Susan Polasek CPC.

• Verified, coded and added modifiers to diagnoses.
• Assigned Coding charges Hospital rounds with Observations and Inpatient Professional Physician charges
• Reviewed and interpreted documentation to identify diagnoses, procedures and determine if a modifier was indicated.
• Used Optum 360, Epic and coding books to assign procedure and diagnostic codes to patient records for billing purposes.
• Reviewed and resolved coding edits and denials
• Ensures diagnosis codes meet local and national medical necessity guidelines
• Maintained and updated knowledge of regulation changes and industry guidance that impacts compliant coding.

• Reviewed all post-billed denials (inclusive of coding-related denials) MUE/for coding accuracy and appealing them based upon coding expertise and coding judgment within Hospital and/or Medical Group.
• Identify and determine root causes of denials.
• Provide detailed understanding and aptitude for resolving denials based on ICD-10-CM diagnosis codes, ICD-10-PCS codes, and CPT-4 procedural codes for UB-04 outpatient or inpatient claims, or other coding reasons and processing charge corrections based on medical record reviews, contracts, regulations.
• Reviews and resolves coding accounts missing modifiers, incorrect modifiers, missing charges, incorrect charges, medical necessity edits, CCI edits, claim edits, and payor denials. Verifies accuracy of ICD diagnosis codes and CPT/HCPCS procedure codes.
• Investigates and researches coding issues identified by Revenue Integrity (RI) and Patient Financial Services (PFS) related to inquiries, complaints and/or denials. Makes coding corrections to resolve coding issues; supports RI by reviewing specified procedures for charge accuracy; reroutes accounts to correct coding team for coding resolution based on revenue codes.
• Maintains turnaround times for coding error and edits resolution to prevent charge lags for facility and professional fee services.
• Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity
• Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting
• Performed duties in accordance with applicable standards, policies and regulatory guidelines.
• Maintained excellent attendance record, consistently arriving to work on time and zero call offs.
• Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
• Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
• Used Optum 360 to assign procedure and diagnostic codes to patient records for billing purposes.
• Processed claims by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.

•Travel to and from medical offices and hospitals arriving on time and in business casual appearance, to audit and conure if correct coding and billing codes convention and guidelines where used in accordance with CMS and other assigned insurance providers

•Use laptop and scanner to abstract requested information from patients charts using flash drive and or scanner for paper charts and EMR charts.

Careful attention to detail as only certain portions of patients chart is requested. Being mindful of HIPAA.

Followed correct flow of how patients chart should be organized and at times, would be asked to educate others.

•Upload scanned charts to our corporate data center using high-speed Wi-Fi internet connection with VPN•

Abstract requested HEDIS and PCMH measures and other requested information.

• Maintained accuracy, completeness and security for medical records and health information.
• Reviewed charts and flagged incomplete or inaccurate information.
• Maintained excellent attendance record, consistently arriving to work on time.
• Proved successful working within tight deadlines and fast-paced atmosphere.
• Analyzes provider documentation to assure the appropriate, ICD-10-CM, CPT, HCPCs, HEDIS and Evaluation & Management (E&M) codes are assigned using the correct codes.
• Conduct system analyses to locate and retrieve HEDIS and quality data from claims and other internal and external sources.

• Received and routed medical records and processed request
• Prepare records for HEDIS
• Audited records for accuracy
• Reviewed and corrected incomplete or inaccurate information
• Created new physical and computer-based files
• Profee code for patient hospital admission and discharge documentation
• Obtained patient releases for dissemination of information
• Increased department productivity 95%. This was completed by moving all phone prior authorizations to online processing
• Entered and scanned outside consultations into the EMR system. (Practice Partner and EPIC)
• Scheduled appointments, registered patients and distributed sample pharmaceuticals as prescribed
• Coded office visits, lab procedures, Nursing home visits and immunizations for 5 physician practice.
• Initiated appropriate claims paperwork, documentation and system entry
• Identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation verified patients' eligibility and claims status with insurance agencies.
• Helped organize, plan and implement our office transition of over 10,000 patients from paper medical records to electronic (EMR)
• Performed clerical duties, such as word processing, data entry, answering phones and scheduling using Practice Partner, EPIC and MYSIS.
• Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes
• Maintained accuracy, completeness and security for medical records and health information.
• Reviewed charts and flagged incomplete or inaccurate information.
• Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
• Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
• Used AAPC Books CPT & ICD-9 10 and Optum 360 encoder to assign procedure and diagnostic codes to patient records for billing purpose

• Managed various general office duties such as answering multiple telephone lines, completing insurance forms and mailing monthly invoice statements to patients.
• Coded office visits, out patient Podiatry surgeries and LTAC visits using CPT and ICD -9 and ICD-10.
• Performed monthly inventory and maintained office and medical supply counts.
• Preformed ordered radiographs requested by physician. (GXMO Licensed through state of OHIO)
• Collected patient vitals and documented into patients medical chart.
• Assessed patients and documented their medical histories.
• Initiated and completed prior authorizations for surgeries, radiological procedures and medications.
• Evaluated patient care needs, prioritized treatment, and maintained patient flow.
• Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
• Guarded against fraud and abuse by verifying all coded data accurately reflected services provided.
• Followed up with appropriate parties to obtain prompt payments