Michele Lynn Furiero CPCO CDEO CPMA CASC CRC CPB COC CPC
Sayreville,NJ
Summary
Knowledgeable individual specializing in a wide range of specialties. Strong attention to compliance regulations, along with detailed knowledge of auditing, revenue cycle and credentialing. Over 26 years of background in reviewing, analyzing and managing medical record information.
Overview
29
29
years of professional experience
Work History
Auditor II SR / Educator
AQuity Solutions
10.2021 - Current
- Manage practical action plans to respond to audit discoveries and compliance violations.
- Guard against fraud and abuse by verifying coded data accurately reflected services provided.
- Interact with physicians and other healthcare staff to ask questions regarding patient services.
- Verifies signatures and checked medical charts for accuracy and completion.
- Utilize active listening, interpersonal and telephone etiquette skills when communicating with others.
- Review patient charts to better understand health histories, diagnoses and treatments.
- Apply official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Develop and enforced audit policies and administrative and technical functions.
- Provide detailed documentation on audit findings, facilitating swift corrective action when necessary.
- Maintained confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
- Ensure compliance with regulatory requirements by performing regular audits and staying up-to-date on industry standards.
- Streamline audit processes, improving efficiency and reducing time spent on each audit engagement.
- Developed strong relationships with clients, building trust and ensuring a high level of satisfaction during the audit process.
- Mentor junior auditors, sharing knowledge and best practices to foster their professional growth within the team.
- Interpret state and federal laws, accepted auditing principles and procedures and program standards to audited materials and data to detect non-compliance and facilitate recommendations.
- Build and present education to both providers and coders based on client need, along with audit results.
- Responsible for audit reporting to clients, along with reportable finding subsequent to financial impact.
- Responsible for client audit escalations.
- Professional Fee
Certified Professional Coder/ Auditor Remote
Maxim Healthcare
04.2021 - 10.2021
- Resourcefully used various coding books, procedure manuals and on-line encoders.
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services.
- Used Epic to assign procedure and diagnostic codes to patient records for billing purposes.
- Coded inpatient charts at rate of 180 per day.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Verified signatures and checked medical charts for accuracy and compliance.
- Guarded against fraud and abuse by verifying all coded data accurately reflected services provided
- Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
- Full remote independent worker
- Maintained strict confidentiality by adhering to HIPAA guidelines and ensuring sensitive patient information was protected at all times.
- Managed high-volume workloads effectively by prioritizing tasks according to urgency and importance while maintaining strict attention to detail.
- Conducted thorough research on complex cases, applying advanced knowledge of medical terminology, anatomy, physiology, and pharmacology to accurately assign codes as needed.
- Served as a reliable resource for both clinical teams and administrative staff by offering expert advice on proper code selection based on diagnosis or treatment specifics provided in the documentation received
- Professional Fee
Auditor/ Revenue Cycle/Compliance/Credentialing
RAI LLC
09.2016 - 04.2021
- Reviewed patient charts to better understand health histories, diagnoses and treatments.
- Used Epic, Medisoft, Medics, Medics Cloud Premier, Allscripts,Codify, 3M Procoder, Optum 360 to assign procedure and diagnostic codes to patient records for billing purposes.
- Resourcefully used various coding books, procedure manuals and on-line encoders.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
- Entered orders into EMR system efficiently and without errors.
- Initiated, performed and documented quarterly coding audits for physicians.
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Accurately selected proper descriptive code when more than one anatomical location was indicated.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
- Maintained confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
- Ensured compliance with regulatory requirements by performing regular audits and staying up-to-date on industry standards.
- Conducted risk assessments to determine areas requiring increased focus during subsequent audits.
- 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.
- Ensured the integrity of financial reporting by verifying the accuracy of accounting records and reconciliations.
- Credential procedures for physicians along with CLIA laboratories.
- OSHA officer during COVID-19
- Professional Fee
Surgical Schedule/Revenue Cycle/Credentialing
Barry R Ellman MD, FACS
05.1996 - 09.2016
- Scanned and filed medical records in alphabetical order to maintain organized and up-to-date filing system.
- Resourcefully used various coding books, procedure manuals and on-line encoders.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Performed billing and coding procedures for ambulance, emergency room and outpatient services, surgical procedures.
- Obtained prior authorization for surgical procedures.
- Scheduled surgical procedures along with Assisting Surgeons
- Entered orders into EMR system efficiently and without errors.
- Initiated, performed and documented quarterly coding audits for physicians.
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient and inpatient medical records.
- Accurately selected proper descriptive code when more than one anatomical location was indicated.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Used Practice Managment to assign procedure and diagnostic codes to patient records for billing purposes.
- Prior authorization of upcoming surgical procedures
- Credentling of physician in all areas
- Professional Fee
Compliance Officer / Provider Educator
Holy Name Hospital
04.2020 - 08.2021
- Liaised with risk management, internal audit and employee services departments to direct compliance issues to appropriate channels for investigation and resolution.
- Managed practical action plans to respond to audit discoveries and compliance violations.
- Implemented improvement initiatives and developed compliance testing program to monitor and identify gaps in new and existing practices.
- Identified potential areas of compliance vulnerability and risk to develop and implement corrective action plans.
- Building education along with presentation to all hospital physicians.
- Working with Compliance attorney to insure compliance plan was within date, along with all department’s compliance along with competence.
- Building physican worksheets, testing and webinars to ensure proper coding guidelines.
- Conducting monthly audits on physician documentation to ensure accuracy along with documentation compliance guidelines.
- Assisted with internal and external audits to confirm compliance with applicable laws and regulations.
- Promoted a culture of continuous improvement through ongoing evaluation and refinement of compliance program elements.l
- Enhanced regulatory compliance by developing and implementing comprehensive policies and procedures.
