Lisa Ortega
Riverside,Ca
Summary
Experienced Medical Coder with extensive knowledge seeking employment in a facility to provide quality service. Precision-driven Medical Coder known for maintaining high productivity and efficiently completing coding tasks. Possess specialized skills in ICD-10-CM, CPT coding, and medical terminology comprehension. Excel in analytical problem-solving, time management, and adaptability, ensuring accurate and timely submission of medical claims in diverse healthcare settings.
Overview
19
19
years of professional experience
Work History
Remote Auditor
Managed Resources
07.2023 - Current
- Conducts medical record documentation reviews for Multiple Specialties : E/M, Surgical CPT and ICD-10-CM coding based on designated audit schedules for professional fee clients.
- Review HCC, E&M, ICD-10CM and CPT
- Evaluate medical records for inaccurate or missing provider documentation
- Audited multiple specialties such as Hospitalist, Nephrology, Gastroenterology, CVT, Cardiology, Oncology, OBGYN, Pediatrics in teaching facilities to enhance performance.
- Interacted regularly with clients to discuss audit progress, findings, and recommendations.
- Collaborated closely with other team members to develop effective audit plans.
- Performed regular reviews of the company's operations for compliance with laws and regulations.
- Ensured timely completion of all assigned tasks within set deadlines.
- Participated in special projects related to due diligence investigations as required.
- Prepared detailed audit workpapers for review by senior auditors.
Remote Lead Coder
Tegria
09.2020 - 05.2023
- Currently designated as Lead Coder for Providence group, proficiently coding various specialties including GI and Nephrology for both E&M and surgical procedures, Family Practice, Pediatrics, Hospitalists, Intensivist.
- Provided assistance across different specialties to ensure coverage and supported coders with any coding inquiries.
- Conducted training sessions for new hires on EPIC and company workflows
- Worked on various Work Queues including Charge Review, Claim Edit, Account, Refunds and Denials.
- Reviewed code to ensure quality and conformance with established standards.
- Maintained up-to-date knowledge of coding changes, updates, and new rules.
- Provided support for coding queries raised by coders or staff members regarding specific cases or coding issues.
- Reviewed patient medical records for accuracy, completeness and compliance with coding regulations.
- Collaborated with other departments such as billing, clinical documentation improvement, quality assurance to ensure accurate coding practices are being followed.
- Verified accuracy of procedure codes to ensure proper reimbursement levels.
- Coded diagnoses and procedures from patient medical records using ICD-10-CM and CPT-4 codes.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
Remote Auditor
Himagine Solutions
07.2017 - 01.2020
- Performs thorough medical record documentation reviews for assigned professional fee clients encompassing various specialties such as E/M, Surgical CPT-4, and ICD-10-CM coding.
- Assigned in HCC, E&M, ICD-10CM, APC and CPT assignments
- Conducted assessments of medical records to identify any inaccuracies or omissions
- Proficient in multiple EMR systems including EPIC, Cerner, PowerChart, Optum CAC, 3M, and Encoder Pro.
- Provided feedback to coders regarding coding errors or deficiencies identified during the audit process.
- Identified potential issues related to documentation or coding that could result in improper payment or fraud.
- Reviewed medical records to ensure accuracy of coding and billing practices.
- Quickly responded to staff and client inquiries regarding CPT codes.
- 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 high accuracy rate on daily production of completed reviews.
- Educated healthcare staff on coding standards and changes in coding guidelines.
- Entered coded data into electronic health record (EHR) systems.
Remote Coder
Himagine Solutions
12.2015 - 07.2017
- Coding various specialties such as CVT, Neonatal care , Neurology EMG procedures , Pulmonary -PFT’s tests and Bronchoscopy examinations helped improve my skills as a Coder at Asante Hospital.
- Validated accuracy of diagnosis codes as well as modifiers used on claims before final submission to payer and insurance companies.
- Performed audits on coded claims to ensure that all required data elements are included for accurate payment processing.
- Researched discrepancies between documentation and billing information in order to resolve any issues prior to submission.
- Verified accuracy of procedure codes to ensure proper reimbursement levels.
Certified Trainer for Resolute –EPIC EHR
Riverside Medical Clinic
Riverside, CA
05.2010 - 12.2015
- Curriculum design Training program development from the ground up Epic Implementation Partner with business office staff and subject matter experts to develop learning objectives and training content Research and organize information, develop and oversee instruction materials including instructor guides, exams and end user documentation.
Lead Coder Auditor
Riverside Medical Clinic
Riverside, Ca
04.2005 - 12.2015
- Appointed as the lead certified coder for a multi-specialist group, I am assigned to work directly with the Director of the Medical Records
- Comprehensive Knowledge in coding and auditing CPT, ICD-9, HCPCS for ASC services, Professional Hospital coding, E&M and surgery coding for multiple specialties that include Cardiology, Interventional Radiology, Internal Medicine, Dermatology, OBGYN, Oncology, Pediatrics, Pulmonary, Gastroenterology, General Surgery and Trauma
- Proficient Knowledge of CCI edits, LCD’s, NCD’s, Medicare’s Fee schedule
- HCC knowledge
- Perform quarterly coding audits for our Compliance department
- Support physician and other departments with coding questions
- Provide coding education to the physicians as needed
- Assist with Application Coordinators in EPIC for validating proper interventional studies, correct drug codes
- I have extensive knowledge and ability working with Microsoft Excel, and Word
- Completed training and passed proficient assessment for ICD-10-CM
- Ability to manage and complete multiple projects
Claims Supervisor
Riverside Medical Clinic
Riverside, Ca
06.2007 - 02.2009
- I supervised twelve employees for claims department of an Accounts receivable of six million
- I managed and prepared payroll
- I also completed appeals to all major insurances, for bundling, medical necessity and low contract pay with proper documentation
- I worked with MPV software
- I verified various fee schedules and insurance contracts for most insurance carriers, as well as their policies and procedures
- I submitted claims electronically for commercial claims as well for Medicare
- I entered information using 10 key data entry
- I read EOB’s and there denial codes
- Appeal process
Education
Seminars Plus- American Academy of Professional Coders
Garden Grove, Ca01.2004
Bryman College-Medical Assistant
Orange, Ca01.1999
Los Amigos High School
Fountain Valley, Ca01.1998
Skills
- Certified Professional Coder
- Certified Resolute Trainer-EPIC
- Certified Professional Medical Auditor
- Certified Professional Risk Coder
- Certified Evaluation and Management Coder
- Certified Risk Management Coder
- Medical Assistant
- EPIC
- Meditech
- Power chart
- CAC
- 3M
- Access HIM
- Cerner
- Audit Coordination
Languages
Speak, read and write Spanish fluently.
Emrexperience
- EPIC
- Meditech
- Power chart
- CAC
- 3M
- Access HIM
- Cerner
References
Available Upon Request
References
References available upon request.
Timeline
Remote Auditor
Managed Resources
07.2023 - Current
Remote Lead Coder
Tegria
09.2020 - 05.2023
Remote Auditor
Himagine Solutions
07.2017 - 01.2020
Remote Coder
Himagine Solutions
12.2015 - 07.2017
Certified Trainer for Resolute –EPIC EHR
Riverside Medical Clinic
05.2010 - 12.2015
Claims Supervisor
Riverside Medical Clinic
06.2007 - 02.2009
Lead Coder Auditor
Riverside Medical Clinic
04.2005 - 12.2015
Seminars Plus- American Academy of Professional Coders
Bryman College-Medical Assistant
Los Amigos High School
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