Alma Salcedo
Burbank,IL
Summary
Certified medical coder with over 15 years of hands-on billing and coding experience. Excellent understanding of medical terminology and strong proficiency in outpatient and inpatient coding. Knowledgeable in the use of ICD-9, ICD-10, CPT-4, and HCPCS books.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Outpatient ED Coder
Ingalls Memorial Hospital-UChicago Medicine
01.2020 - Current
- Thoroughly review patient medical records for the correct narrative description of the applicable diagnoses and procedures
- Accurately convert the narrative diagnoses and procedures into ICD-10-CM, ICD-10-PCS and CPT coding via automated techniques
- Appropriately sequence diagnoses and procedures according to current guidelines
- Accurately assign codes to achieve optimum reimbursement
- Accurately abstract demographic, diagnostic, and procedural information from medical documentation
- Attend all mandatory Departmental and Hospital in-services and meetings
- Seek educational and learning experiences in identified areas of need and review progress through the annual review process
- Maintain knowledge of current medical practices and coding guidelines through review of the coding literature and attendance at continuing education seminars
- Maintain credentialing as appropriate
- Maintain a minimum of 95% accuracy rate for coding and abstracting
Denial & Audit Management Coordinator
Ingalls Memorial Hospital-UChicago Medicine
04.2019 - 12.2019
- Responsible for investigating and resolving third-party insurance denials and claim issues in regards to all medical plans by responding to payors documentation requests from ins carriers
- Analyze medical records to ensure coding is accurate and recommend coding corrections when necessary
- Obtain medical records through EMR, site request or hospital portals for reconsideration purposes
- Effectively utilize ICD, CPT/HCPCS and related material to investigate and ensure that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claim
- Organize work/resources to accomplish objectives and meet deadlines
- Meet productivity requirements to ensure excellent service is provided to customers
- Identify root cause of the denial and address/report the denial issue with the appropriate payor/internal department and supervisor
- Comply with adjustment and appeal or reconsideration in conjunction with each service area’s Coding and Reimbursement guidelines
- Utilize all appropriate systems to effectively research claims and complete steps to submit information necessary to process or appeal denied claims
Senior Risk Adjustment Coding Specialist
Optum Shared Services
06.2015 - 10.2018
- Code and abstract medical records for risk adjustment purposes that map at a unique date of service level
- Code and abstract medical records for risk adjustment purposes utilizing full code capture at a date of service level
- Meticulously identify and rectify inconsistencies, deficiencies, and discrepancies in medical documentation
- Maintain strict patient and physician confidentiality
- Resourcefully use various coding books, procedure manuals, and online encoders
- Conscientiously review medical record information to identify appropriate coding based on CMS HCC categories
- Completed daily production logs
Ambulatory Coder (Temp position)
University of IL Hospital & Health Sciences System
03.2015 - 06.2015
- Reviewed clinical documentation to extract data apply appropriate ICD-9 and CPT-4 codes for billing
- Charge Entry for multiple specialties, Outpatient
- Assisted and handled coding issues
- Resolved error reports associated with the billing process
- Generated and analyzed daily reconciliation reports to capture missing revenue for outpatient services
Coding Specialist
Axa Assistance- BCBS
02.2013 - 03.2015
- Reviewed international clinical documentation to extract data and apply appropriate ICD-9 and CPT-4 codes for billing
- Converted currencies to US as needed
- Charge Entry for multiple specialties including Dental services, Outpatient
- Assisted in translation of Spanish documentation
Reimbursement Specialist
Alivio Medical Center
04.2007 - 02.2013
- Charge entry for multiple specialties, Medical and Dental
- Applied correct CPT and ICD-9 coding for claim submission
- Assisted and handled coding, billing, and reimbursement issues
- Processed patient statements, research and respond to patient inquiries regarding billing issues
- Monitored unpaid claims, resubmitted appeals as necessary
- Private insurance, Medicaid, and Medicare
- Balanced daily batches and reports
- Prepared income reports for six facilities
- Assisted EMR manager in special projects during Electronic Medical Record conversion
Education
Diploma -
Argo Community High School
Summit, IL01.1997
Skills
- Ability to code and maintain corporate quality standards
- Knowledge of medical terminology
- Knowledge of accepted medical abbreviations
- Knowledge of anatomy and physiology
- Knowledge of disease process
- Knowledge of pharmacology
- Adhere to official coding guidelines
- Adhere to HIPPA security standards
- Advanced personal computing skills
- Experience with MS Word
- Experience with MS Excel
- Experience with Cerner Soarian Financials
- Experience with Cerner PowerChart
- Experience with 3M
- Experience with Epic
- Experience with Mediconnect
- Experience with Mag
- Experience with Centricity
- Experience with Lytec
- Experience with Powertrak
- Experience with Ecare
- Experience with EncoderPro
- Experience with Medical Record Manager
- Experience with Gemstone
- Experience with HCC Coder
- Experience with Optum ID
- Experience with Availity
- Experience with Versalus
- Experience with Allscripts
- Experience with SSI Client Portal
- Experience with NaviNet
- Experience with DentaQuest
- Ability to work independently
- Ability to interact positively with a team
- Experience with current healthcare based technology
- Experience with coding
- Experience with EHR
- Effectively write and verbally communicate with physicians and staff
- Experience with Risk Adjustment
- Experience with Hierarchical Condition Category (HCC) coding
Certification
CPC, American Academy of Professional Coders (AAPC), 13
Languages
Spanish
Native or Bilingual
Timeline
Outpatient ED Coder
Ingalls Memorial Hospital-UChicago Medicine
01.2020 - Current
Denial & Audit Management Coordinator
Ingalls Memorial Hospital-UChicago Medicine
04.2019 - 12.2019
Senior Risk Adjustment Coding Specialist
Optum Shared Services
06.2015 - 10.2018
Ambulatory Coder (Temp position)
University of IL Hospital & Health Sciences System
03.2015 - 06.2015
Coding Specialist
Axa Assistance- BCBS
02.2013 - 03.2015
Reimbursement Specialist
Alivio Medical Center
04.2007 - 02.2013
Diploma -
Argo Community High School
CPC, American Academy of Professional Coders (AAPC), 13
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