Sheila E. Gilmer
Eugene,OR
Summary
Results-driven professional seeking position as Risk Adjustment Auditor. Focused on performance and flexible with specific needs of different assignments. Collaborates professionally with individuals from broad array of backgrounds and cultures.
Overview
16
16
years of professional experience
1
1
Certificate
Work History
Risk Adjustment Coding Specialist
PacificSource Health Plans
Springfield, OR
05.2016 - Current
- MA risk adjustment coding for our health plan members.
- Working the Scode program (comprehensive health assessment) for our selected provider groups to give feedback and support from the RA coding side.
- Working the ACA coding audits as needed. Collaborating with coding team to offer support and direction when needed.
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Utilized active listening, interpersonal and telephone etiquette skills when communicating with others.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures
Radiology Coder
Oregon Medical Group
Eugene, OR
03.2010 - 05.2016
- Interacted with physicians and other healthcare staff to treatment procedures contained in outpatient medical records. ask questions regarding patient services.
- Reviewed, analyzed and managed coding of diagnostic
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Utilized active listening, interpersonal and telephone etiquette skills when communicating with others.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- I started doing Billing reconciliations in 2010.
- I moved to provider credentialing in 2012 , then moved into radiology coding in 2014.
Patient Scheduling Coordinator
Oregon Neurosurgery Specialist
Springfield, OR
09.2005 - 06.2009
- Verified insurance coverage and obtained pre-authorizations.
- Confirmed patient appointments day before scheduled.
- Reviewed new patient paperwork before scheduling appointments.
- Reviewed medical histories and current information to provide accurate information to surgeons.
- Checked patients in and out and collected payments.
- Answered telephone calls to offer office information, answer questions and direct calls to staff.
- Received, recorded and addressed incoming and outgoing communication via telephone and email.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Carried out front office duties utilizing data entry skills in framework of medical database.
Education
General Studies
Hiwassee College
Madisonville, TN1993
High School Diploma -
Lenoir City High School
Lenoir City, TN06.1992
Skills
- CPC certification from AAPC
- CRC certification from AAPC
- Coding Understanding
- CMS Guidelines
- Medical Records and Documentation
- Collaboration
- Self-motivated professional
Certification
CPC certification from AAPC
CRC certification from AAPC
Timeline
Risk Adjustment Coding Specialist
PacificSource Health Plans
05.2016 - Current
Radiology Coder
Oregon Medical Group
03.2010 - 05.2016
Patient Scheduling Coordinator
Oregon Neurosurgery Specialist
09.2005 - 06.2009
General Studies
Hiwassee College
High School Diploma -
Lenoir City High School
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