Rutu Patel
Summary
Experienced in medical coding and auditing, seeking a position to contribute to the success of a healthcare organization. Possess a strong foundation in coding, auditing, and healthcare administration. Background includes roles as a medical records coder, coding denial and collection specialist, debt collector, medical assistant/administrator, and patient access representative. Adaptable to various aspects of medical billing, coding, and patient services. Strong understanding of healthcare billing processes and regulatory requirements.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Medical Coder (Remote)
P4 Clinical
01.2023 - Current
- Review Medical Lab requisitions and reports timely to identify diagnoses & CPT procedures relative to the patients' encounter
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications
- To assign ICD 10-CM and CPT codes, Modifier on Excel Datasheets
- To check medical necessity & NCCI edits for assigning Dx code and Procedure codes
- To maintain a higher accuracy level of up to 99% in coding as well as in auditing
- Increased coding accuracy by diligently reviewing medical documentation and applying appropriate codes.
- Recently working on pathology coding for Women's healthcare procedures like Molecular tests, Histology tests, PAP/HPV, and STI disease tests which are performed in the office laboratory of the OBGYN Provider
- Ability to research applicable policies and regulations, LCD & NCD Policies, and local/state/federal laws and serve as resources to provide feedback to the Company department, team, and Provider education session
Remote Medical Records Coder (Contract)
Law firm in New York
06.2022 - 11.2022
- Conduct a review of more than 11000 medical records of pain management and urgent care patient to find the appropriate location
- Document audit conclusion relevant objectives and significant findings
- Analyzes documentation to determine the accuracy and completeness of clinical information maintained in support of the encounter using Scanned documents and proper guidelines from the attorney's office
- Entered all the details in an Excel spreadsheet
Coding Denial Specialist (Remote-Contract)
Trinity Health System
01.2022 - 07.2022
- Accurately and efficiently code specialty services such as oncology and radiology ,SDS ,E/M ,Pro fee coding
- Submit clean claims for payment
- Maintain an error rate of 5% or less
- Improved claim denial resolution by thoroughly researching and identifying root causes of denials.
- Monitor, research, and correct claim denials within health plan requirements and document any trends with which to follow-up
- Complies with Federal and State standards utilizing NCCI edits, Medicare bulletins, ACR bulletins, etc
- Follow-up with multi-specialty practices on coding holds
- Maintain patient confidentiality and information security
- Performs day-to-day billing and follow-up activities within revenue operations of an assigned Patient Business Services location
Medical Collection /Debt Collector (Remote)
Radius Global Solution (AMEX)
03.2021 - 02.2022
- Make outbound contacts and take inbound calls to debtors regarding delinquent account and negotiates settlement options
- Prepare correspondence on delinquent accounts
- Research disputed accounts balances ad make necessary corrections
- Resolved customer disputes and disagreements through professional, calm communication to find mutually beneficial solutions.
- Collected on delinquent accounts to reduce overdue balances.
- Educated debtors about repayment options, enabling them to make informed decisions while preserving positive business relationships.
Collection Specialist (CPC)/Coding Specialist-Freelance
Shree Hari Medical Group
02.2020 - 03.2021
- Resolving invoice discrepancies and submitting claims to insurance companies
- Highly proficient in analyzing Medicare Advantage and Commercial Charts to determine the risk adjustment codes to their highest level of specificity
- Collaborate with management to ensure deadlines are met on time
- Negotiated payment plans with customers, prioritizing account resolution and maintaining professionalism throughout interactions.
- Assure that all ICD-10-CM high-risk chronic/acute condition diagnoses are reported in accordance with CMS payment and Risk adjustment guidelines
- Correlation and re-submission of rejected or denied claims
- Responsible for assisting with account revenue and account receivable
- Submission of claims and follow-up carriers, use of Navinet and other electronic claims submission portals
- Pain management/ Orthopedic surgeries claims experience with No-fault, workers' compensation, NY and NJ PPI claims, OON Commercial Insurance, including appeals, follow-ups aging reports
- Assign diagnosis codes that Risk adjust Medicare advantage along with research and abstract diagnosis codes from medical records
Collection/Coding Specialist (CPC)
Datta Endoscopic Back Surgery and Pain Center
11.2018 - 01.2020
- Look through patients 'charts to determine which procedures and services have been performed
- Abstracting, coding, and interpreting outpatient services for professional and or facility billing
- Assure that all ICD-10-CM high-risk chronic/acute conditions diagnoses are reported in accordance with CMS payment and Risk Adjustment guidelines
- Maintains compliance with both external regulatory and accreditation requirements, and with State and Federal regulations
- Must sign and agree to abide by the Risk Adjustment department's standard operating procedure documents and expectations Performs other duties as assigned
- Utilizes the physician query process to obtain/validate missing information and/or discrepancies for clarification of documentation for accurate code assignment
- Follow up with insurance companies for any denial of surgeries, anesthesia, injections, or office visits received on any given date
- Knowledge of Medical Terminology, CPT Codes, Modifiers & ICD 10 Diagnosis Codes
- Improved claim resolution times by efficiently managing a high volume of appeals and coordinating with various departments.
Education
CPC And CPMA -
AAPC
Medical Assistant With Billing & Coding - Medical Billing And Coding
Hohokus School
Hackensack, NJ04-2010
Bachelor in Accounting - Accounting
M.S University
Gujarat ,India04-2004
Skills
● More than 12 years of healthcare industry experience in various areas
● Comprehensive understanding of compliance, and safety according to HIPAA/OSHA regulations
● Follow all regulations and guidelines set by Medicare, state programs, and HMO/PPO
● Expertise in working with the hospital’s quality procedures under CLIA / JACAHO and CARF regulations
● Effectively Code and report according to ICD-10_CM and HCPCS , CPT guidelines
● Microsoft Outlook, MS Office, Teams, and Excel spreadsheets
● Familiar with Commercial and Government insurance carriers
● Knowledge of Anatomy & Physiology and Medical Terminology
● Knowledge of coding specialists in Internal Medicine,General surgery (SDS), Orthopedics, Pain Management, E&M, OBG/GYN, and Pathology for women’s health
Languages
English
Hindi
Gujarati
Software
NaviNet, Optum, ECW, Practice Fusion, EHR, Dr. Chrono, Epic, Athena
Certification
- Certified Medical Assistant, National Association for Medical Certification (NAMC) 2015.
- Certified Phlebotomy Technician, National Association of Certified Technicians (NACT) 2014
- Certified Professional Coder (CPC Thru AAPC-2018)
- Certified outpatient coder(COC from AAPC certificate 2021)
- Certified Professional Medical Auditor (CPMA Thru AAPC-2024)
Timeline
Medical Coder (Remote)
P4 Clinical
01.2023 - Current
Remote Medical Records Coder (Contract)
Law firm in New York
06.2022 - 11.2022
Coding Denial Specialist (Remote-Contract)
Trinity Health System
01.2022 - 07.2022
Medical Collection /Debt Collector (Remote)
Radius Global Solution (AMEX)
03.2021 - 02.2022
Collection Specialist (CPC)/Coding Specialist-Freelance
Shree Hari Medical Group
02.2020 - 03.2021
Collection/Coding Specialist (CPC)
Datta Endoscopic Back Surgery and Pain Center
11.2018 - 01.2020
CPC And CPMA -
AAPC
Medical Assistant With Billing & Coding - Medical Billing And Coding
Hohokus School
Bachelor in Accounting - Accounting
M.S University
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