Doris Quintana Mayes
West Palm Beach,FL
Summary
Knowledgeable certified medical coder with comprehensive expertise in medical coding and compliance. Proven track record in ensuring accurate coding practices, contributing to efficient and effective healthcare operations. Demonstrated proficiency in ICD-10-CM and CPT coding, along with strong analytical and problem-solving abilities. Expert knowledge of HCC coding. Well versed in collaborating with physicians to ensure proper progress note documentation.
Overview
36
36
years of professional experience
1
1
Certification
Work History
Certified Professional Coder
Humana
09.2014 - 12.2023
- Performed accurate coding of patient records according to established guidelines and regulations, utilizing ICD-9-CM, ICD-10, CPT, HCPCS codes.
- Verified diagnosis and procedure codes for accuracy prior to submission of claims for reimbursement.
- Audited patient charts prior to visit with primary care physician searching through entire medical records looking for potential new diagnoses with focus on HCC risk adjustment codes.
- Audited patient charts after visit with primary care physician to insure all conditions were documented and discussed on progress note as per CMS guidelines.
- Assisted the physicians with location of the documents reflecting proof of newly found diagnoses
- Minimized errors by providing ongoing feedback to clinical staff regarding proper documentation practices.
- Attended continuing education courses in order to stay up-to-date on changes in healthcare industry standards and regulations
- Provided feedback to providers regarding proper documentation requirements necessary for correct code assignment
- Managed workload efficiently by prioritizing tasks according to urgency and importance
- Collaborated with medical staff to ensure accurate documentation and appropriate coding practices were followed leading physicians to score 95% or higher in quarterly company audits.
- Utilized advanced computer skills to navigate various software programs, further enhancing the efficiency of coding processes.
- Reduced claim denials by attentively reviewing medical records and addressing discrepancies prior to submission.
- Maintained strict confidentiality by adhering to HIPAA guidelines and ensuring sensitive patient information was protected at all times.
- Contributed to interdisciplinary team meetings, offering valuable insights into optimizing patient care from a coding perspective.
- Managed high-volume workloads effectively by prioritizing tasks according to urgency and importance while maintaining strict attention to detail.
- Provided comprehensive training for junior coders, resulting in increased productivity and skill development.
- Maintained up-to-date knowledge of industry regulations, ensuring compliance with all relevant guidelines and legislation.
- Coordinated with other departments to address any discrepancies or issues arising from billing-related matters promptly and professionally.
- Conducted thorough research on complex cases, applying advanced knowledge of medical terminology, anatomy, physiology, and pharmacology to accurately assign codes as needed.
- Identified opportunities for process improvement, leading to a more efficient workflow within the coding department.
- Supported the implementation of new electronic health record systems, providing expert guidance on coding best practices.
Referral Coordinator
Humana
05.1992 - 09.2014
- Scheduled appointments with specialists on behalf of clients.
- Contributed to practice growth by maintaining positive relationships with both patients and referring providers.
- Provided exceptional customer service, addressing patient concerns and inquiries regarding the referral process.
- Called insurance companies to get precertification and other benefits information on behalf of patients.
- Streamlined referral process by implementing efficient tracking and communication systems.
- Developed and maintained strong working relationship with referral sources to streamline processing.
- Demonstrated strong attention to detail and organizational skills in managing a high volume of referrals while maintaining exceptional levels of patient care.
- Developed comprehensive knowledge of insurance requirements, advocating for patients when necessary to secure approval for needed services.
Medical Assistant
Humana
07.1987 - 05.1992
- Obtained and documented patient medical history, vital signs and current complaints at intake.
- Performed phlebotomy tasks efficiently while ensuring minimal discomfort for patients during blood collection procedures.
- Ensured patient safety and comfort during examinations, effectively addressing concerns and answering questions.
- Built strong relationships with patients through effective communication skills that foster trust in the clinic''s commitment to quality care.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
Education
Associate in Arts (A.A.) - Communication
Palm Beach State College
West Palm Beach, FLMedical Assistant Certificate -
Ross Medical Education Center
West Palm Beach, FLSkills
- ICD-10 proficiency
- HIPAA compliance awareness
- Team collaboration
- Documentation review expertise
- Medical terminology
- Electronic health records navigation
- Continuing education commitment
- Clinical documentation improvement
- CPT coding
- Auditing and quality assurance
- Regulatory guidelines adherence
- Proficiency in Microsoft Office
- Multitasking Abilities
- Excellent communication
Accomplishments
- Achieved 95 to 100% scores on all quarterly medical coder audits.
Certification
- Certified Professional Coder
Affiliations
- AAPC
Languages
Spanish
Native or Bilingual
English
Full Professional
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference
Work Type
Full TimeWork Location
RemoteImportant To Me
Work-life balanceFlexible work hoursHealthcare benefitsPaid sick leavePaid time off401k matchSoftware
Microsoft Works
Timeline
Certified Professional Coder
Humana
09.2014 - 12.2023
Referral Coordinator
Humana
05.1992 - 09.2014
Medical Assistant
Humana
07.1987 - 05.1992
Associate in Arts (A.A.) - Communication
Palm Beach State College
Medical Assistant Certificate -
Ross Medical Education Center
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