Rox Burgin Jr.
Toledo,OH
Summary
Hardworking, highly motivated professional eager to lend combined coding knowledge and skills to enhance business performance. Operates well in both individual and team capacities, leveraging seasoned work ethic to quickly adapt to different processes and drive company objectives. Resourceful and results-driven with a passion for growth and efficiency to meet company needs.
Overview
24
24
years of professional experience
1
1
Certification
Work History
BOI Coder I/Senior Coder
Agilon Health
Westerville, OH
05.2023 - Current
- Validated and guaranteed accuracy, completeness, and specificity of diagnosis codes aligned with services rendered.
- Examined detailed medical record data to determine precise coding classifications according to CMS HCC guidelines.
- Demonstrated analytical and problem-solving skills to identify and resolve barriers in obtaining and validating accurate HCC information.
- Executed AHIMA-compliant queries to providers as required.
- Conducted thorough evaluations resulting in an average score of 98% on internal quality audits for HCCS, reinforcing commitment to quality assurance.
Coding Educator
Mindpath Health
Adrian, MI
11.2020 - 02.2023
- Ensured clinician compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.
- Reviewed claims data to ensure that assigned codes met required legal and insurance rules.
- Provided targeted coding education with clinicians whose documentation was not up to industry standards.
- Conducted medical records research and corresponded with insurance companies and healthcare professionals to resolve if a claim was denied due to incorrect coding.
- Maintained up-to-date knowledge of CPT, ICD-10-CM and HCPCS code sets, medical coding and documentation standards.
Billing Specialist
Mercy LifeStar Ambulance
Toledo, OH
04.2002 - 11.2019
- ICD-10-CM diagnosis coding of all Medicare transports (40-50 reports coded per day)
- Applied HCPCS Level II codes for all Medicare claims
- Appointed billing representative on the Q/A committee to help achieve maximum revenue return by assuring quality documentation in the field
- Created a Q/A documentation template for all EMT's and Paramedics to use while on duty to help document medical necessity per Medicare/Medicaid guidelines
- Mercy LifeStar terminated in-house billing operations on 8-1-2016, but kept me on as a consultant for new billing protocols and as a spot auditor of claims being billed by the new company.
Education
Certificate - Medical Coding
Mercy College Of Ohio
Toledo, OH08-2018
High School Diploma - undefined
Anthony Wayne High School
Whitehouse, OH05-1998
Skills
- ICD-10 (International Classification of Disease Systems)
- CPT-4 Coding
- E/M Code Assignment
- Medical Claims Coding
- Code Assignment Research
- Coding Error Resolution
- Proficient in EMR software
Certification
Certified Professional Coder (July 2020)
Timeline
BOI Coder I/Senior Coder
Agilon Health
05.2023 - Current
Coding Educator
Mindpath Health
11.2020 - 02.2023
Billing Specialist
Mercy LifeStar Ambulance
04.2002 - 11.2019
High School Diploma - undefined
Anthony Wayne High School
Certificate - Medical Coding
Mercy College Of Ohio