Coder I LifePoint Health – Remote May 2019 to Present
>Assign accurate ICD-10 diagnosis codes using compliant documentation.
>Assign accurate CPT/HCPCS codes to records using compliant documentation.
>Apply knowledge of Coding Guidelines to select the appropriate diagnosis code, and use available research and reference tools to understand the disease process and diagnosis.
>Interpret physician documentation within the coding guidelines and obtains clarification from physicians regarding vague or ambiguous record documentation.
>Enhances coding knowledge and skills with continuing education activities by reviewing pertinent literature.
>Effectively utilize Microsoft Office (Outlook) and department specific software applications. Able to communicate effectively and cooperatively in the workplace. Actively contributes to the achievement of Quality Improvement activities.
>Utilize critical thinking skills, decisive judgment and the ability to work with minimal supervision, and able to work in a stressful environment and take appropriate action.
Coding Claims Facilitator Ballad Health, MSMG – Johnson City, TN October 2018 to May 2019
> Currently interim coding for Mountain States Medical Group Neurosurgery and Neuroendovascular
> Previous projects include Hospitalist provider inpatient E/M audits/billing, Pre Bill claims edits, audits of claims held for use of high level subsequent inpatient codes.
> Responsible to provide accurate and timely coding, claims editing or correction of denials for diagnostic data, and accountable for conversion of diagnoses and treatment procedures into ICD- 10, and CPT coding classification systems. Coded diagnostic information is also used in strategic and long range planning.
> Acts independently in highly diversified and complex situations, and able to make sound decisions objectively and follow through. Much initiative is required in obtaining diagnoses from physicians. Has responsibility in orientation and training of new employees and/or students. Is active in Corporation wide performance improvement processes and participate as a PI team member as requested. Meets 95% accuracy, and consistently meets coding productivity standards.
> Satisfies all edits and denials for claims across the system which could include modifier edits, medical necessity edits, separate procedure edits, mutually exclusive edits, etc., and able to satisfy the edit or denial and process the claim for billing by reviewing the edit sent by the billing system, identifying the reason for the edit, then changing the codes reported, reviewing the medical record for documentation and adding ICD-10 diagnoses codes or CPT/ HCPCS codes, adding modifiers, etc. in compliance with all regulatory agencies.
> Maintains cooperative working relationships with coworkers, patients and providers, by use of good communication skills. The Coding Claims Facilitator will code claims as assigned before claim is processed for billing. Is able to work with limited supervision.
> Deals with confidential and sensitive information, as the position requires access to protected patient information (PHI). Therefore is accountable for appropriate use of the record and compliance with all confidentiality and security policy and procedures related to use, access, and disclosure of PHI. Patient Access Representative
Ballad Health, Johnson City Medical Center ED – Johnson City, TN August 2015 to October 2018
> Responsible for compassionate and comprehensive collection of accurate demographic, financial and clinical information needed to effectively register a patient for emergency services in JCMC. Completes patient admission/registration in registration system, reviews completeness and accuracy, obtains authorizations and signatures on required documents and maintains patient confidentiality.
> Proficient in accessing the correct medical record number on each patient to avoid creating duplicate medical record numbers. This is monitored by weekly reports to management and tracking any occurrences of duplicate entries. Accuracy of data entry in order to avoid creating duplicate Medical Records, including overlays, is of utmost importance.
> Responsible for verifying insurance eligibility and ensuring that all requirements, (i.e., referrals, pre-certifications, letters of medical necessity, etc..) set forth by third party payers are met prior to the registration of the patients for scheduled procedures and that appropriate information is available to case managers for follow-up on all inpatient admissions. Insurance verification must be obtained in a timely manner with emphasis on accuracy.
> Responsible for calculating and documenting required deductibles, co-payments and deposits and is further required to collect the patient’s out of pocket expense at the time of service according to Mountain States Health Alliance credit and collection policy. Required to maintain daily deposits for the facility, answer billing questions for our walk-in patients, ability to accept and apply payments in the cash management system, and required to enter discounts in the patient accounting system
> Monitors the Emergency Department Soarian Tracking Board.
> Provides direct compassionate and excellent customer service in all interactions with patients, family, physicians, nursing, EMS, and other departments within the facility.
> Multi-task in high paced situations while staying team oriented with excellent interpersonal communication skills
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