Esmeralda McNeil
San Antonio,USA
Summary
Dynamic medical professional and Certified Professional Coder with over 10 years of experience in healthcare, specializing in accurate coding and billing processes. Proven track record in medical record auditing, insurance claims analysis, and compliance with regulations, achieving a quality accuracy of 98%. Skilled in CPT coding, revenue cycle management, and patient care coordination. Ready to leverage expertise to enhance coding education and empower students as a tutor, ensuring they excel in the medical billing field.
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Pediatric Home Health RN, Pediatric Private Duty Nursing
San Antonio, USA
12.2024 - Current
- Delivered compassionate nursing care to medically fragile children in home settings.
- Identified health issues during home care visits and coordinated with the patient's physician to determine optimal resolutions.
- Communicated effectively with patients and family members, providing detailed information regarding care and medications.
- Monitored patients' progress through thorough reporting and documentation at each visit.
- Administered direct patient care, stabilized patients, and assessed subsequent steps in treatment.
RN - MSPCU-7, HCA - Methodist Hospital
San Antonio, USA
11.2023 - 12.2024
- Employed the nursing process, critical thinking skills, scientific judgment, technical skills, and leadership to deliver safe nursing care to patients independently.
- Evaluated patient condition during admission and each shift, documenting and reporting any changes in patient status.
- Executed procedures or functions as ordered by the medical provider with precision.
- Documented the administration of care in the patient medical record promptly and thoroughly.
- Administered prescribed medications and monitored patient responses effectively.
- Maintained comprehensive knowledge of medications, procedures, and equipment used in the care of post-ICU and medical-surgical patients.
- Collaborated with physicians to swiftly assess patients and provide appropriate treatment while managing rapidly changing conditions.
Travel LVN- LTC, Fusion Medical Staffing
Santa Fe, USA
02.2023 - 11.2023
- Directed Nurse Aides on appropriate care practices for residents.
- Administered medications to residents accurately and in accordance with physician's orders.
- Implemented resident care plans in compliance with company and federal guidelines, alongside physician directives.
- Accurately transcribed physician orders and ensured timely documentation of residents' charts.
- Conducted nursing assessments as required and participated in shift reports.
- Maintained a safe working environment, adhering to infection control and body mechanics procedures.
- Performed routine evaluations of each patient's status, needs, and preferences.
- Administered controlled substances, inserted IVs, and performed catheterizations as necessary.
- Collected lab specimens, ordered tests, and interpreted results for patient diagnosis.
Medical Coder, Optysuite
Remote, USA
10.2018 - 11.2023
- Reviewed patient charts to thoroughly understand health histories, diagnoses, and treatments.
- Utilized electronic medical record systems for efficient storage, retrieval, and processing of patient data.
- Accurately coded and billed medical claims for a variety of hospitals and nursing facilities.
- Applied official coding conventions and guidelines from the American Medical Association and Centers for Medicare and Medicaid Services to assign appropriate diagnostic codes.
- Analyzed outpatient records and interpreted documentation to identify accurate diagnoses and procedures.
Travel LVN - LTC, Fusion Medical Staffing
Kalispell, USA
10.2022 - 01.2023
- Assessed, planned, and implemented resident care in the memory care unit effectively.
- Evaluated the need for lab tests and ordered or obtained appropriate samples for analysis.
- Managed chronic patient care in the memory care unit, adeptly handling all aspects of treatment for 15-30 patients per shift, including medication administration, wound care, and monitoring.
- Served as charge nurse on a long-term care unit, overseeing an average of 15-30 patients per shift.
Triage LVN - Refugee Resettlement Operations, Garda world Federal
Fort Bliss, USA
04.2021 - 10.2022
- Worked with unaccompanied children (UC), gathering health information for diagnosis and documenting symptoms and medical history in Spanish for translation to English for providers.
- Assessed UC needs and provided appropriate care as required.
- Identified changes in UC's symptoms and intervened effectively in emergencies.
- Participated in pain management protocols for UCs.
- Administered medications and vaccines following age-appropriate guidelines.
- Monitored vital signs such as temperature, pulse, respiration, and blood pressure while maintaining accurate records.
- Documented complete patient information to address problems and expected outcomes clearly.
- Assisted with feeding and monitored intake to help patients achieve nutritional goals.
- Obtained case histories and gathered triage information to inform care pathways.
- Scheduled non-emergency appointments for patients needing examinations and consulted directly with providers.
- Performed routine evaluations of each patient's status, needs, and preferences.
