizational / time management skills and be able to work independently or as a team
  • Current CPC or CCS - P Certification