Nationally Registered Certified Coding Specialist (NRCCS) with detail-oriented extensive experience in both Inpatient behavioral health, Military Inpatient Behavioral health and emergency department settings. 3M Encoder systems, ICD-10, HCPCS, and CPT coding, HMS (AS/400 "Green Screen") and AR recovery including No Surprise Act (IDR) protocols. Proven ability to manage extreme backlogs. Maintaining Audit-Ready documentation standards according to CMS/Joint Commission mandates. Active participant in audit webinars to maintain superior accuracy and earning ongoing educational credits. Independent work habits. End-to end medical record lifecycle including revenue cycle. Adaptable nature and superior work ethic. Working effectively unsupervised, ready to apply experience to contribute to organizational success.
Reduced AR days by identifying systemic bottlenecks, resolving technical denials, correcting claims, and resubmitting for high-volume emergency services.
Perform expert audits of Remittance Advice (RA) using CAS codes (e.g.,CO-45) to determine eligibility for the Independent Dispute Resolution (IDR) process under the No Surprise Act.
Coordinated complex third-party liability claims for Motor Vehicle Accidents, Workers Compensation, and legal liens to ensure timely processing.
Applied primary insurance adjustment codes for accurate submission of secondary insurance claims, enhancing claims processing accuracy.
Monitor and track the status of missing Electronic Remittance Advice (ERAs) and Electronic Fund Transfers (EFTs).
Synchronized HMS (AS/400 "Green Screen") and UHS Clinical Inquiry to extract and analyze data for the 3M Encoder, overseeing medical record lifecycle including assembly, qualitative analysis, and ICD-10 coding for all four specialized military "Mission" units.
Collaborated with HIM Director as Sole Compliance Specialist, serving as primary liaison for Physicians and NPs to ensure 100% compliance with CMS and Joint Commission 30-day mandates.
Active participant in audit webinars, maintaining superior accuracy and earning ongoing educational credits.