Carol Dautrich
Springfield,MA
Summary
With over two decades at OptumInsight I have excelled in medical coding, particularly in the area of Diagnostic Radiology. I have showcased top-tier accuracy and productivity. My expertise in ICD-10 and CPT proficiency and dedication to continuous learning have significantly enhanced reimbursement rates and compliance. As a mentor to junior coders in the past, my attention to detail and interpersonal communication skills have fostered a collaborative and efficient workplace.
Overview
21
21
years of professional experience
Work History
Medical Coder II
OptumInsight
06.2004 - 02.2025
- Coded and billed medical claims for Optum for over twenty years. Top performer in accuracy and productivity.
- Audited claim denials through meticulous review and correction of automated claims/ reports. Interpreted physicians’ diagnostic reports to accurately indicate patient eligibility and coverage benefits prior to claim submission.
- Worked closely with audit teams to accurately assign ICD-10 diagnostic codes for optimal reimbursement rates from insurance companies.
- Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Collaborated with other billing professionals during team meetings to exchange best practices and strategies for overcoming common challenges in the industry.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Enhanced compliance with industry regulations by staying up-to-date on changes to medical billing and coding guidelines.
- Pursued extensive continuing education opportunities, consistently exceeding CEU requirements, staying abreast on advancements in medical billing and coding, thereby elevating the overall quality of work.
- Trained and mentored junior coders to support growth and development applying high-quality coding practices.
- Utilized electronic medical record (EMR) systems to store, retrieve and process patient data.
- Verified accuracy of patient information in medical records.
- Researched and resolved medical record discrepancies.
- Consistently utilized classification manuals to gain additional knowledge of disease and diagnostic processes.
Education
Certificate of Technical Studies - Medical Billing And Coding
Springfield Technical Community College
Springfield, MA05-2004
Bachelor Of Science, Magna Cum Laude - Community Health
Springfield College
Springfield, MA05-1999
Skills
- HIPAA compliance
- ICD-10-CM proficiency
- CPT proficiency
- Medical billing procedures
- Anatomy and physiology
- Medical terminology
- Medical claims coding
- Coding error resolution
- Proficiency in software
- Regulatory agency guidelines
- Attention to detail
- Precision and accuracy
- Outstanding work ethic
- E-filing system organization
- AAPC CPC as of 09/2009
- Interpersonal communication
Affiliations
- American Academy of Professional Coders
- Holyoke Chapter MA, Worchestor Chapter MA
- Served as Holyoke Chapter Secretary and Education Officer, 2010-2012
Timeline
Medical Coder II
OptumInsight
06.2004 - 02.2025
Certificate of Technical Studies - Medical Billing And Coding
Springfield Technical Community College
Bachelor Of Science, Magna Cum Laude - Community Health
Springfield College
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