Managed coding responsibilities for numerous hospital accounts encompassing Inpatient cases
Collaborated with Epic and CDI.
Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural code
Accurately assigned codes using software and official print copy of code book.
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.
Communicated with healthcare personnel, including practitioners to promote accuracy.
Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
Resolved coding discrepancies and denials to maximize reimbursement.
Kept abreast of updates and changes in coding guidelines and reporting requirements.
Entered coded data into electronic health record (EHR) systems.
Analyzed patient charts and records to extract relevant coding information.
Collaborated with healthcare providers to verify necessary documentation for coding accuracy.
Managed coding for multiple specialties, ensuring specific codes are accurately applied.
Participated in coding team meetings to discuss challenges and best practices.
Verified proper coding, sequencing of diagnoses, and accuracy of procedures.
Updated coding skills and knowledge through continuous education and training.
Utilized coding software and tools efficiently to expedite the coding process.
Utilized ICD-10, CPT, and HCPCS coding systems to process claims and billing.
Reviewed clinical data from medical records to assign ICD, CPT, and HCPCS codes.
Hospital Coding & ROI Coordinator
St Margret's Health Peru & Spring
Peru, IL
01.1996 - 07.2024
Managed the daily running of DNFB and DNFC
Oversaw the distribution of coding work to individual team members
Worked closely with billing department on resolving accounts flagged for DX or modifier discrepancies
Implemented strategies to enhance the skills and productivity of new coders resulting in improved Trading Team Contributions (TTCs).
Assisted with coding questions and audited work.
Help set up the new EMR and did PowerPoints for the department on each of their jobs using the new EMR.
Optimized systems for time cards and PTO requests
Increased ROI through effective communication and compliance checks for client requests
Engaged in coding projects when possible and handled ROI responsibilities while on PTO.
Managed day-to-day operations of the department including scheduling tasks and assigning duties.
Resolved customer complaints in a timely manner while upholding company standards.
Maintained calendars of upcoming events, meetings and deadlines.
Created and maintained accurate records of departmental activities, including budgets, personnel documents and project timelines.
Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
Delegated work to staff, setting priorities and goals.
Implemented departmental policies and standards in conjunction with management to streamline internal processes.
Researched and prepared reports required by management or governmental agencies.
Coordinated with other supervisors, combining group efforts to achieve goals.
Guided employees in handling difficult or complex problems.
Reviewed employees' work to check adherence to quality standards and proper procedures.
Discussed job performance problems with employees, identifying causes and issues to find solutions.
Recruited, interviewed and selected employees to fill vacant roles.
Consulted with managers to resolve problems relating to employee performance, office equipment and work schedules.
Developed work schedules according to budgets and workloads, covering priority tasks.
Analyzed financial activities of department to share budgetary input with managers.
Interpreted and explained work procedures and policies to brief staff.
Participated in subordinates' tasks to facilitate productivity or help overcome difficulties.
Recommended solutions related to staffing issues and proposed procedural changes to managers.
Reviewed reports on employee attendance, productivity and effectiveness to evaluate performance.
Computed balances, totals or commissions to support accounting team.
Resolved customer complaints or answered customers' questions.
Issued work schedules, duty assignments and deadlines for office or administrative staff.
Trained employees on best practices and protocols while managing teams to maintain optimal productivity.
Coordinated with other departments to ensure projects were completed on time and within budget.
Ensured compliance with company policies and procedures related to project management activities.
Facilitated communication between different departments in order to resolve issues quickly.
Monitored inventory levels and ordered additional supplies as needed.
ROI Specialist
MMRA
01.2005 - 03.2023
I did all the releasing of subpoenas and insurance, attorneys, and all audits and SSI.
Provided guidance and support on best practices when it comes to managing resources efficiently in order maximize ROI outcomes.
Tracked and processed release of information requests.
Maintained complete confidentiality in accordance with organization and legal requirements.
Supported administration staff with records requests to support patient care.
Processed and invoiced records requests from patients, providers and third parties.
Pulled patient charts for upcoming appointments.
Observed confidentiality and safeguarded all patient-related information.
Scanned incoming documentation.
Kept department clean, organized and professional.
Implemented updates and improvements to electronic health records systems as directed.
Processed and responded to external requests for medical records following established protocols.
Participated in quality assurance activities to enhance the accuracy and privacy of patient records.
Retrieved medical charts for healthcare staff for filing in medical records.
Retrieved medical records upon request from healthcare professionals.
Assisted patients with requests for their medical records, guiding them through the process.
Coder 2
PeakHealth Solutions
09.2015 - 01.2019
Coder ER, Observation's , SDS, Outpatient's
HCC coding
Arrohealth
07.2015 - 09.2017
I did HCC coding for different Insurance companies that they worked with
Restaurant Team Member
Burger King
Peru, IL
02.1987 - 03.1989
Maintained cleanliness of dining area by wiping down surfaces, sweeping floors.
Assisted in taking customer orders and providing recommendations.
Cleaned cooking equipment after use according to safety protocols.
Organized takeout orders for customers on the go or ordering ahead of time.
Delivered food to tables in a timely manner.
Stocked front-of-house supplies such as napkins, utensils, straws.
Replenished condiments and other supplies at tables and stations.
Followed health code regulations when handling food items safely.
Provided quality customer service with a friendly attitude.
Performed opening side work duties including setting up dining area for guests arrival.
CNA
LaSalle Health Care
La Salle, IL
Education
High School Diploma -
LaSalle Peru High School
La Salle, IL
08-1983
Skills
Expertise in reviewing and assigning accurate medical codes
Training new coders
Supervising coders and ROI Specialist
Working with billing department
Running financial reports
Educating Coders
Knowledge of medical coding rules and regulations
Proficient in correct application of coding rules and regulations
Proficient with medical terminology
Familiar with ICD-10 code books
Knowledge of integrating coding and reimbursement rule changes
Proficient in general office duties
Querying Doctors
Vitals
2141 Rock Street, Peru, IL, 61354
References
Heather Mautino, HIM Manger OSF, 1711 Peru Princeton Road, Spring Valley, IL, 61362, (815) 488-1660
Dr. Joannis Karkatzounis, Hospitalist & Sleep Study, 4 Stonebrook CT, Bloomington, IL, 61704, (312)730-8637
Kathy Koehler, Coder Unity point, 1803 JoAnn Drive, Peru, IL, 61354, (815) 579-595-5959