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Yyyyyy x. yyyyyy
0000 xxxxxx xxxx , xxxx , xxxxx 00000 xxx-xxx-xxxx ● Abc@xyz.com
Dedicated Reimbursement / Coding Specialist eager to contribute exceptional managerial skills toward supporting a dynamic organization in optimizing bottom-line performance
Office Management ~ Training ~ Staff Management ~ Revenue Cycle ~ Appeals / Denials
Profile
Substantial experience in managing all facets of healthcare office operations including hiring/staffing, training, payroll, budgeting, purchasing, performance management, billing, coding, and regulatory compliance,
Adept at reporting, reviewing, and auditing reimbursements from third-party payors in accordance with stringent regulatory, accounting, and contractual rules and regulations.
Ensure and enforce medical office compliance with HIPAA, OSHA, JCAHO, and CLIA regulations for maximum quality and control.
Meticulous, resourceful, and quality-focused with considerable talents in staff supervision, calendar management, coaching, mentoring, problem solving, and prioritization.
Extremely well-versed in medical terminology and Medicaid, Medicare, and third-party reimbursement regulations.
Adept at supporting, promoting, and maintaining a cohesive and respectful workplace climate essential to maximizing staff retention, morale, and satisfaction.
Excel in analyzing existing healthcare practices and orchestrating process improvements to elevate patient satisfaction while controlling expenses.
Selected Achievements
Continually praised by Surgery and Vascular departments for exhibiting exceptional performance.
Successfully maintained number of TES edits >30 days below goal of 15% of total number of edits.
Grew revenue by tightening department policies regarding proper use of CPT codes, modifiers, ICD10 codes, and medical documentation.
Formally recognized for exhibiting Patient First, Teamwork and Respect for five consecutive years, and presented with Reward and Recognition Certificate in 2011.
Championed new processes and elevated standards for customer service resulting in 99.1% positive feedback on 2011 patient survey.
Hired, trained, evaluated, and managed team of administrative professionals at the Perinatal Center.
Identified and persuasively authored six justifications for urgent capital items not in budget which were all approved by Director.
Employed sharp organizational skills toward planning and orchestrating opening of new office space within defined timeline and budget parameters.
Professional Experience
Washington Hospital Center, District of Columbia 1992 to Present
Reimbursement/Coding Specialist 2012 to Present
Plan, organize, and deliver in-depth coding and documentation training for all physicians and non-physician practitioners, including residents.
Continued ►
Yyyyyy x. yyyyyy Page 2 of 2
Professional Experience continued
Actively support Compliance Department in ensuring practitioner coding compliance by performing regular chart audits.
Closely review physician coding charges and compare patients MR and other documentation for accuracy and completeness.
Communicate incorrect coding and provide recommendations for continued training and targeted rebilling projects to ensure timely and optimal reimbursement.
Proactively identify unresolved coding edits and distribute Claims Manager reports to appropriate department managers.
Join forces with outsourced billing companies to analyze and respond appropriately to denial trends.
Continually update or revise super bills to ensure accuracy of CPT and ICD10 codes.
Research and resolve countless multi-specialty TES edits daily caused by unbundling, CPT and ICD10 inappropriateness, missing details, invalid place of service, duplicates, co-surgery billing, and other payor-specific edits.
Contribute dynamic communication skills toward effectively liaising between executives and internal/external stakeholders in support of achieving corporate objectives.
Spearhead solution determination for appeal vs. closure processes for CMS/commercial audits.
Scrutinize billing error trends and communicate specific information to providers for improvement and swift resolution.
Prior Roles with Washington Hospital Center:
Supervisor of Clerical Support 2008 to 2011
Medical Office Assistant III 2004 to 2008
Medical Office Assistant II 1997 to 2004
Medical Secretary 1992 to 1997
Professional Development
Plastics Coding and Reimbursement 2016
ICD10 Code Set Training 2014
Mastering General Surgery Coding 2013
Evaluation and Management (E&M) Services Coding 2012
Gynecologic Surgical Coding 2012
Obstetrical Coding 2012
Coding and Reimbursement for Vascular Surgery 2012
Good to Great Leadership Series 2011
Getting along with Difficult People 2011
Coding for Maternal-Fetal Medicine 2009
Communicate with Confidence to Physicians: Coding as a second language 2009
Certified Professional Coder 2008
Peer to Boss 2008
Microsoft Word and Excel 2007
Technology
Microsoft Office Suite (Word, PowerPoint, Excel), ReportXpress, Lotus Notes
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