Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
13
13
years of professional experience
Work History
Surgical Coder
R1 RCM
03.2020 - Current
Reviewed clinical data from medical records to assign ICD, CPT and HCPCS codes.
Entered charge rationale in patient account notes.
Responded to coding questions from callers and other internal departments.
Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
Accurately assigned codes using software (3M)
Maintained updated knowledge of coding requirements, which included continuing education and certification renewal.
Assigned value codes and modifiers to provide specific information for services provided.
Reviewed account information to confirm patient and insurance information is accurate and complete.
Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
Communicated with insurance companies to provide patient information.
Interpreted medical terminology and pharmacological information to translate information into coding system.
Collected documentation and clarified ambiguous patient care statements by contacting providers.
Collaborated with billing team to confirm no additional diagnosis codes available for LCD and NCD coverage.
Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
Maintained high accuracy rate on daily production of completed reviews.
Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
Communicated with healthcare personnel, including practitioners to promote accuracy.
Interpreted medical reports to apply appropriate ICD-10, CPT codes.
Verified proper coding, sequencing of diagnoses and accuracy of orthopedic surgical procedures.
Quickly responded to staff and client inquiries regarding CPT codes.
Acted as liaison between business department, billers and third party payers in resolving billing and reimbursement accuracy.
Quality Analyst
ACS Global Tech Solutions Pvt. Ltd.
04.2014 - 02.2017
Remained calm and professional in stressful circumstances and effectively diffused tense situations.
Audit surgery coding charts for medical coders
Track quality of medical coders and publish weekly, monthly quality reports
Explained reasons behind denials and recommended further action.
Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
Responded to client inquiries and concerns and escalated complex problems to supervisors and onshore client.
Surgery Coder
E4E Healthcare
07.2013 - 04.2014
Reviewed and analyzed patient medical charts to assign appropriate ICD and surgery codes
Participate in quality and training calibrations
Clinical Investigator
Genpact
05.2011 - 06.2013
Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMS guideline along with referring to client specific guidelines and member policies.
Adherence to state and federal compliance policies and contract compliance.
Assist the prospective team with special projects and reporting.