Julissa Rodriguez
Moreno Valley,CA
Summary
Seasoned Senior Medical Coder with comprehensive background in healthcare coding and billing systems. Skilled at reviewing and analyzing patient records, ensuring accuracy of diagnostic codes, and maintaining compliance with federal regulations. Demonstrated strengths include problem-solving capabilities, advanced knowledge of medical terminology, and ability to streamline process for improved efficiency.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Senior Medical Coder
Optum, UnitedHealth Group
Moreno Valley, CA
07.2016 - Current
- Analyzed clinical documentation to determine the most accurate HCC code assignment.
- Identified any potential risk areas or areas needing further review by physician or other staff members.
- Verified that all necessary information is accurately documented in the patient's record prior to assigning a code.
- Assigned HCC diagnosis codes based on provider documentation while adhering to established coding guidelines and conventions.
- Resolved discrepancies between diagnoses as stated by providers and those identified through medical record reviews.
- Collaborated with physicians, nurses, and other health care professionals to ensure proper coding of services provided to patients.
- Maintained current working knowledge of CPT and ICD-10-CM coding principles, government regulation, protocols and third-party billing requirements.
- Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
- Maintained updated knowledge of coding requirements, which included continuing education and certification renewal.
- Maintained high accuracy rate on daily production of completed reviews.
- Assigned additional HCC diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
- Verified proper coding, sequencing of diagnoses, and accuracy of procedures.
- Analyzed patient charts and records to extract relevant coding information.
- Maintained positive working relationship with fellow staff and management.
Medical Coding and Billing Specialist
American Medical Response, AMR
Torrance, CA
10.2009 - 09.2015
- Verified patient information, including medical history and insurance coverage via web, phone, and IVR, if necessary, to ensure accuracy of coding and billing.
- Conducted audits of medical records to identify missing or incorrect documentation that could affect accurate coding and billing.
- Submitted claims electronically to insurance companies in accordance with regulations.
- Assign appropriate ICD-9, CPT, HCPCS, and Modifiers using supporting documents from Patient Care Reports and/or Computer Aided Dispatch (CAD) notes while maintaining quality and productivity.
- Obtained prior authorizations to further process and submit a claim.
- Maintained up-to-date knowledge of healthcare reimbursement policies, regulations, and industry trends.
- Coordinated with other departments on projects to ensure timely completion of tasks related to prior authorizations.
- Ensured that all patient statements were sent out in a timely manner with current balance information included.
Medical Biller, Accounts Receivable
JB Medical Billing Inc.
Temecula, CA
02.2008 - 08.2009
- Responsible for assigning ICD-9, CPT, and modifiers to claims based on patient charts and billing to appropriate carrier or facility.
- Add insurance payments to verify payments are paid according to fee schedules
- Resolving issues with NSF, bankruptcy, and returned mail.
- Follow up with third-party insurance carriers on unpaid claims and resubmitting or appealing for proper payment.
- Maintained a low Aging Report.
- Post payments of all third-party remittance vouchers/EOBs and send invoices to patients, if necessary.
- Correct any errors of overpayments and adjust accordingly.
- Maintained records of all billing activities in a timely manner.
- Performed data entry functions for entering new patient information into the system.
- Processed credit card payments and other forms of payment received from patients or insurance companies.
Education
Medical Billing And Coding Diploma - Medical Billing And Coding
Everest College
Ontario, OR09-2007
High School Diploma -
Rancho Verde High School
Moreno Valley, CA06-2003
Skills
- Medical terminology proficiency
- Medical billing experience
- Revenue Cycle Management
- Medicare and Medicaid regulations
- Strong attention to detail
- Anatomy and physiology understanding
- Medical coding and abstracting
- Clinical Documentation
- Healthcare claim coding
- HCC coding
- Coding Error Resolution
- Data Entry
- Data Verification
- HIPAA Compliance
- Knowledgeable in EPIC Systems
- Medical claims coding
- Workflow Management
- Medicare insurance regulations
- Effective communication abilities
- Decision-making capabilities
- Organizational abilities
Certification
- Certified Risk Adjustment Coder (CRC)
- Certified Outpatient Coder (COC)
- Both Certifications through Americal Academy of Professional Coders (AAPC)
Languages
Spanish
Full Professional
Timeline
Senior Medical Coder
Optum, UnitedHealth Group
07.2016 - Current
Medical Coding and Billing Specialist
American Medical Response, AMR
10.2009 - 09.2015
Medical Biller, Accounts Receivable
JB Medical Billing Inc.
02.2008 - 08.2009
Medical Billing And Coding Diploma - Medical Billing And Coding
Everest College
High School Diploma -
Rancho Verde High School