Coding Resume Samples

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R Kutch

Rosalyn

Kutch

89390 Luis Course

Los Angeles

+1 (555) 282 1447

89390 Luis Course

Los Angeles

Phone

p +1 (555) 282 1447

Experience Experience

Phoenix, AZ

Supervisor, Coding

Phoenix, AZ

Wyman, Mraz and Leannon

Phoenix, AZ

Supervisor, Coding

Assists in the selection, responsible for the orientation, training, counseling, and mentoring of coding staff. Closely monitoring the work of new coding staff member to ensure the quality and quantity of a new employees work meets department's expectations. Schedules staff to ensure adequate coverage of the coding function. Assists in the completion of performance evaluations
Assists in the development, implementation, monitoring, and maintenance of any coding compliance programs set for Steward and/or Morton that supports sound and compliant coding practices by employed and contract coders
Responds to requests for data/information, such as outstanding queries, denials due to coding, staff productivity monitoring and reporting, coding accuracy rates etc. in a timely manner
Provide support to the Revenue Enhancement Coordinator and coders when identifying and correcting claims that have failed coding edits
Review claim denials and rejections pertaining to coding and medical necessity issues
Perform duties and responsibilities in a fashion which coincides with the service management philosophy of the UPMC including the demonstration of the basics of service excellence towards patients, visitors, staff, peers, physicians and other departments within the medical center
Participate in the recruitment and evaluation of coding department staff members under direct supervision. Assist management in the formation of quarterly and yearly goals and other special projects as requested

New York, NY

Coding Education & Quality Coordinator

New York, NY

Bosco-Hilll

New York, NY

Coding Education & Quality Coordinator

Analyzes and evaluates highly complex clinical and operational systems relative to inpatient and outpatient reimbursement through chart review and other special study methods
Provides assistance with coding as workload permits
Monitors highly complex coding compliance via pre-billing coding, DRG and APC quality audits, case mix analysis, and compliance software reviews and through other methods
Provides feedback to the coding management team and staff regarding highly complex ICD-9-CM/CPT-4 or ICD 10 CM/PCS coding and DRG/APC assignment and related clinical documentation
Provides assistance with highly complex coding as workload permits
Provides coder orientation, training and education on all relevant issues which will impact technical coding in HIM. Assists with the analysis of case mix reports and other statistical reports
Makes recommendations for data quality improvements and revenue enhancements

present

Detroit, MI

Manager, Coding

Detroit, MI

Gerlach, Graham and King

present

Detroit, MI

Manager, Coding

present

Provides staff development through performance management, training and mentoring
Evaluates and recommends new technology to assist the departments in performance of their duties
Will perform a variety of complex tasks related to the leadership and managing work of others
Develops departmental strategic operational planning including staffing and fiscal management
Maintains department statistics on work volume, productivity and accuracy for use in long range planning and budgeting
Completes employee performance evaluations within 14 days of due date
Develop HIM coding tools, resources, and education materials

Education Education

Bachelor’s Degree in Health Information Management

University of Massachusetts Amherst

Bachelor’s Degree in Health Information Management

Skills Skills

Maintains a professional appearance and demeanor
Thorough knowledge and significant experience in ICD-10/CPT4 coding, DRG assignment, APC assignment, PPS payment systems and CMS compliance issues
Assists in the orientation of others and actively participates in mentoring
Handles interruptions in a skillful way
Is cooperative in interactions, treating customers with courtesy, respect and compassion
Strives to prevent/resolve customer concerns to the customer's satisfaction
Is responsible for ongoing development of his/her work skills through the use of available resources (i.e.: in-services, formal educational programs, other work groups and on-the-job training)
Responds to requests in a timely manner
Performs analytical and decision making functions with minimal supervision
Recognizes and seeks assistance/consultation when appropriate

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Asset Management Guideline Management Ptc Tripwires & Thinkfolio Coding Associate Resume Examples & Samples

