Anabel Filpo

Perform a variety of multiple tasks;

• Perform prospective review before a patient's appointment to identify potential unreported diagnoses to ensure accurate capture of relevant conditions.
• Perform retrospective reviews to validate all diagnoses and procedures coded on each encounter to ensure proper billing and accurate documentation.
• Evaluate internal and external audit findings to identify trends or patterns, leading to more targeted training and coding education sessions with PCPs, coders, and office staff regularly to ensure staff are up-to-date on industry best practices, coding guidelines, and regulatory changes.
• Contribute to ongoing process improvements within the department by identifying inefficiencies or inconsistencies in current workflows and suggesting practical solutions.
• Hold educational sessions for department staff one-on-one and in groups.
• Reduced claim denials by identifying and addressing common errors in the coding process.
• Contribute to quality improvement initiatives by identifying areas for potential enhancement within the medical coding department.
• Serve as a liaison between coders, physicians, and other clinical staff to ensure accurate information exchange related to diagnosis codes and treatment plans.
• Assist in developing internal coding policies, promoting consistency across the organization.
• Establish strong relationships with insurance companies and third parties, facilitating smoother processes.
• Monitor changes in coding regulations to provide recommendations for compliance.
• Follow up with medical staff regarding missing information in patient records.
• Generate and maintain statistical data related to office improvement.

• Performed ongoing pre-chart review to identify potential diagnoses that map Risk Adjustment models (HCC) based on supporting supporting documentation.
• Helped providers to improve overall compliance by conducting regular coding audits and providing recommendations for improvement.
• Led training/education sessions on medical coding guidelines, contributing to a knowledgeable workforce capable of upholding compliance standards.
• Validated HCC diagnoses codes following Medicare RADV audit guidelines, payor guidelines and Coding guidelines.
• Prepared detailed reports outlining audit findings; communicated results to stakeholders promptly for prompt resolution of issues identified during audits.
• Established strong working relationships with physicians and other healthcare professionals to facilitate open communication regarding best documentation practices.
• Contributed to cost savings by identifying areas of potential overbilling or underbilling in medical claims processing and provide support as necessary.
• Trained new employees on accounting principles and company procedures.
• Managed Multiple offices and projects.

• Conducted chart review to identify unreported and/or unresolved medical conditions that map risk adjustment models based on supportive medical documentation.
• Performed data quality reviews on outpatient encounters to ensure ICD-10-CM codes are accurately assigned and
  supported by clinical documentation in accordance with all established CMS regulation and coding guidelines.
• Forwarded compliant documentation and coding queries to providers when necessary.
• Responsible for accurate codes assignment ICD10-CM, CPT, HCPCS, and modifiers to ensure a clean claim is submitted.
• Contributed to ongoing process improvements within the department by identifying inefficiencies or inconsistencies in current workflows and suggesting practical solutions.
• Ensured compliance with CMS regulations and guidelines by staying up-to-date on industry standards and best practices.
• Supported the onboarding of new team members by providing mentorship and guidance as they learned the intricacies of risk adjustment coding.
• Provided ongoing physicians and office staff education on HCC coding, HEDIS measures and documentation requirements.
• Analyzed trends based analytical data provided by payor and identify the areas of improvement, and providing targeted training.

• Audited, reviewed and reported all denials related to coding assigning and indicating reason for coding denials.
• Reviewed/scrubbed claims prior to submitting to the insurance carriers for coding accuracy.
• Evaluated aging reports to identify members to be included in monthly outbound collection calls.
• Reviewed full history of past due accounts and contacted client or attorney regarding collection, implementation of payment plan.
• Submitted insurance claims to the clearinghouse, governmental insurance and commercial payer electronically
  or CMS-1500 paper form.
• Posted insurance and patient's payments.
• Supported call center for billing issues when necessary.