Amanda Wagner

• Review medical records for accuracy and completeness
• Monitor provider discrepancy reports and supply guidance and education as needed
• Educating Physicians and APCs in the understanding of documentation, clinical documentation, and AMA Guidelines
• Participate in clinical roundtables with Physician's, APC's, and Residents.
• Creating new SOP Processes in various areas such as Procedures, Diagnostic interpretations, and EKGs.
• Quality performance audits
• Monthly participation in EDPMA meetings
• Creating and presenting education webinars to physicians, APCs, and Residents.

Coordinated with other departments to ensure efficient workflow processes.

• Performed compliance audits for both Profee and Facility coding
• Pre-bill and/or post-bill audits for assigned coding teams,
• Provider education regarding documentation deficiencies
• Worked collaboratively with physicians and APCs to communicate opportunities and educate about documentation guidelines, coding requirements, and service line-specific requirements
• Prepared detailed audits for review by physicians, APC's and coders
• Communicate with coders, compliance specialists, and/or clinical documentation analysts about documentation clarification and accuracy of coding as needed.

• Ensured all codes were current and active in the charge entry database,
• Reported missing and/or incomplete documentation to meet daily coding production goals,
• Updated, and maintained document lists, performed correct charge data entry, reported missing or incomplete documentation and ensured proper coding on provider documentation
• Aid billing department with denial resolutions
• Research coding requirements for new and existing office/ASC Services and procedures
• Educate and train providers and surgeons with the new 2021 Outpatient AMA Guidelines.

• Audited medical charts from reimbursement coders and providers
• Evaluated key administrative, operational, and compliance requirements and informed leadership and the Executive team of audit findings, potential deficiencies, and aids in the development of corrective action plans
• Provider education on areas of deficiencies
• Weekly Coder and Physician education to review deficiencies
• Supply written and oral communication to coders and physicians on audit findings
• Reviewed and educated providers/coders on coding/documentation opportunities
• Abstract medical data from medical records which included Observation and Critical Care from physician documentation and interpreting into CPT/HCPC/ICD-10 codes
• Charge entry of all coding including modifiers and procedures
• Communication with physicians as needed to obtain documentation or clarification of medical records.

• Reviewed medical records for accuracy and completion as required by insurance companies
• Assigned additional diagnosis codes based on specific clinical findings in support of existing diagnosis
• Followed all federal and state guidelines for release of information
• Reviewed accuracy of codes to be entered into billing
• Resolved billing errors
• Responded to physician and client inquiries
• Evaluates medical record documentation and coding to optimize reimbursement by making sure the diagnostic and procedural codes and documentation reflect and support the visit and complies with legal stands and guidelines
• Identifies and corrects potential coding issues and seeks clarification of conflict, ambiguous, or non-specific documentation prior to assigning codes.

• Maintained up to date documentation with all insurance requirements including patient financial responsibilities, fee-for-service and managed care plans
• Communicated with patients of their financial responsibilities prior to service and resolved billing /patient questions
• Posted payment charges and adjustments
• Examined diagnosis coding for accuracy, completeness, and specificity according to services rendered
• Performed quality control audits of the data entry system to verify claims and payments posted correctly
• Performed coder audits to determine if CPT and ICD- 10 codes were applied correctly based upon patient insurance
• Constant communication with Clinicians and Support staff to ensure compliance and billing services are completed correctly, identified trends, and produced solutions to resolve them promptly
• Supplied individual or group educational feedback
• Supervised 15 medical coders daily making sure they all had work assigned and support when needed
• Generated end of month billing reports and data analysis reports to show monthly fluctuations in coder productivity Assigned Evaluation & Management, procedure CPT, HCPC & ICD 9 codes on all medical records to the highest level to assure proper billing and reimbursement
• Obtained insurance referrals and verification of coverage for services rendered
• Maintained up to date knowledge of health care billing laws, rules, and regulations
• Helped other coders to keep up to date with their assignments
• Data entry of all CPT, HCPC & ICD 9 codes.

• Completed & maintained updated patient and insurance demographics
• Verified Insurance eligibility
• Charge Entry of all CPT & ICD 9 codes
• Ensured correct documentation within patient charts
• Verified level of service by cross-referencing patient charts and encounter documentation
• Responsible for encounter forms being submitted with the correct CPT/ICD 9 code for the correct provider and service within timely filing guidelines along with coding processes and procedures
• Researched and resolved claims that were incomplete or unable to be billed
• Answered billing questions
• Established patients with insurance based on financial and state guidelines
• Completed all WC & No-Fault claims, submitted all C4 forms.

• Collection and allocation of payments
• Processed Durable Medical Equipment claims and denials, Billing/collection, and reporting weekly/monthly reports
• Answered inbound customer service calls from patients and providers
• Processed and verified all patient account data and reviewed and posted all 1st and 3rd payments
• Analyzed billing and other records to ensure that all providers credentials and data was accurately entered
• Identified and resolved problems with accounts by working with facility health staff, billing, and insurance companies.

• Reviewed customer claims, identified discrepancies and determined the appropriate course of action.
• Conducted investigations to gather evidence in support of claims resolution.
• Prepared detailed reports on claim status, payment history, and other relevant information.
• Maintained accurate records of all claim activities in accordance with company policies.