Manage all aspects of guideline management, from sign-off of new mandates, interpretation and coding, through to review breach information
Interpretation of investment restrictions for Funds (Regulatory, Prospectus and Internal restrictions) and segregated mandates, covering Equity, Multi Asset, Private Equity and Real Asset portfolios
Negotiate guidelines with investment desks and CPMs to prevent manual guidelines
Ensure any agreed upon manual guidelines are documented fully via the Risk Acceptance process
Oversight and coding of investment guidelines into our proprietary compliance system PTC/Tripwires (Equity) and our vendor based application thinkFolio (Multi Asset)
Foster strong working relationships with the front office, whilst maintaining an independent view
Attend external user group forums to discuss the impact of regulatory changes
Review guideline restriction coding as part of the account reviews process
Updating department procedures
Good Product knowledge covering all the major asset classes
Ability to deal with people at all levels within the organisation
Able to multi-task and constantly prioritise workflow
Working knowledge of the regulatory framework for European funds (UCITS)
Control orientated
Strong all round PC skills (Microsoft applications)
Good organisational skills

Coding Support Coordinator Health Information Management Hour Days Resume Examples & Samples

3 years Health Information Management experience in an acute care facility
Preferred data entry and basic office skills, i.e.; fax, copy machine, printer, computer
EPF and Cerner process and workflow, Synapse radiology system, Allscripts Clinic notes, and Aria/Varian radiation oncology notes

Health Care Coding Consulting Manager Resume Examples & Samples

Develops, grows and manages coding members of the consulting group's Health Care Regulatory Compliance practice
Develops opportunities and manages coding audit and validation services to our Health Care clients
Works with the practice offices and their health care clients to provide coding and compliance support
Uses technical knowledge and professional consulting experience to provide effective project management and practice development
Minimum of 6 years coding experience to healthcare organizations
One of the following required CPC, CCS-P, CCS, or RHIT
Auditing experience specific to Coding Auditing and Validation Reviews preferred
Thorough knowledge of ICD-9-CM and CPT/HCPCS coding classification systems
ICD-10 Training or approved by AHIMA
Knowledge of medical terminology and anatomy/physiology
Experience working with Electronic Medical Records preferred
Creative and persistent problem solver with strong organizational skills, attention to detail and accuracy
Ability to multi-task, prioritize workload, and meet deadlines

Health Care Coding Senior Consultant Resume Examples & Samples

High School diploma or equivalent required; Bachelor’s degree in related field preferred
CPC, CCS-P, CCS, or RHIT required
Minimum of 3 years of chart abstraction and coding
Knowledge of rules and regulations related to coding and billing (including Medicare, Medicaid, and commercial payers) required
Auditing experience preferred
Knowledge of ICD-9-CM and CPT-4 coding classification systems
Strong interpersonal and presentation skills required for training, implementation of educational programs for client staff and physicians, education programs, and client interaction
Experienced with MS Office Suite (Excel, Word, PowerPoint)
Travel will be required 10%-25% travel required; up to 50% travel possible

Technical Coordinator, Securities Coding Resume Examples & Samples

Works well with the Pricing as well as other internal partner areas. Builds/Maintains close working relationships with global Pricing partners for best practice sharing and internal consulting in support of valuations
Carries out complex activities with significant financial, client, and/or internal business impact
Assists Team Lead in proactively ensuring effective workload management and queue monitoring is done
Keeps abreast of emerging industry trends, and reflects industry knowledge in internal decision making and improvement recommendations
2-3 years of previous securities operations experience and/or college or University degree. Experience with market data vendors and products is preferred

Business Analyst Billing & Coding Resume Examples & Samples

Business requirement elicitation experience
VS&R documentation experience
Familiarity or experience with Electronic Medical Record and Practice Management systems
Prior work history in a fast paced shared support organization
Bachelor’s Degree in Business or a related field
Working knowledge of MS Office
Able to travel up to 50%
Billing and Coding knowledge
Ability to configure accurate billing and/or coding settings
Worked in a physician practice/health system environment leveraging electronic medical record and practice management systems
Familiarity with Humana’s IT or Systems Development Life Cycle (SDLC) processes

Healthcare Coding Resume Examples & Samples

3-5 years’ experience in coding, billing, and/or auditing in physician practice or hospital-based physician setting
Certified coder by AAPC or AHIMA (i.e. CPC)
Knowledge of ICD-10-CM and/or ICD-10-PCS
Knowledge of work RVUs and compilation
Articulate with excellent communication skills
Ability to code
Bachelor's Degree in Science

