Julie Zausmer, CPC, CRC
Senior Medical Coder
Scottsdale,AZ
Summary
Results-driven Senior Medical Coder with extensive expertise in medical coding and documentation, recognized for a strong commitment to accuracy and compliance. Proven ability to implement initiatives that enhance billing processes and improve coding accuracy, demonstrating proficiency in ICD-10 and CPT coding systems. Known for analytical skills and a deep understanding of medical terminology, fostering collaboration and adaptability in dynamic environments. Reliability and integrity are hallmarks, complemented by a track record of effectively managing complex coding projects to achieve outstanding results.
Overview
12
12
years of professional experience
2
2
AAPC CPC & CRC
Work History
Senior Medical Coder
United Health Group/Optum
08.2015 - Current
- Analyzed medical records to identify pertinent diagnoses for precise risk adjustment coding. Extracted and submitted diagnosis codes adhering to ICD-10-CM classification standards. Preserved a coding accuracy rate exceeding 95% while consistently meeting daily production targets and deadlines.
- Utilized advanced knowledge of anatomy, physiology, and medical terminology to accurately code intricate medical records. Analyzed coding trends and identified areas for improvement in documentation and coding practices.
- Received training on Risk Adjustment guidelines, including Open Suspect, Chart Review, Targeted Review, IOA, TAMPER Guidelines, MEAT Guidelines, SOAP, DRG-related coding, and Auditing.
- Ensured compliance with all applicable federal and state regulations governing risk adjustment coding.
- Actively acquired skills in effective management, becoming a coder coach and auditor when necessary.
- Mentored junior coders, enhancing team proficiency in coding guidelines and best practices.
- Led coding initiatives to ensure compliance with CMS regulations and improve reimbursement accuracy.
- Analyzed complex medical records to assign accurate codes, improving documentation standards across departments.
Streamlined coding processes, reducing turnaround time and increasing overall operational efficiency. - Conducted audits of coded records to identify discrepancies and promote adherence to best practices.
- Mentored junior coders, providing guidance on complex cases and fostering professional development.
- Increased coding accuracy by diligently reviewing medical documentation and applying appropriate codes.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Conducted regular audits of coded records, identifying areas for improvement and implementing corrective measures.
Identified new methods to optimize medical records management. - Assisted in training new staff on medical record processing and filing procedures.
Researched and resolved medical record discrepancies. - Analyzed medical documentation to ensure accurate coding and compliance with regulatory standards.
Billing Analyst/Auditor
Desert Family Physicians
09.2015 - 10.2017
- Analyzed billing discrepancies to ensure accurate patient invoicing and compliance with insurance policies.
Collaborated with clinical staff to streamline billing processes and enhance operational efficiency. - Implemented automated billing systems, reducing processing time and minimizing errors in claims submissions.
Trained junior analysts on billing software, improving team proficiency and accuracy in handling accounts. - Conducted comprehensive audits of billing processes, identified discrepancies, and implemented corrective actions in the software, improving accuracy by 15%. Analyzed billing data to detect trends, providing insights that streamlined operations and reduced billing errors.
- Collaborated with cross-functional teams to resolve billing inquiries and disputes.
Managed patient inquiries regarding billing issues, resolving concerns promptly to maintain high satisfaction levels.
Conducted audits of billing practices, ensuring adherence to regulatory standards and enhancing overall financial integrity.
Maintained strict confidentiality with all personal data as per company guidelines. - Utilized data analysis techniques to identify trends and patterns in billing data. Monitored key performance indicators (KPIs) to track billing performance and identify areas for improvement. Implemented process improvements to streamline billing operations, resulting in a 10% increase in billing efficiency.
Billing & Coding Specialist
First Medical Plus Family Practice & Chiro Plus
10.2013 - 06.2015
- Processed medical claims using ICD-9/ICD-10, CPT, and HCPCS coding systems, ensuring a high level of accuracy in claim submissions. Analyzed denial trends and implemented corrective actions to reduce claim rejections. Participated in coding audits and quality assurance initiatives.
- Collaborated with medical staff to resolve billing discrepancies, enhancing service delivery and patient satisfaction.
- Improved claim processing efficiency by 228% for family practice and 778% for chiropractic, compared to the previous coder, by ensuring claims were processed, which directly impacted revenue generation. This showcases strong problem-solving abilities with implementing procedures so every paper chart was billed to insurance. Implemented workflow improvements that streamlined billing processes and reduced turnaround times.
- Processed insurance claims accurately, ensuring compliance with billing regulations and guidelines.
- Collaborated with physicians and other healthcare professionals to clarify documentation and coding requirements. Stayed current with coding guidelines, regulations, and payer policies. Conducted training sessions for clinical staff to improve documentation and coding practices. Proactively credentialed and maintained insurance contracts.
- Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
- Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
- Generated monthly billing and posting reports for management review.
- Monitored outstanding invoices and performed collections duties. Facilitated onboarding of new staff by verifying licenses, certifications, and background checks efficiently.
- Managed comprehensive credentialing processes for healthcare providers, ensuring compliance with regulatory standards.
Education
Associate of Science - Medical Billing & Coding
12.2011
- Alpha Beta Kappa Honor Society Member
- summa cum laude graduate
- Ranked in Top 10% of class
- Dean's List : Graduated with Dean's List
- 3.85 GPA
- Acquired a comprehensive understanding of medical terminology and coding systems, thereby enhancing capabilities in healthcare professions.
Bachelor of Arts - Interior Design
05.2009
Possess a strong academic background with a Bachelor of Arts Degree, providing a solid foundation for creative and innovative design solutions.
- Professional Development: Acquired proficiency in customer communication and the ability to discern their design preferences.
- Ranked in Top 25% of class
Skills
- HCC Risk Adjustment coding expertise
- Diagnostic coding accuracy
- Training, Mentor, and Guidance of team Members
- Team Collaboration
- Proficient in Microsoft tools, EncoderPro and clinical EMR software
- Analytical problem-solving
- Proficient in handling multiple tasks
- Commitment to ongoing professional growth
- Clinical documentation improvement
- Compliance quality auditing
- Strong leadership experience
- Strong attention to detail
- Medical billing experience
- Medical record review
Certification
- 2012 CPC - Certified Professional Coder
- 2019 CRC - Certified Risk Adjustment Coder
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Billing Analyst/Auditor - Desert Family Physicians
09.2015 - 10.2017
Senior Medical Coder - United Health Group/Optum
08.2015 - Current
Billing & Coding Specialist - First Medical Plus Family Practice & Chiro Plus
10.2013 - 06.2015
Anthem College Online - Associate of Science, Medical Billing & Coding
The Art Institute of Phoenix - Bachelor of Arts, Interior Design
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Supervised team of 9 staff members.
- Created New Ideas to implement into our software to saving coders minutes on charts by implementing the NPI look up tool being in MRM instead of going to an outside source.
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