Sammia Fiorentini
Sacramento,CA
Summary
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
22
22
years of professional experience
2
2
Certificate
Work History
Outpatient Coding Specialist
Sutter Healthcare
Sacramento, CA
06.2010 - Current
- Executed interpretation of medical terminology to translate into coding software and obtain accurate reimbursement from insurance companies and healthcare programs.
- Reviewed, analyzed and managed correct coding of diagnostic and treatment procedures contained in outpatient medical records with recent 2022-6 month audit with 100% accuracy rate
- Resourcefully used various coding books, procedure manuals and on-line encoders.
- Achieved production goals of over 105 charts with +98% accuracy while ensuring accurate code assignment
- Maintained knowledge of current trends and practices in coding principles and government regulations. Attends educational meetings and seminars.
Inpatient Coding Boot-Camp
Sutter Shared Services HIM
Sacramento, CA
06.2015 - 06.2016
- Assigns codes into hospital encoder system within established Health Information Management standards y
- Abstracts and codes Inpatient records and all others as assigned based on deep functional expertise
- Determines principal and secondary diagnoses and procedures
- Inpatient records, for Commercial, Mom, and Baby, and Commercial cases
- According to all applicable coding rules and regulatory standards
- Assigns medical diagnoses and surgical procedures codes and abstracts necessary data elements for billing, reimbursement and state reporting
- Codes are used to calculate MS-DRG assignment required for reimbursement, as well as APR DRG used for Quality metrics and analysis
- Ensures all collected data is accurate, complete and compliant with state and federal regulations as well as Coding Guidelines
- Coding and Reporting and Sutter defined coding policies and procedures
Customer Service Representative
Health Net of California
Sacramento, CA
05.2009 - 06.2010
- Performed assistance with State Health Programs (SHP) such as Medi-Cal, Healthy Families (HF), AIM, and Healthy kid's members and providers
- Perform updates to assist pharmacies, members, and hospitals in analyzing and updating patient eligibility based on research using State
- AEVS program
- Analyze denied claims for providers and advise of reasons for denials
- Assist members with Utilization Management, authorizations, and referrals
- Maintain clear verbal/written communication with members, providers, and co-workers; provide support with appeals, grievances, 15-day cap deductions, transportation requests, EOB, check tracers, claim escalations, and appeals escalations.
- Provided primary customer support to internal and external customers.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Trained new personnel regarding company operations, policies and services.
Research Analyst
Health Net Federal Services
Rancho Cordova, CA
02.2000 - 03.2006
- Research and review of claims VA/Tricare/HNT payment method reports
- Analysis of chart components for completeness
- Input Data into
- Centers for Medicare & Medicaid Services (CMS) DRG Pricers
- Performed calculations for payment method recoupment
- Researched and resolved data/ report inaccuracies
- Researched and documented payment adjustments on multiple systems
- Performed payment methodology validation for selected cases under direction of DRG Quality Coordinator
- Provided customer support by addressing incoming provider calls and letters
- Assisted in collections of over 10 million dollars in DRG overpayments for VA in 2006
- Have experience with Tricare, Tricare North, Health Net of Arizona, VA, Champ/VA and VHA
- Assisted in keeping Policies and Procedures manuals up to date as well as assisting with all follow up letters and Technical Denials
- Have extensive experience working with Tricare system in obtaining claims and other needed information; knowledge includes various systems such as DOMA, Pricers, RRS, CMMS, MC400, and SAS
- Maintained documentation and records for all correspondence
- Awarded 5 years Certificate of Appreciation in 2005 for outstanding service and dedication to Health Net Federal Services
- Awarded 2006 Certificate of Appreciation for professionalism, dedication, cooperation and work ethic demonstrated during work on VA DRG Recovery Contracts
- Letter of recommendation from Manager John Bell, RHIT available.
Education
Certified Coding Specialist - Health Information Technology
Cosumnes River College
Sacramento, CA03.2014
Associate of Science - Health Information Technology
Cosumnes River College of Sacramento
Sacramento, CA09.2011
Medical Assistant Certificate Program - Medical
Western Career College of Sacramento
Sacramento, CA06.1994
Skills
- 3M
- CAC
- Epic
- ICD-10 (International Classification of Disease Systems)
- CPT
- Coding Outpatient/Ancillary/ Recurring
- Charging Outpatient
- Inpatient Mom/Babies
- ICD-10-PCS
- External Audit (SNF)
Certification
- RHIT - Registered Health Information Technician
- CCS - Certified Coding Specialist
Languages
Spanish
Native or Bilingual
Affiliations
AHIMA-2010-Current
CHIA- 2010-Current
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Additional Information
California Health Information Association (CHIA) Alternate Delegate 2016
California Health Information Association (CHIA) Education Chair 2015
Timeline
Inpatient Coding Boot-Camp
Sutter Shared Services HIM
06.2015 - 06.2016
Outpatient Coding Specialist
Sutter Healthcare
06.2010 - Current
Customer Service Representative
Health Net of California
05.2009 - 06.2010
Research Analyst
Health Net Federal Services
02.2000 - 03.2006
Certified Coding Specialist - Health Information Technology
Cosumnes River College
Associate of Science - Health Information Technology
Cosumnes River College of Sacramento
Medical Assistant Certificate Program - Medical
Western Career College of Sacramento