Angela Cunningham
Lucasville
Summary
Accurate HIM Coding & Clinical Documentation Educator with over 9 years of experience that performs all aspects of medical billing, including coding, charge entry, transmission, correction and resubmission. Detail-oriented and helpful professional with expertise in resolving billing issues and reviewing claim denials. Also knowledgeable in training and educational processes due to the vast experience in training both outsource coders and the coders within the organization.
Overview
38
38
years of professional experience
1
1
Certification
Work History
HIM Coding & Clinical Documentation Educator
Southern Ohio Medical Center
Portsmouth
04.2019 - Current
- Maintain current working knowledge of CPT and ICD-10 coding principles, government regulations, protocols and third-party billing requirements.
- Complete training and routine audits on staff and outsource coders to guarantee compliance with Medicare, Medicaid, and Commercial payers.
- Train new coding staff. Educate current staff.
- Complete MCC/CC reviews on records to increase the organization's case-mix index and therefore its reimbursement.
- Verifiy and abstract all medical data to assign appropriate codes for hospital inpatient and outpatient records.
- Keep updated on current changes to coding guidelines and LCD/NCD policy updates.
- Maintain updated knowledge of coding requirements, which include continuing education and certification renewal.
- 8 years experience: Process and track denied claims to understand the reason for the denials, review patients health records, insurance policies and payer requirements.
- Write appeal letters for all payers per policy for DRG, RAC, CPT, professional, Intervential Radiology, urology, cardiac rehab, and pharmacy coding and charging denials.
- Monitor denial trends and root causes to provide education to all departments involved for process improvements.
- Collaborate with insurance companies, physicians, department managers, CDI, and coders to provide a proactive approach and provide checklists to be checked off for a clean bill before it goes out to billing.
- Use online portals to process all denial appeals that are required to process through an online portal.
- Mail and fax appeals per insurance policy.
- Track and record and follow up on appeals.
Managing Co-Owner Business
Stylist Two Salon
Lucasville
01.1988 - 12.2024
- Overseen daily operations and finances, while ensuring high customer satisfaction.
- Creating schedules and handling operations like inventory and cleanliness, financial management through budgetting and tracking transactions and customer service, which includes managing appointments, handling complaints, and implementing marketing strategies.
- Managing orders through suppliers.
- Managed and obtained CEU hours for facility.
HIM Coder/Level II
Southern Ohio Medical Center
Portsmouth
11.2017 - 04.2019
- Sought clarification from physicians and other hospital personnel for answers to needed coding interpretations prior to abstracting records.
- Verified and abstracted all medical data to assign appropriate codes for both hospital inpatient and outpatient records.
- Reviewed and abstracted relevant clinical data from electronic medical records to select appropriate codes for procedures.
- Coded medical observations and professional services delivered for each patient.
- Read through patient health data, including histories, physician diagnoses and treatments to gain understanding for coding purposes.
HIM Coder/Level I
Southern Ohio Medical Center
Portsmouth
10.2013 - 11.2017
- Reviewed clinical data from medicall records to assign ICD, CPT, and HCPCS codes.
- Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
- Collaborated with billing team to confirm no additional diagnosis codes available for LCD and NCD coverage.
- Verified and abstracted all medical data to assign appropriate codes for Cancer Center, Recur and Cardiac Lab records.
- Verified final claim submissions by comparing account charges with documentation.
Reimbursement Charge Specialist
Southern Ohio Medical Center
Portsmouth
04.2012 - 10.2013
- Reviewed and assigned codes and modifiers to update and verify accuracy to 96%.
- Input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
- Examined patient's encounters forms and diagnosis codes to validate accuracy, completeness, and specificity.
- Assessed billing statements for correct diagnostic codes and identified problems with coding to maximize revenue for OH Medicaid EAPG.
HIM Clerk II
Southern Ohio Medical Center
Portsmouth
09.2008 - 04.2012
- Advised physicians and nurses to find methods to enhance quality of patient health documents and records.
- Entered patient insurance, demographic and health information into software and confirmed records.
- Logged all requests for medical records.
- Verified record copies before handing each over to check for and remove unnecessary details.
Education
CCS Certification
AHIMA
01-2018
CDI Apprenticeship
AHIMA
01-2020
Basic Coding
AHIMA
High School Diploma -
Shawnee State University
Portsmouth, Ohio, OHSkills
- Knowledgeable in Solventum, HDM, Meditech, CDI Collaborate, Corro Health CDI, Vital Ware, and multiple online Insurance Portals
- Medical record security
- Healthcare claim coding
- Medical terminology
- Critical thinking
- Time management
- Documentation oversight
Certification
CCS (Certified Coding Specialist) AHIMA 2018
Timeline
HIM Coding & Clinical Documentation Educator
Southern Ohio Medical Center
04.2019 - Current
HIM Coder/Level II
Southern Ohio Medical Center
11.2017 - 04.2019
HIM Coder/Level I
Southern Ohio Medical Center
10.2013 - 11.2017
Reimbursement Charge Specialist
Southern Ohio Medical Center
04.2012 - 10.2013
HIM Clerk II
Southern Ohio Medical Center
09.2008 - 04.2012
Managing Co-Owner Business
Stylist Two Salon
01.1988 - 12.2024
CCS Certification
AHIMA
CDI Apprenticeship
AHIMA
Basic Coding
AHIMA
High School Diploma -
Shawnee State University