Renoma Town
Baton Rouge,LA
Summary
Detail-oriented Medical Coder with several years of experience Gastroenterology, Colorectal, Urology, and expertise in CPT, HCPCS, and ICD-10 coding. Proficient in coding resources such as encoders,3M, Optum, Codify. EHR that includes EPIC, eCW, Cerner, ProVation, Meditech, and gGastro. Certified Outpatient Coder (COC), Certified Gastroenterology Coder (CGIC), Certified General Surgery Coder (CSGC), Certified Urology Coder, CUC), with a Certified Professional Medical Auditor (CPMA). Proven ability review operative reports analyzed and level E/M documentation, and validate modifier application with a 95% accuracy rate to enhance coding accuracy and compliance while minimizing revenue loss through effective coding and billing.
Overview
1
1
Certification
35
35
years of professional experience
Work History
Medical Coding Auditor & Provider Educator
The Specialty Alliance
Dallas, Texas
07.2018 - Current
- Reviewed operative reports and documentation to confirm accuracy of assigned CPT, HCPCS, and ICD-10-CM codes.
- Reviewed Evaluation and Management, and all diagnostic ancillary services documentation and billing to confirm accuracy of assigned CPT, and ICD -10 CM codes.
- Validated modifier usage and bundling compliance with NCCI edits and payer guidelines.
- Confirmed adherence to billing regulations to prevent errors. with CMS, AMA, AND payer - specific billing regulations.
- Examine claims for compliance with relevant billing and processing guidelines and identify opportunity for fraud, abuse, and denial prevention.
- Conducted retrospective and concurrent audits of professional billing for surgical evaluations.
- Document audit findings and recommendations in accordance with established audit standards.
- Collaborated with coding/compliance managers to analyze coding patterns, supporting risk mitigation and denial prevention.
- Delivered feedback to providers and coding and billing teams to enhance coding accuracy and compliance.
- Ensured coding accuracy to support accurate billing processes. and meet established productive standards audit performance.
Surgical Coding Specialist II
Amsurg - Louisiana Endoscopy Center
Baton Rouge, Louisiana
05.1998 - 06.2018
- Review and analyze medical records, including clinical documentation to accurately apply diagnosis and procedure codes utilizing ICD -9, ICD-10-CM, ICD-10-PCS, CPT, and HCPCS for both outpatient and inpatient ProFee endoscopies, and general surgery services.
- Apply ICD-10-CM diagnosis codes to the highest level of specificity available.
- Independently coded medical records for accuracy and compliance. within assigned specialty of specialties.
- Collaborated with health providers to resolve documentation discrepancies, enhancing coding accuracy and compliance.
- Accurate use of modifiers specific to both professional & facility services.
- Collaborate with medical billing team to facilitate correct claim submission and resolve coding discrepancies.
- Calculate ProFee Evaluation and Management inpatient/outpatient services.
- Maintained compliance with all coding guidelines, regulations, and payer requirements.
- Utilized EMR, EHR, and Encoder systems efficiently to abstract only necessary information for accurate billing.
- Conducted audits of coded data to ensure accuracy and identify opportunities for coding improvement.
- Investigated and corrected rejected and denied claims to minimize revenue loss and ensure timely reimbursement.
- Queried physicians both written and verbally for clarification to help resolve coding issues and incomplete documentation.
- Maintained 95% or above coding accuracy and meet established productive standards.
- Maintained up-to-date knowledge of coding guidelines.
- Assisted in coding diagnostic and ancillary specialties services.
Hospital Admission Representative - Part - Time
Woman's Hospital
Baton Rouge, LA
04.2004 - 06.2009
- Managed patient registration process, ensuring accurate data entry and compliance with health regulations to enhance patient experience.
- Verified insurance benefits and processed payments efficiently, ensuring timely receipt issuance for patients.
- Requested prior authorizations from insurance providers to facilitate patient admissions. for inpatient admissions.
- Facilitated communication between patients and medical staff, improving service delivery and patient satisfaction.
- Maintain accurate records by updating patient demographics, insurance, and financial information.
- Retrieved medical data for physicians and patients for hospital admission process.
- Supported hospital compliance efforts by adhering to HIPAA guidelines and maintaining the confidentiality of patient information.
- Monitored data entry for completeness and accuracy. minimizing errors in patient records.
Insurance Claims/Enrollment Specialist
Metra Health (Acquired by UHC)
Baton Rouge, LA
02.1992 - 05.1998
- Managed enrollment processes for health plan members at Metra Health.
- Review and verify medical claims for accuracy and completeness before processing.
- Ensured compliance with policies, facilitating timely reimbursements for healthcare providers.
- Reviewed laws, policies, and guidelines to maintain compliance in insurance claims processing.
- Upheld a high level of accuracy by consistently double-checking figures, data entries, calculations, before finalizing any payments.
- Entered patient information and medical claims data into company database, supporting accurate processing and record-keeping.
- Maintained up-to-date knowledge of ICD-9, HCPCS, and CPT coding guidelines.
Education
High School Diploma -
West Feliciana High School
Saint Francisville, LA05-1988
Some College (No Degree) - Accounting And Finance
Delta Junior College
Baton Rouge, LASkills
- CPT, ICD- CM, HCPCS coding
- Modifier application
- Medicare compliance coding guidelines
- Medical claims processing
- Effective communication
- Attention to detail
- Time management
- Critical thinking
- Multitasking and organization
- Analytical problem solving
- Internal auditing
- Compliance standards
- Deficiency documentation
- Workload management
- Problem solving
- Billing regulations
- Reliable
- Compliance auditing
Certification
- COC (Certified Outpatient Coder)
- CPMA (Certified Professional Medical Auditor)
- CGSC (Certified General Surgery Coder)
- CGIC (Certified Gastroenterology Coder)
- CUC (Certified Urology Coder)
Timeline
Medical Coding Auditor & Provider Educator
The Specialty Alliance
07.2018 - Current
Hospital Admission Representative - Part - Time
Woman's Hospital
04.2004 - 06.2009
Surgical Coding Specialist II
Amsurg - Louisiana Endoscopy Center
05.1998 - 06.2018
Insurance Claims/Enrollment Specialist
Metra Health (Acquired by UHC)
02.1992 - 05.1998
High School Diploma -
West Feliciana High School
Some College (No Degree) - Accounting And Finance
Delta Junior College