Maria Fuentes
Lehigh Acres,FL
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Results-driven professional with over 20 years of expertise in home health care documentation and Medicare/Medicaid compliance. Highly skilled in fast-paced environments, excelling in teamwork and client interaction. Fluent in English and Spanish. Proven track record in ICD/CPT coding, medical billing, insurance verification, and claims management. Proficient in Oasis transmissions, EMR systems, medical scheduling, and medical records management. Possess comprehensive knowledge of anatomy, medical terminology, and physiology. Experienced in quality assurance, leadership, and management, with a strong background in electronic health records and best practices. Well-versed in CMS, HIPAA regulations, Medicare, Medicaid, and private insurances. Experienced with the joint commission and ACHC polices. Adept in office and team management, transcription, auditing, quality assurance, and consulting for Medicare/Medicaid compliance.
Overview
24
24
years of professional experience
Work History
OASIS & Coding Auditor, Quality Assurance, Coding/
Bee Well Home Health Care
12.2015 - Current
- Conduct OASIS and coding audits to ensure compliance with Medicare/Medicaid regulations.
- Perform quality assurance reviews to maintain high standards of documentation and billing accuracy.
- Oversee coding and billing processes, ensuring timely submission and reimbursement.
- Collaborate with interdisciplinary teams to develop and implement patient care plans (POCs).
- Identified control gaps in processes, procedures and systems through in-depth research and assessment and suggested methods for improvement.
- Consulted clients on internal control systems development and audit program improvements.
- Planned audits and audit activities to allocate necessary resources and determine consistency of plans with audit objectives.
- Coordinated, managed and implemented auditing projects and prepared for evaluation.
- Obtained and interpreted relevant and authoritative criteria for program or issues under audit.
- Interpreted state and federal laws, accepted auditing principles and procedures and program standards to audited materials and data to detect non-compliance and facilitate recommendations.
- Performed observations and evaluated supporting documents to supplement audit findings.
- Administered auditing program to address risks and evaluate compliance with regulatory requirements.
OASIS & Quality Assurance. Coding/Billing, POC's
Royal Quality Home Health Care
01.2009 - 04.2014
- Conducted OASIS and coding audits to ensure compliance with Medicare/Medicaid regulations.
- Performed quality assurance reviews to maintain high standards of documentation and billing accuracy.
- Oversaw coding and billing processes, ensuring timely submission and reimbursement.
- Collaborated with interdisciplinary teams to develop and implement patient care plans (POCs).
OASIS & Coding, QA, Coding/Billing, POC's
San Lazaro Home Health
07.2000 - 01.2009
- Conducted OASIS assessments and coding audits to ensure compliance with Medicare/Medicaid regulations.
- Performed quality assurance reviews to maintain high standards of documentation and billing accuracy.
- Developed and implemented patient care plans (POCs) in collaboration with interdisciplinary teams.
- Facilitated Oasis transmissions and ensured accurate coding and billing processes.
- Demonstrated leadership skills in managing projects from concept to completion.
- Proven ability to develop and implement creative solutions to complex problems.
Education
Billing And Coding - Billing And Coding
Branson Medical Career Training School
Colorado City, United States02.2023
M.D. - Medical Sciences
Medical Sciences Superior Medical Sciences
Santa, United States07.1993
Skills
ICD/CPT Coding
Medical Billing
Insurance Verification and Claims Management
Oasis documentation expertise
EMR Systems
Medical Office Experience
Anatomy Knowledge
Medical Terminology
Physiology Knowledge
Medical Scheduling
Medical Records Management
HIPAA Compliance
Transcription
Data Entry
- Root Cause Analysis
- Risk mitigation strategies
- Process evaluations
- Regulatory Compliance
- Bookkeeping
- Issue Resolution
- Deficiency documentation
Quality Assurance
Supervision and Leadership
Management
Clerical Experience
Electronic Health Records (EHR) Best Practices
Experience with Medicare, Medicaid, private insurance Experience with CMS, HIPAA, Medicare, Medicaid and private insurances Experience with Joint Commission and ACHC accreditation processes
Languages
Spanish
Native or Bilingual
English
Full Professional
Timeline
OASIS & Coding Auditor, Quality Assurance, Coding/
Bee Well Home Health Care
12.2015 - Current
OASIS & Quality Assurance. Coding/Billing, POC's
Royal Quality Home Health Care
01.2009 - 04.2014
OASIS & Coding, QA, Coding/Billing, POC's
San Lazaro Home Health
07.2000 - 01.2009
Billing And Coding - Billing And Coding
Branson Medical Career Training School
M.D. - Medical Sciences
Medical Sciences Superior Medical Sciences
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