CHERRIE GUINTO Macapinlac
Senior Coding Quality Analyst
Orange,CA
Summary
To obtain a challenging position as a Medical Coding Lead, utilizing my 15+ years of experience in medical coding, leadership, and revenue cycle management to contribute to the success of the organization. SUMMARY: Highly skilled and experienced Medical Coding Lead with a proven track record of success in managing and leading medical coding team. Possessing extensive knowledge of medical coding guidelines, revenue cycle management, and healthcare regulations. Adept at developing and implementing coding policies and procedures, ensuring compliance with regulatory requirements, and optimizing revenue cycle processes. Demonstrated ability to lead and motivate teams to achieve goals and objectives.
Overview
27
27
years of professional experience
1
1
year of post-secondary education
2
2
Certifications
Work History
Senior Coding Quality Assurance Analyst
Optum/Multispecialty
10.2022 - 02.2023
- Conducted regular coding audits to ensure compliance with regulatory requirements and coding guidelines
- Reviewed medical records to ensure that the code assigns are accurate and supported by documentation
- Provided feedback to coders and physicians on areas where improvement is needed
- Stay up-to-date on coding guidelines
Physician Educator/Coder
Saint Joseph Heritage
Anaheim, Ca.
06.2014 - 01.2016
- Reviews and analyzes patient records according to current compliance policies and providers documents are compliant
- Documents results of all coding audits and suggestions for coding and documentation improvement
- Presents the findings to Coding Service Director, providers and other internal departments
- Reports and applications supporting HCC/Risk Adjustment program
Coder/Contractor
University of Arkansas
, Arkansas
11.2013 - 05.2014
- Coding the facility side for Gastroenterology, Renal/Liver transplant and Internal Med.
Coding Compliance Auditor
Kaiser Permanente
Downey, CA
10.2012 - 04.2014
- Coding and Auditing documentation before billing Medicare for Home Health Billing Department.
Coder
Permanente
Anaheim, CA
02.2011 - 09.2012
- Review Medical Records to identify diagnoses/procedures
- Under supervision, codes all diagnostic and operative information from the medical record using ICD-9-CM, CPT and HCPCS coding classification systems
- Verifies and abstracts all professional services medical data from the record to assign appropriate codes for the following settings: Inpatient Hospital (IP), Hospital Emergency (ED), Hospital Observation (HOBS), Hospital Ambulatory (HAS), Hospital Outpatient (HOV) and Medial Office
- Corrects data as appropriate
- Took a leave for personal reasons from 4
Coding Coach
Trippler Medical Center
Honolulu, HI
01.2011 - 07.2011
Coder
Dermatology
01.2010 - 04.2010
- (Contract ended)
- OP
Supervisor
- 01.2010
- Supervised the daily work of a team of medical coders to ensure accurate and timely coding of medical records
- Monitored coding productivity to ensure that all work is completed in a timely an accurate manner
- Developed and implemented coding policies and procedures to improve coding accuracy and efficiency
- Created custom coding rules and coding logic through Waystar (Claim Scrubbing) to avoid coding denials and improve revenue cycle management where Waystar’s coding validation engine automatically checks each claim for coding errors and flags any potential issues before submission
- This helps to ensure that claims are accurate and compliant with payer requirements
- Collaborated with healthcare providers and billing staff to resolve coding-related issues and ensure timely and accurate reimbursement
- Trained and mentored new coders on coding guidelines, regulations, and software systems
- Performed periodic audits of coding accuracy and provide feedback and coaching to coders as needed
- Educated and Trained providers on how to utilize available tools to improve their knowledge and coding skills while staying within the guidelines
- Maintained up to date knowledge of the current changes of coding practices by continuing education and reading resource material
- Providers clinical documentation improvement
Coder and Auditor, Coder
Alpharetta, GA
10.2009 - 01.2010
- Outcomes Health Information Solution – Contracted through end client, ended)
- Coding OP /
Coding Coach
A&T, Brooke Army Medical Center
Houston, TX
11.2007 - 09.2009
- Provided Brooke Army Medical Center with a uniform methodology for processing workload, evaluating medical record coding and documentation, provided feedback and training based on medical record evaluation to:
- Quantify the extent of over and under coding
- Identified areas of weakness to use as basis for data quality improvement and focused education and training
- Established uniform and consistent reporting mechanisms for internal and external coding audits
- Supported the importance of accurate, complete and consistent coding practices for the production of quality healthcare data
- Used skills and knowledge of current coding and documentation requirements to provide education and training through Power Point Presentation and monthly Newsletter to any staff documenting or coding on the medical record
Coder
University of California Irvine – FTE
Orange, CA
06.2006 - 11.2007
- Patient Record Abstractor111
Patient Record Abstractor 111
UCI Medical Center
Orange
05.1996 - 06.2006
- (Moved)
- Performed ICD-9 and CPT coding for various billing specialties in the department of Physicians Billing Group
- Such duties include but are not limited to abstracting, identifying and correcting the correct CPT and ICD-9 codes from various encounter forms and/or medical reports (Scrubber), prior to sending the billing claims out to insurance for reimbursement
- Analyzed and evaluated findings, diagnosis and procedure codes identified by physicians
- I exercised a sound professional coding judgment consistent with government and private payer requirements to ensure all codes/ modifiers are appropriate and assure maximum reimbursement
- Responsible for assisting other staff with CPT and ICD-9 coding issues hindering expedient collections processes in addition to clientele 'physicians
- Such responsibilities include but are not limited to confirming modifier coding, use sound professional coding judgment in establishing priority sequencing of diagnosis codes and services to assure maximum allowable reimbursement, consistent with but not limited to University Compliance Regulations, HCFA, Medicare, Commercial Insurance Carriers and all other related entities
- Reviewed chart documentation to support ICD-9 and CPT codes, and takes appropriate action if documentation does not support, by coding appropriately
- Maintained accurate and up to date logs of error/problematic coding trends that negatively impact the collections in the department.
- Obtained necessary signatures on information release forms to obtain medical and treatment records from other service providers.
- Maintained patient confidence by keeping patient records information confidential.
Education
Delano High School
01.1986 - 05.1987
Skills
Experience in auditing medical records for accuracy and compliance with regulatory requirementsundefined
Certification
Certified Professional Coder (CPC)–AAPC
Timeline
Senior Coding Quality Assurance Analyst
Optum/Multispecialty
10.2022 - 02.2023
Physician Educator/Coder
Saint Joseph Heritage
06.2014 - 01.2016
Coder/Contractor
University of Arkansas
11.2013 - 05.2014
Coding Compliance Auditor
Kaiser Permanente
10.2012 - 04.2014
Coder
Permanente
02.2011 - 09.2012
Coding Coach
Trippler Medical Center
01.2011 - 07.2011
Coder
Dermatology
01.2010 - 04.2010
Coder and Auditor, Coder
10.2009 - 01.2010
Coding Coach
A&T, Brooke Army Medical Center
11.2007 - 09.2009
Coder
University of California Irvine – FTE
06.2006 - 11.2007
Patient Record Abstractor 111
UCI Medical Center
05.1996 - 06.2006
Delano High School
01.1986 - 05.1987
Supervisor
- 01.2010
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