- Reduced the risk of financial penalties by conducting thorough internal audits on a regular basis.
- Evaluated new regulations for potential impact on business operations, taking proactive measures to ensure readiness for implementation.
- Provided expert guidance on complex regulatory matters, enabling informed decision-making within the organization.
- Spearheaded investigations into potential violations, promptly addressing issues to maintain company reputation and avoid sanctions.
- Mitigated legal risks by proactively identifying gaps in existing policies and recommending improvements.
- Professional Fee
Chapter Secretary
AAPC Morristown
01.2021 - 12.2022
- Maintained an up-to-date directory of member contact information, ensuring seamless communication throughout the chapter.
- Streamlined administrative processes for increased efficiency in scheduling meetings, events, and conferences.
- Ensured accurate record-keeping by maintaining a comprehensive filing system for all chapter documentation.
- Prepared materials for annual reports, highlighting significant accomplishments in line with organizational goals.
- Collaborated with executive board members to develop strategic plans and initiatives for chapter growth and development.
- Enhanced chapter communication by managing and distributing meeting agendas, minutes, and other important documents.
- Supported membership recruitment efforts by organizing open houses, informational sessions, and follow-up communications with prospective members.
- Organized volunteer opportunities for chapter members to engage in community service activities together.
- Served as a liaison between officers and general membership, fostering open dialogue to address concerns or suggestions.l
- Arranged meeting agendas, distributed details and documented meeting activities.
- Helped chairperson plan and run successful club meetings.
- Oversaw membership roster, registration processes and recordkeeping for individual members.
Chapter Vice President
AAPC Morristown
01.2023 - 01.2024
- Collaborated with fellow board members to establish chapter goals, objectives, and action plans.
- Promoted professional development opportunities within the organization resulting in higher member engagement levels.
- Fostered a positive chapter culture by promoting open communication, teamwork, and camaraderie among members.
- Increased event attendance through effective promotion and coordination of engaging activities.
Education
CPC - Certified Professional Coder
AAPC
Salt Lake City, UT12.2020
CPCO - Certified Professional Compliance Officer
AAPC
Salt Lake City, UT12.2021
CPMA - Certified Professional Biller
AAPC
Salt Lake City, UT08.2021
CRC - Certified Risk Coder
AAPC
Salt Lake City, UT04.2022
CASCC - Certified Ambulatory Surgery Center Coder
AAPC
Salt Lake City, UT08.2022
CDEO - Certified Document Expert Outpatient
AAPC
Salt Lake City, UT12.2022
COC - Certified Outpatient Coder
AAPC
Salt Lake City, UT08.2022
CPB - Certified Professional Biller
AAPC
Salt Lake City, UT11.2023
AAPC Member
01796083Skills
- Expert in Denials and Appeal Process
- Problem Solving
- Interpersonal Communication
- Attention to Detail
- Time Management
- Resourceful and reliable worker
- Adept multi-tasker
- Familiar with inpatient and outpatient surgical coding
- Skilled in Telehealth and Covid coding
- Skilled in Radiology, Psychiatry, Internal Medicine, E/R, Pediatrics, OB/GYN, Dental, Clinics, Special Procedures, Neonatology, Dermatology, Urology, Registration Review, Charge Review, Follow Up, Managed Care
- MEAT proficient
- HCPCS Coding Guidelines
- Maintains current knowledge of ICD 10 coding compliance
- Active AAPC member #01796083
- AAPC Exam Proctor
- Coding error resolution
- Proficiency in Epic, Medisoft, Allscripts, Codify, EMR, HCS, Medics, Medics Cloud, 3M Procoder, Optum360 Encoder, Encoder Pro, I Clinical Works, Relay, Lockbox
- Credentialing oversight
- Document review
- Insurance procedures
- Credentialing documentation
- Credential verification
- License verifications
- Microsoft office
- Remote conferencing and communication
- Conflict resolution
- Claims review
- Claims processing proficiency
- HIPAA compliance
- Denial management
- Medical billing expertise
- Analytical problem solving
- Revenue cycle management
- Debt collection procedures
- Analyzing claims
Timeline
Chapter Vice President
AAPC Morristown
01.2023 - 01.2024
Auditor II SR / Educator
AQuity Solutions
10.2021 - Current
Certified Professional Coder/ Auditor Remote
Maxim Healthcare
04.2021 - 10.2021
Chapter Secretary
AAPC Morristown
01.2021 - 12.2022
Compliance Officer / Provider Educator
Holy Name Hospital
04.2020 - 08.2021
Auditor/ Revenue Cycle/Compliance/Credentialing
RAI LLC
09.2016 - 04.2021
Surgical Schedule/Revenue Cycle/Credentialing
Barry R Ellman MD, FACS
05.1996 - 09.2016
CPC - Certified Professional Coder
AAPC
CPCO - Certified Professional Compliance Officer
AAPC
CPMA - Certified Professional Biller
AAPC
CRC - Certified Risk Coder
AAPC
CASCC - Certified Ambulatory Surgery Center Coder
AAPC
CDEO - Certified Document Expert Outpatient
AAPC
COC - Certified Outpatient Coder
AAPC
CPB - Certified Professional Biller
AAPC
AAPC Member
Similar Profiles
KRISTY JOSEPHSONKRISTY JOSEPHSON
Medical Transcriptionist/Editor at Aquity SolutionsMedical Transcriptionist/Editor at Aquity Solutions
Shaniqua JonesShaniqua Jones
Virtual Medical Scribe at AQuity SolutionsVirtual Medical Scribe at AQuity Solutions
Aruna ManiAruna Mani
Quality Analyst at AQuity SolutionsQuality Analyst at AQuity Solutions