Summary
Overview
Work History
Education
Skills
Certification
CODING AND AUDITING BACKGROUND
Timeline
Generic

JAIMY PINHEIRO, CPC

Summary

Results-driven Compliance Auditing Manager with over 12 years of expertise in leading comprehensive compliance programs and conducting internal audits. I have a proven track record in identifying and mitigating risks, enhancing controls, and ensuring adherence to regulatory guidelines. Skilled in data analysis and strategic risk management, with a strong ability to develop high-performing audit teams to achieve compliance goals.

Overview

22
22
years of professional experience
1
1
Certification

Work History

Compliance Auditing Manager

National Spine and Pain Centers
01.2014 - Current
  • Develop and conduct routine and risk-based audits based on payer and state-specific guidelines.
  • Develop Compliance Work Plan
  • Develop and deliver Provider training on coding and documentation practices.
  • Due diligence on new acquisitions and new services
  • Develop and present Compliance auditing efforts to Board Members and Physician Leaders regarding
  • Manage all organizational post-payment audits (CERT, RAC, UPIC, OIG, CIDs, and TPEs)

Sr. Coding Compliance Auditor

National Pain Institute
04.2004 - 03.2012
  • Perform routine audits to ensure CPT, ICD, and HCPCS accuracy and compliance with payor and state guidelines
  • Perform routine training sessions with Physicians, NPPs, and other ancillary staff on proper coding and documentation
  • Collaboration with the Coding Manager and RCM leadership on coding and documentation concerns
  • Worked with the Compliance Officer to develop an Annual Training and Auditing Schedule

Education

Certified Professional Coder - Medical Coding and Advanced Medical Terminology

Allied Business Schools
California
06.2009

Medical Assistant - Medical Terminology

Concorde Career Institute
Florida
11-2001

Skills

    Regulations

  • Knowledge of CMS, Medicaid, and other healthcare compliance guidelines

    • Coding

  • Extensive knowledge of ICD, CPT, and HCPCS coding

    • Auditing

  • Extensive knowledge in developing and performing internal risk-based audits and identifying discrepancies

    • Compliance

  • Knowledge in healthcare billing and coding practices, compliance controls, and developing training programs

    • Software

  • Athena, Modernizing Medicine (EMA), ChartLogic, IMS, Integrity, HealthFusion/NextGen, Centricity, Greenway, eClinicalWorks, HST, MDAudit, HealthStream

    • Communication

  • Excellent written and communication skills

    • Microsoft Office

  • Excel, Word, Outlook, Power Point

Certification

  • CPC - Certified Professional Coder
  • MA - Medical Assistant

CODING AND AUDITING BACKGROUND

· Evaluation and Management Services (E&M)

· Pain Management Minimally Invasive Surgical Procedures (ASC)

· Pain Management Interventional Procedures (In-Office and ASC)

· Durable Medical Equipment (DME)

· Physical Therapy

· Psychotherapy

· Laboratory

Timeline

Compliance Auditing Manager

National Spine and Pain Centers
01.2014 - Current

Sr. Coding Compliance Auditor

National Pain Institute
04.2004 - 03.2012

Certified Professional Coder - Medical Coding and Advanced Medical Terminology

Allied Business Schools

Medical Assistant - Medical Terminology

Concorde Career Institute

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