Years of professional experience
PETER CHIN
Palm Coast,FL
Summary
AAPC CPC and CRC Credentials held. Three plus years experience in Health Care Industry. Experienced HCC Quality Analysis and Surgical coder, multi-specialty procedural and diagnosis coding. Client management and Risk Adjustment HCC education experience. Superior interpersonal and communication skills. Generating innovative ideas including coding particulars. Excellent leadership, organizational, analytical, verbal and written communication skills. Goal oriented, very keen on details and fine print, result driven and exceeds expectations under pressure. Reliable Medical Coder with a background in document oversight, data security procedures and resolving coding errors. Detail-oriented performer with medical terminology knowledge. Considered a team player with exemplary multitasking skills.
Overview
3
3
2
2
Certifications
Work History
HCC Quality Assurance Coder III
Inovalon, Inc
Bowie (Remote), Maryland
01.2022 - Current
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Hold responsibility for quality and efficiency of the clinical review process and the assigned quality assurance review team
- Conduct quality improvement studies/Audits under guidance of Senior Analytics QM/Director to ensure high quality medical record review are completed with 95% accuracy or above including duties as performing quality pullback and analysis; compiling and tracking data using identified analysis worksheet per project; maintaining communication with senior analytics leadership regarding variance and inconsistencies found throughout the review process and perform high quality assessment within project deadline requirements
- Continued ongoing management and oversight of quality reporting including monthly analysis reporting on offshore vendor partners and Medical Record Reviewers Quality leads and Quality Managers
- Assisted with design, execution and management of ongoing quality assessment procedures for all review personnel
- Assisted with development, organization and implementation of company-wide quality improvement efforts
- Maintained control and ongoing monitoring of quality standards and reliability as well as quality reporting mechanisms and management tools
- Gather and track data to identify opportunities for process improvement within the company
- Ensured compliance with contractual, local, state and national quality standards
- Maintained ongoing proficiency across all product lines
- Maintained open lines of communication with Directors, Quality analytics, MRR Quality Department and other departments as needed regarding on-going quality activity as it relates to clients and operations management
- Maintained compliance with all company policies, procedures and mission statement
- Adhered to all confidentiality and HIPPA requirements as outlined within their policies and procedures in all ways and at all times with respect to any aspect of data handled or services rendered
- Fulfilled all responsibilities and/or duties that may be reasonably achieved for the purpose of achieving operational and financial success of the company
Senior MRA Coder
Island Doctors
Palm Coast, FL
03.2021 - Current
- Review completed charts, including progress notes, labs, consultations and hospital discharge reports and flag definitive risk-adjustment diagnoses
- Document found diagnoses with respective codes and location of definitive diagnosis
- Maintain binders for pre and post visit chart review including reviewing patient records before scheduled visits and updating patients MRA card as needed
- Review post visit progress notes, ensuring supporting documentation and ICD-10 codes are accurate
- Ensure all significant chronic conditions are identified and documented in patients chart to ensure clinical providers can discuss conditions during patient visits
- Meet with affiliate staff to address observed trends, provide education and training and list encounters to re-bill missing codes captured
- Input all data reviewed and collected into MS Excel spreadsheets and also provide quarterly reports to clinical providers
- Responsible for maintaining up to date knowledge of coding guidelines as they relate to professional services and HCC Coding
- Responsible for maintaining knowledge of managed care principles, RAF scores, insurance industry practices, codes, and medical terminology
