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Skills

  • NDCMedisoft
  • Performance metrics analysis
  • Records review
  • Collaborative team leadership
  • Relationship development
  • Supervision
  • DRG assignment
  • QMSoftware Receivables Management
  • Clinical documentation improvement (CDI)
  • Continuous improvement in healthcare processes

Work Experiences

  • Achieved coding compliance of 39% across the network.
  • Collaborated with 14 regional offices.
  • Achieved a 84% reduction in initial error rates.
  • Achieved 10% faster reimbursement cycles.
  • Accurately processed 7+ outpatient claims weekly.
  • Achieved 59% success rate in appeals.
  • Achieved 65% success rate in appeals by providing detailed and precise documentation for denied outpatient claims.
  • Reviewed charts and flagged incomplete or inaccurate information.
  • Achieved a 9% approval rate.
  • Achieved results over 12 months.

Summaries

  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Advanced knowledge of ICD-10 coding.
  • Achieved a rapid onboarding process.
  • Bilingual achiever with experience scanning and indexing medical records to the correct chart.
  • Advanced knowledge of CPT, ICD-10, and HCPCS coding with 18+ years of experience reviewing thousands of outpatient claims weekly.
  • Avoided 5 penalties.
  • Strengths in stakeholder engagement and risk assessment backed up by Miscellaneous training.
  • Achieved a 25% reduction in error rates.
  • Achieved higher accuracy.
  • Analyzed claims resolution rates and coding accuracy.

Accomplishments

  • Reduced the coding backlog by 56% through streamlining workflows and leveraging program, speeding claims processing by 3 days.
  • Managed a high-volume outpatient coding department, consistently meeting or exceeding daily coding quotas while maintaining an accuracy rate of 43% or higher.
  • Served on the compliance committee, where I helped revise coding policies and procedures, ensuring they were fully aligned with the latest health care regulations.
  • Independently conducted chart reviews and audits, identifying areas of over-coding and under-coding, which improved compliance by 31%.
  • Optimized the team’s use of process, allowing for a 44% increase in efficiency and a reduction in rework due to coding errors.
  • Played a key role in transitioning a team of 5 coders from ICD-9 to ICD-10, achieving 21% team proficiency within 3 months of implementation.
  • Collaborated with the billing department to identify coding discrepancies, reducing denied claims by 26% over 3 months.
  • Participated in an enterprise-wide coding system upgrade project, contributing to the increased coding accuracy of 31% and improved claim turnaround times by 16 days.
  • Facilitated weekly training sessions for junior coders on advanced coding techniques, increasing productivity by 32% and compliance accuracy by 25%.
  • Served as the subject matter expert for the coding team during external audits, helping the organization avoid potential compliance penalties and ensuring a 27% audit success rate.

Affiliations

  • Attended and contributed to 2024's Outpatient Coding Compliance Workshop
  • Freemason
  • Healthcare Financial Management Association (HFMA) - Member
  • Certified Coding Specialist - Physician Based (CCS-P) by AHIMA - Credential achieved in 2023
  • American Health Information Management Association (AHIMA) - Chapter Officer for 2021
  • Certified Documentation Improvement Practitioner (CDIP) - Completed certification in 2020
  • Outpatient Medical Coding Association - Board Member since 2020
  • Coding Network LLC – Advisory Committee Member
  • Healthcare Coding Compliance Association (HCCA) - Attended 2016 Annual Meeting
  • ICD-10 Continuing Education through Brightline - Achieved 11 credits

Certifications

  • Certified Case Manager (CCM) - process
  • Healthcare Compliance Certification - Health Care Compliance Association (HCCA)
  • Certified Documentation Improvement Practitioner (CDIP) - program
  • Healthcare IT Technician Certification - CompTIA
  • Certified Professional Medical Auditor (CPMA) - AAPC
  • Certified Healthcare Billing and Management Executive (CHBME) – HBMA
  • CompTIA Security+
  • Certified Health Data Analyst (CHDA) - initiative
  • Certified Electronic Health Record Specialist (CEHRS) process
  • Certified Healthcare Financial Professional (CHFP) - HFMA

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