Rita Weaver-CPC, CRC

IVA (Initial Validation Audit) review of charts from previous year data validation of submitted ICD10 codes and assisted with QA also -responsible for ensuring the codes abstracted and submitted to CMS were supported with adequate documentation.

• Performed coding audits to determine accuracy and compliance with coding and client guidelines.
• Verified signatures and checked medical charts for accuracy and completion.
• Reviewed patient charts to better understand health histories, diagnoses, and treatments.
• 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.
• Verified signatures and checked medical charts for accuracy and completion.
• Abstraction of ICD10 codes from medical records in a production environment, worked on various different HCC projects.
• Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.

• Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information in PACE environment. HCC coding for organizations through ICD-10 coding with EMR's in complete code capture environment. Retrospective reviews also conducted as needed.

• Chart Review - Extracted HCC codes and applied them to Medicare Advantage Charts via EMR system as review well targeted charts- production based environment while applying appropriate guidelines for multiple projects (also coded Medicaid and Commercial as needed) .
• Responsible for coding 5.75-6.40 charts per hour while maintaining 95% accuracy.

• Extracted HCC codes from medical charts and applied codes for processing utilizing ICD-10 coding and client specific guidelines. Coding was seasonal.
• Proved successful working within tight deadlines and fast-paced atmosphere
• Improved operations through consistent hard work and dedication
• Exceeded goals through effective task prioritization and great work ethic
• Maintained energy and enthusiasm in fast-paced environment

• Handle incoming electronic claims for processing ensuring proper coding and paying close attention to McKesson edits, performed proper adjudication of claims to maximize reimbursement, contacting provider if coding is incorrect. Process claims in high quality, production oriented environment, proficiency in error finding and adjusting claims that need corrected, utilization of proper modifiers to avoid claim denials, work with McKesson Edits daily. Processed between 40-50 claims per day.

• Responsible for first notice of loss reports from policyholders/claimants and enter details for homeowners and automobile claims via the telephone into the computer, requiring use of dual monitors while gathering details and setting up services (appraisals, rentals, etc), assignment of claim details. Gather claim information quickly and accurately while having empathy for the caller in their time of need in stressful situation. Provide callers with claim status on already reported claims, regarding payment (for injury files, vehicle damage, etc) and claim review. Casualty adjusters license for this position.

• Process and pay medical, dental, DME, hospital and prescription claims according to policy after applying the appropriate codes based on provider submission via HCFA and UB92 forms. Examine diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered. Analyze patient medical and surgical records to determine billable services. Worked independently from home office for this position and handled high volumes of claims and processed according to deadline to meet accuracy and production standards.

• Processing and paying medical claims according to policy and assigning appropriate codes for accurate adjudication. Assigning additional diagnosis codes based on specific clinical findings (laboratory, radiology and pathology reports as well as clinical studies) in support of existing diagnoses. Adding modifiers as appropriate, code narrative diagnoses and verify diagnosis. Salary based on accuracy and production.

• Input trip reports for ambulance transport (ALS and BLS) and bill insurance companies according to services rendered. Accurately enter procedure codes, diagnosis codes and patient information into billing software for processing.