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Yyyyyy x. yyyyyy

- 2202 Eagle Bluff Dr.Ÿ Valrico, FL 33596 ( (xxx-xxx-xxxx *


Evaluation & Management (E & M) Auditor

Qualifications Profile


    Self-assured and efficiency-driven certified medical auditor with more than 22 years providing healthcare administration, medical coding compliance, revenue management, and evaluation/management audits in several healthcare businesses in the state of Florida.

    Detailed and meticulous with strong perseverance in delivering or exceeding expected outcomes.

    Well-organized and resourceful with multitasking skills that optimize limited resources to achieve outstanding results.

    Effective interpersonal communication skills and strong people management that bring diversity as an advantage in achieving shared commitments.


Key Expertise

    Medical Billing & Coding (CPT4, ICD9, & HCPCS)

    Healthcare Management

    Relationship Management (Clients, Stakeholders, Healthcare Professionals, & Suppliers)

    Policies & Regulatory Compliance (i.e., HIPAA, & Medicare/Medicaid)


    Healthcare Apps: EClinicals, Athena Health, Epic, Advantx, Isynergy, Zirmed, Medic 5.0/6.0, Medicaid Verification System, Vision/Misys, Availity, & WebMD

    Chiropractic Transcription

    Office Tools: WordPerfect 6.0



Professional Experience


Tampa Bay Hearing & Balance Center/ Select Physicians Alliance Ÿ Tampa Bay FL

Business Office Manager/ Revenue Cycle Management Nov 2008 - Present

    Abstract cases and assign CPT4, ICD9, and HCPCS codes for all inpatient and out-patient surgery evaluation and clinical procedures, reviewing claims to ensure assigned codes meet legal and insurance rules prior to submission.

    Conduct coding evaluation and management services using 1995/1997 guidelines for 4 ENT/Otology/Neurology physicians, and document audits of E/M services and procedures for 25 ENT physicians.


Brandon Ambulatory Surgery Center Ÿ Brandon, FL

Coding/Billing Specialist Jan 2007 Oct 2008

    Evaluated operative reports thoroughly to ensure correct reimbursements, assigning CPT4, ICD9, and HCPCS codes for billing purposes, maintaining logs to ensure proper reimbursement for all DME and special equipment used, and filing claims electronically while sending printed claims to insurance companies on a daily basis.

    Posted all Managed Care, Commercial, Medicare, and Worker s Compensation payments, adjusting and balancing entries as needed to ensure accuracy.

    Assisted Appeals and A/R Departments with codingrelated claims denials

    Reduced coding related denials by over 50% through proper analysis of rejection data and identifying trends.

    Maintained latest versions of the NCCI, LCD, NCD and other information for accurate claims submission.

    Developed and implemented several improvements in department policies and guidelines.


Women s Care of Brandon / DBA: Tampa Bay Women s Care

Coding Specialist/Assistant Office Manager Mar 2005 Dec 2006

    Abstracted/assigned CPT4, ICD9, and HCPCS codes on in- and out-patient surgery evaluation and medical records.

    Interacted with insurance companies to ensure settlement of claims, filing appeals to Managed Care plans, Medicare, Medicaid and Commercial Plans for proper reimbursements, responding to all Medicare requests, and appealing downcoded claims as necessary.

    Scheduled surgeries and obtained necessary authorization and pre-certifications

    Processed all patient and insurance refunds, posted patient payments, and performed daily bank deposits

    Provided administrative support, processing payroll timesheets and purchases of office supplies


Dr. Hyatt & Dr. Paniello / DBA: Tampa Bay Women s Care

Billing Supervisor Feb 1998 Feb 2005

    Reviewed all inpatient and out-patient medical records, surgical and clinical services, and invoices to assign CPT4, ICD9, and HCPCS codes for proper insurance billing and reimbursement.

    Reviewed EOB s for accurate payment and appealed improperly paid or denied claims, communicating results to management and initiating proper action as needed.

    Documented audits of E/M services and procedures, streamlined communications and appeals to insurance companies with new form letters, and simplified office procedures and discovery of reimbursement opportunities.




Yyyyyy x. yyyyyy

- 2202 Eagle Bluff Dr.Ÿ Valrico, FL 33596 ( (xxx-xxx-xxxx *


Professional Experience (continued)


Lee Memorial Health System Ÿ Fort Myers, FL

Financial Counselor/Outpatient Collector Mar 1996 Dec 1997

Physicians Primary Care of Southwest Florida Ÿ Fort Myers, FL

DBA: Gulfshore Obstetrics and Gynecology

Medical Secretary/Medical Records May 1994 Mar 1996

Gulf Coast Chiropractic Ÿ Fort Myers, FL

Assistant Office Manager Jan May 1994


Education & Credentials



    Prerequisite Courses for Registered Nurse Program


Professional Training & Certifications

    Active Notary Public

American Academy of Professional Coders

    Certified Professional Coder (2004 Present) | Certified Outpatient Coder (2005 Present)

    Certified Professional Medical Auditor (2013 Present)

Awards & Recognition

    Recognized for recovering large balances and winning major insurance appeals, Brandon Ambulatory Surgery Center

Professional / Academic Affiliations & Community Involvement

    Member: American Academy of Professional Coders

    Member: Association of Notary Public (2004 Present)

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