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Yyyyyy x. yyyyyy
- 2202 Eagle Bluff Dr. Valrico, FL 33596 ( (xxx-xxx-xxxx * abc@xyz.com
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 (CPT‐4, ICD‐9, & HCPCS)
Healthcare Management
Relationship Management (Clients, Stakeholders, Healthcare Professionals, & Suppliers)
Policies & Regulatory Compliance (i.e., HIPAA, & Medicare/Medicaid)
Technical
Healthcare Apps: E‐Clinicals, 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 Tampa Bay FL
Business Office Manager/ Revenue Cycle Management Nov 2008 - Present
Abstract cases and assign CPT‐4, ICD‐9, and HCPCS codes for all in‐patient 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 Brandon, FL
Coding/Billing Specialist Jan 2007 Oct 2008
Evaluated operative reports thoroughly to ensure correct reimbursements, assigning CPT‐4, ICD‐9, 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 coding‐related 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 CPT‐4, ICD‐9, 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 in‐patient and out-patient medical records, surgical and clinical services, and invoices to assign CPT‐4, ICD‐9, 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. Valrico, FL 33596 ( (xxx-xxx-xxxx * abc@xyz.com
Professional Experience (continued)
Lee Memorial Health System Fort Myers, FL
Financial Counselor/Outpatient Collector Mar 1996 Dec 1997
Physicians Primary Care of Southwest Florida Fort Myers, FL
DBA: Gulfshore Obstetrics and Gynecology
Medical Secretary/Medical Records May 1994 Mar 1996
Gulf Coast Chiropractic Fort Myers, FL
Assistant Office Manager Jan May 1994
Education & Credentials
EDISON COMMUNITY COLLEGE Fort Myers, FL (1994)
Pre‐requisite 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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