- Assist in training and teaching new team members company work systems and programs used, work flows and any and all risk adjustment guidelines and questions
OutPatient Coder (Remote)
Grace Elliot Global Coding Solutions
Sanford, FL
02.2020 - 02.2021
- Reviewed daily Evaluation and Management (E&M) charges pending in E&M work que
- Was responsible for resolving charge review edits related to registration, insurance and authorizations
- Reconcile daily operating room (OR) schedule and cross-reference charges in the surgical work que
- Reviewed surgical cases for missing documentation or errors regarding operative notes or case attestation
- Reviewed missing charge report twice per week for any missing charges. Reviewed cases in EPIC to determine if surgery case was actually completed or cancelled
- Communicated to providers any charges not submitted. Reported any issues back to supervisor regarding billing and coding edits. Reviewed codes assigned by physicians, or assign appropriate, ICD-10, ICD-9 and CPT codes based on reports and/or progress notes provided by physicians
- Assisted providers with coding education and feedback to improve their accuracy in code selection. Ensure continuous quality improvement of physician coding and team billing practices. This includes views of and recommendations for ICD-10; ICD9/CPT coding to ensure compliance with policies for coding and claim submission. Monitor that reimbursement levels are appropriate, especially in areas that are at risk for improper reimbursement
- Reviewed and analyzed rejections to determine trends; propose solutions for change in process as appropriate. Identify payer-specific trends and provide support to resolve claim issues
- Participated in group discussions and problem resolution activities pertaining to the division and department; proactively served as a resource for providers for coding/compliance issues. Worked collaboratively with providers, peers, payers and others. Tracked and resolved provider enrollment issues for new providers. Worked with others to ensure that billing numbers are received and A/R is released for timely payment. Demonstrated working knowledge of Managed Care processes. Staying abreast of annual coding updates
Education
Certified Risk Coder - CRC - Risk Adjustment
Exellus The Medical And Coding Movement
Brooklyn, NY10.2021
Certified Professional Coder - CPC - Professional Medical Coding
ABC Training
Bronx, NY09.2019
High School Diploma -
Pocono Mountain HS
Swiftwater, PA08.1999
Skills
- Data Management
- Analytical Skills
- Leadership
- Distance learning tools
- Strong knowledge of CPT, ICD-10 CM and HCPCS
- ICD-10 Coding Guidelines
- CMS Coding Guidelines
- HCC Compliance and Guidelines
- Risk Adjustment Models
- Data Entry and Data Management
- Coding Error Resolution
- Records Review and Analysis
- Interpersonal Communication
- Problem Solving
- Compliance Verification
- Exceptional paperwork and proofreading skills with keen attention to detail
- Ability to comprehend common coding procedures and trends
- MS Office including Word, Excel, PowerPoint, Internet, Outlook MS Publisher, Adobe Acrobat, AS400 and Social Media
- Knowledge of different EMR/EHR systems such as E-clinical, EPIC, EnCoder Pro, Quanam, Office Alley, Allscripts Practice Fusion, DCD and Allscripts EMR
- Knowledgeable in writing software user guides, quick reference guides, and training materials
- Experienced trainer for all levels of classroom training, Physicians, clinical and clerical personal
- Hospital Inpatient and Outpatient Coding
- Reading Comprehension
- Critical Thinking
Certification
- CPC - Certified Professional Coder
- CRC - Certified Risk Adjustment Coder
Timeline
HCC Quality Assurance Coder III
Inovalon, Inc
01.2022 - Current
Senior MRA Coder
Island Doctors
03.2021 - Current
OutPatient Coder (Remote)
Grace Elliot Global Coding Solutions
02.2020 - 02.2021
Certified Risk Coder - CRC - Risk Adjustment
Exellus The Medical And Coding Movement
Certified Professional Coder - CPC - Professional Medical Coding
ABC Training
High School Diploma -
Pocono Mountain HS
Similar Profiles
Kavithalakshmi BaskarKavithalakshmi Baskar
Principal Software Data Engineer at Inovalon, IncPrincipal Software Data Engineer at Inovalon, Inc
Kelli B. SmithKelli B. Smith
Director of Clinical Quality Operations at Inovalon, IncDirector of Clinical Quality Operations at Inovalon, Inc
Todd PulhamTodd Pulham
Manager, Customer Success at Inovalon, IncManager, Customer Success at Inovalon, Inc