Danielle Krupp
Bensalem,PA
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. CPC, CBCS, CHERS, & CMAA
Overview
32
32
years of professional experience
Work History
OI PI Clinical Ops - Recovery/Resolution Analyst Sr.
Optum Insight
07.2021 - Current
- Ability to performs quality audits of clinical review cases of CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment
- Manage approximately 30 + cases a day
- Able to determine accuracy of medical coding/billing and payment recommendation for pre-payment claims
- Ability to include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, and consideration of relevant clinical information
- Ability to determine appropriate level of service utilizing Evaluation and Management coding principles
- Able to ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
- Able to identify aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommends providers to be flagged for review
- Able to maintain and manage daily case review assignments, with accountability to quality, utilization, and productivity standards
- Provides clinical support and expertise to the other investigative and analytical areas
- Participates in team and department meetings
- Engages in a collaborative work environment when applicable but is also able to work independently
- Serves as a clinical resource to other areas within the clinical investigative team
- Able to work with applicable business partners to obtain additional information relevant to the clinical review
- Ability to mentor teammates to help them progress in their career.
- Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.
- Validated results and performed quality assurance to assess accuracy of data.
- Present PowerPoint presentations for team meetings.
- Supported successful reimbursement claims by accurately assigning appropriate ICD-10-CM, CPT, and HCPCS codes to medical records.
- Reduced claim denials by accurately coding diagnoses and procedures
- Reduced errors in charge capture by maintaining up-to-date knowledge of Review Guidelines and resources.
- Worked well in a team setting, providing support and guidance.
- Passionate about learning and committed to continual improvement.
CPC
NJ UROLOGY, LLC
01.2017 - 07.2021
- Receive and review patient charts for documentation accuracy
- Ensure all codes are current and active
- Report missing or incomplete documentation
- Meet daily coding production
- Update and maintain document lists
- Perform accurate charge entries
- Resolving issues and resubmitting claims
- Responsibilities Include assigning, verifying, and confirming diagnosis codes, procedure codes, HCPS codes, and modifiers for a urology practice.
- Collaborated with medical coders to ensure proper use of CPT, ICD-10, and HCPCS codes for accurate claim submission and compliance with industry standards.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Spoke with physicians on a daily basis to correct their charts.
- Provided educational training to the Physicians.
- Reviewed out-patient medical documents of diagnosis and procedures and assigned ICD-10, CPT, and HCPCS according to coding guidelines.
- Supported successful reimbursement claims by accurately assigning appropriate ICD-10-CM, CPT, and HCPCS codes to medical records.
- Reduced claim denials by accurately coding diagnoses and procedures using ICD-10, CPT, and HCPCS codes.
- Reduced errors in charge capture by maintaining up-to-date knowledge of CPT, ICD-10, and HCPCS codes.
- Worked well in a team setting, providing support and guidance.
- Passionate about learning and committed to continual improvement.
Deli Manager
A&P Food Store
02.1992 - 01.2015
- Managed 20- 25 employees on a daily basis
- Established standards for personnel performance and customer service
- Scheduled staff hours and assigned duties
- Maintained product inventories and kept inventory records
- Monitored compliance with health regulations regarding food preparation
- Managed daily activities of employees to improve sales performance
- Supervised employees in various duties such as cooking, serving, packaging
- Managed product storage, maintenance and rotation activities to avoid any damages or spoilage
- Assisted in interviewing, hiring and training associates
- Provided training to staff on company policies and sales guidelines
- Interacted politely with clients while solving problems related to sales, dissatisfied service and issues regarding store operation.
Education
CPC/CBCS/CEHRS/CMAA -
NETWORK LEARNING INSTITUTE
MOUNT LAUREL, NJ03.2017
Skills
Medical Coding
Problem Solving
MS Word
Analytical Thinking
MS Excel / PowerPoint
Team Collaboration and Leadership
Documentation And Reporting
Root Cause Analysis
Data Analysis
Qualifications Summary
Strong knowledge base of ICD-10, CPT-4 and HCPCS. Background in Healthcare with the ability to work independently, as well as a team. Excellent time management and attention to details. Knowledgeable in Medical terminology. Experienced in Epic, Greenway, Athena, OPRS, EMR systems. An extensive background in Coding and Electronic Health Records. Proficient in Microsoft Office Suite (Word, Excel, PowerPoint and Outlook). CPC Certified.
Timeline
OI PI Clinical Ops - Recovery/Resolution Analyst Sr.
Optum Insight
07.2021 - Current
CPC
NJ UROLOGY, LLC
01.2017 - 07.2021
Deli Manager
A&P Food Store
02.1992 - 01.2015
CPC/CBCS/CEHRS/CMAA -
NETWORK LEARNING INSTITUTE
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