LVN - Covid-19 Vaccinator - LTC Facilities in Texas, Angel Healthcare Staffing
San Antonio, USA
09.2020 - 04.2021
- Delivered bedside care, including medication administration and vital sign monitoring (temperature, pulse, respiration, and blood pressure), as well as accu-checks and urinary catheter care.
- Reported any abnormalities to the charge RN promptly.
- Administered medications accurately and in a timely manner.
LVN - Covid-19 EMD Louisiana and Texas, BCFS HHS
San Antonio, USA
02.2020 - 09.2020
- Provided bedside care, monitoring patient vital signs (including temperature, pulse, respiration, and blood pressure).
- Promptly reported any abnormalities to the charge RN.
- Administered medications accurately and in a timely fashion.
- Obtained vital signs and input/output measurements from inpatients and conducted close monitoring of respiration, blood pressure, and blood glucose levels.
- Collaborated with an interdisciplinary team of healthcare and social service providers to address patient needs through effective interventions and care planning.
- Documented patient information meticulously to address problems and ensure expected outcomes were met.
LVN - Charge Nurse, Oak Park Nursing & Rehabilitation
San Antonio, USA
01.2019 - 02.2020
- Gathered case histories and triage information to determine appropriate avenues for patient care.
- Performed clinic duties, including instructing patients in general and specific medical care as well as administering medications and injections.
- Prepared and administered injections and/or enemas safely.
- Coordinated patient treatment protocols using Schmitt-Thompson and Barton-Schmitt protocols along with institution-specific guidelines to construct comprehensive care plans.
- Collected samples and monitored catheter conditions effectively.
- Monitored compliance and evaluated the effectiveness of home treatment instructions.
- Provided wound care as necessary.
- Reviewed and updated compliance with Texas and federal patient treatment policies to optimize care while adhering to standards.
- Coached staff members as necessary to improve performance.
LVN, Pediatric Private Duty Nursing, Inc
San Antonio, USA
03.2018 - 01.2020
- Provided specialized care to children with diagnoses such as Cerebral Palsy, Prematurity, Autism, Developmental Delay, Down Syndrome, Fragile X, and Fetal Alcohol Syndrome.
- Delivered in-home nursing services that included wound care, ventilator and tracheostomy care, G-Tube feeding and care, respiratory treatments, IV therapy, and hygiene assistance.
- Followed rehabilitation and treatment plans to accelerate patient recovery, minimize pain and risk of infection, and optimize patient outcomes.
- Monitored, assessed, and documented patient progress, symptoms, and vital signs during each visit.
- Educated clients and their families on safe treatment practices for injuries, illnesses, and conditions.
HCC Coder, Optum-UHG
Cincinnati, USA
08.2015 - 09.2019
- Reviewed medical records to evaluate their accuracy and completeness concerning patient risk adjustment scores.
- Analyzed medication lists to verify correlating conditions and treatment efficacy.
- Audited documentation to confirm that all assessed conditions and screenings were accurately reported.
- Identified appropriate ICD-10 code assignments for outpatient physician and facility services provided in office settings.
- Abstracted additional data elements during the chart review process as needed during coding.
- Performed medical record reviews, abstraction, and data entry for HEDIS, HQPAF, and Clinical Chart Reviews related to Quality and Performance Improvement programs.
- Achieved daily production goals while maintaining a quality requirement of 98% accuracy.
Senior HIM Consultant (Coding Auditor), United Audit Systems, Inc.
Cincinnati, USA
10.2013 - 04.2016
- Audited records/accounts to ensure compliance with code assignments, utilizing ICD-9-CM and CPT-4 for outpatient settings.
- Identified education needs related to potential coding quality risks and communicated these with the education department for action plan formulation.
- Reported on the accuracy of coded and abstracted data elements as part of quality assurance efforts.
- Documented noncompliance issues detected through auditing and monitoring processes.
- Utilized both internal and external resources to clarify coding policies, guidelines, and 'gray areas,' while conforming to client and facility-specific coding policies.
- Communicated findings to coding supervisors and project managers in a timely manner.
HCC Coder, ArroHealth (MedSave USA)
Remote, USA
12.2014 - 12.2015
- Reviewed, analyzed, and coded diagnostic information within patient medical records, adhering to client-specific guidelines.
- Assigned unique ICD-9 codes that map to HCC/RxHCC according to specified criteria.
- Ensured compliance with established ICD-9, CM coding guidelines, and third-party reimbursement policies alongside accreditation standards.
Medical Coder, Aviacode
Remote, USA
09.2009 - 01.2014
- Responsible for accurately coding inpatient physician evaluations, management services (E&M), bedside minor procedures, and renal dialysis services for Temple University Hospital.
- Handled the entry of charges using the IDX system along with coding responsibilities.
Coding Auditor, Scio Health Analytics (National Audit)
Remote, USA
08.2011 - 05.2013
- Performed in-house audits at various healthcare facilities, including hospitals, clinics, urgent care centers, and private offices for multi-specialty providers as a travel consultant.
- Remotely identified work files to audit through query processes and evaluated current procedures for efficiency.
- Conducted extensive reviews of accounts to ensure correct payments were made effectively.
- Accurately repriced complex claims using multiple client claims systems and documented audit findings efficiently.
- Identified control gaps in processes and procedures through thorough research, suggesting improvement methods.
- Executed all audit phases and entered data into accounting software for comprehensive analysis, managing auditing projects from start to finish.
Billing Coder, Geisinger Community Medical Center
Scranton, USA
05.2011 - 11.2012
- Reviewed patient medical records to assign appropriate levels for E/M services, minor procedures, modifiers, and diagnoses across multiple specialties utilizing EMR.
- Utilized professional judgment regarding medical terminology, disease processes, and pharmacology for the assignment of numeric codes based on applicable coding systems.
- Applied the International Classification of Disease (9th Revision) Clinical Modification (ICD-9-CM), Current Procedural Terminology (CPT), the Health Care Financing Administration Common Procedure Coding System (HCPCS), and recognized standards for accurate code assignment.
Coding Supervisor/Coding Educator, Pocono Medical Center
East Stroudsburg, USA
04.2003 - 11.2011
- Acted as the liaison for department staff, payers, and physicians to facilitate effective communication.
- Conducted weekly accounts receivable staff meetings to inform the team of current billing issues and discuss trends in billing.
- Maintained up-to-date knowledge on medical compliance and reimbursement policies to ensure team alignment.
- Performed coding and audits for various types of surgical interventions and inpatient/outpatient services within the facility's Ob/Gyn and orthopedic provider groups.
- Participated in seminars and continuing education activities to enhance knowledge pertinent to coding and billing practices.
Education
RN -
Excelsior University
Albany, USALVN - undefined
Galen School of Nursing
San Antonio, USAAS - undefined
Northwest Vista College
San Antonio, USAHS - undefined
John Dewey HS
Brooklyn, USASkills
- Revenue cycle management
- Insurance claims analysis
- Coding error resolution
- Records management
- CPT coding
- Medicare insurance regulations
- Medical coding and abstracting
- HIPAA compliance
- Coding appeals
- Patient care plans
- Compliance procedures
- Interpersonal and written communication
- Clinical documentation improvement
Certification
- CPC- Certified Professional Coder
LANGUAGES
Spanish
Timeline
Pediatric Home Health RN, Pediatric Private Duty Nursing
12.2024 - Current
RN - MSPCU-7, HCA - Methodist Hospital
11.2023 - 12.2024
Travel LVN- LTC, Fusion Medical Staffing
02.2023 - 11.2023
Travel LVN - LTC, Fusion Medical Staffing
10.2022 - 01.2023
Triage LVN - Refugee Resettlement Operations, Garda world Federal
04.2021 - 10.2022
LVN - Covid-19 Vaccinator - LTC Facilities in Texas, Angel Healthcare Staffing
09.2020 - 04.2021
LVN - Covid-19 EMD Louisiana and Texas, BCFS HHS
02.2020 - 09.2020
LVN - Charge Nurse, Oak Park Nursing & Rehabilitation
01.2019 - 02.2020
Medical Coder, Optysuite
10.2018 - 11.2023
LVN, Pediatric Private Duty Nursing, Inc
03.2018 - 01.2020
HCC Coder, Optum-UHG
08.2015 - 09.2019
HCC Coder, ArroHealth (MedSave USA)
12.2014 - 12.2015
Senior HIM Consultant (Coding Auditor), United Audit Systems, Inc.
10.2013 - 04.2016
Coding Auditor, Scio Health Analytics (National Audit)
08.2011 - 05.2013
Billing Coder, Geisinger Community Medical Center
05.2011 - 11.2012
Medical Coder, Aviacode
09.2009 - 01.2014
Coding Supervisor/Coding Educator, Pocono Medical Center
04.2003 - 11.2011
LVN - undefined
Galen School of Nursing
AS - undefined
Northwest Vista College
HS - undefined
John Dewey HS
RN -
Excelsior University