Coding Claims Cost Research & Opportunity Analyst Resume Examples & Samples

Extensive Knowledge of CPT & ICD9-CM coding experience or Certified CPT Coder
1 year or more of medical claims experience
Proven experience analyzing data and identifying trends
Excellent time management and ability to work under minimum supervision
Proven examples of utilizing Microsoft Access, Excel (ability to manipulate/filter)
Ability to thoroughly research inconsistences and find applicable solutions
2 years of previous technical, discounting, claims processing or subrogation experience
Experience with Medicaid and/or government funded healthcare plans
Experience with Commercial and/or Medicare healthcare plans
2 years or more of medical claims experience
Medical Claims adjudication
Provider At A Glance, Contract Information System
Ability to read and interpret physician and/or facility contract language
Proven experience with facility and/or physician medical claims payment reimbursement

Learning & Development Coding Content Coordinator Resume Examples & Samples

3+ years of experience in the Training Technology / Content Management function; 2+ years of solid experience in creating and delivering Coding & Documentation training
Bachelor's Degree in Training and Development, Organizational Design, Organizational Development, Human Resources, Psychology, Business / Technical Writing, Communications, Literature or a related discipline
Knowledge of ICD-10
Strong knowledge of learning and development technologies and content management
Experience in implementation and testing of eLearning content
Knowledge of various eLearning rapid-development software products
Solid critical thinking and problem solving skills
Solid analytical and creative problem solving skills
Able to multitask efficiently and effectively

Health Care Coding Consulting Senior Manager Resume Examples & Samples

Develops opportunities and manages regulatory compliance, investigations, coding and billing projects to our Health Care clients
Works with the practice offices and their health care clients to provide compliance and coding support
Actively pursues marketing opportunities to develop the business
Minimum of 7 years coding experience to healthcare organizations
One of the following required CPC, CHC, CMCO, CPCO
Knowledge of rules and regulations to coding and billing (including Medicare, Medicaid, and commercial payers) required
Understanding of reimbursement and billing
Strong written and verbal communication skills, including strong interpersonal and presentation skills required for educational programs and client interaction
Proven experience effectively managing multiple healthcare consulting projects desired
Experienced with MS Office Suite (Excel, Word, PowerPoint). Advanced Excel skills

Senior Analyst, Securities Coding Resume Examples & Samples

Analytical and problem solving skills are required
Technically sound in area of expertise and has broader knowledge of other areas
Emerging as an expert in a specific skill set but remains focused primarily on daily execution
3-5 years of related experience a plus

Clinical Coding Resume Examples & Samples

5+ years of relevant work experience
CCS, CCS-P, RHIA, or RHIT
Background knowledge of Inpatient DRGs and aspects of the Prospective Payment System
In-depth knowledge of Guidelines for proper assignment of diagnoses and procedure codes
Expert coding knowledge
Full knowledge of DRG Validation process
Thorough knowledge of proper application of ICD coding guidelines, rules and regulations

Supervisor, Coding Resume Examples & Samples

1-2 years Health Information Management experience in an acute care facility
Knowledge of Electronic Health Record process and workflow
A Fire and Safety card must be presented upon hire or must be obtained at our facility within the first 30 days of hire and maintained by renewing before expiration date

Coding Investigator Resume Examples & Samples

Certified Coder with either CPC, CCS, RHIT, or RHIA
3-5 years inpatient DRG coding experience or physician coding experience or risk adjustment coding
Strong communication skills both written and verbal
Computer literate (MS, Word, Excel)
Bachelor’s Degree in business or health related field
8-10 years coding experience
3-5 years auditing experience
3M Coder experience
Prior healthcare fraud investigations experience

Business Process Lead-email Coding Resume Examples & Samples

Bachelor's Degree with up to 5 or more years of related experience
Proficiency with the Adobe Creative Suite
Experience in HTML, XHTML, CSS, and JavaScript is required
Ability to work in a fast paced fluid environment against tight timelines

MRA Coding Production Lead Resume Examples & Samples

Monitor and recommend improvements to increase team productivity by providing expert advice and assistance to other associates, as needed
AAPC Certified
CPC Certified
ICD-10 certified
Experience in another position where you have earned the respect of team members and management
Clear and concise written and verbal communication skills
Proven ability to remain objective, professional and focused regardless of the business situation
Exceptional attendance with a history of schedule flexibility and willingness to work extended hours as necessary to meet business needs
Proficiency in all Microsoft Office Programs (Word, Excel, PowerPoint
Demonstrated aptitude toward coaching and developing associates both formally and informally
Must have the confidence to act as an authority in managing the call floor and providing constructive criticism in a positive and professional manner
Experience in training or formal presentations with confidence to train or present to a variety of audiences including management
Willing to commit 2 years to the role
Exposure to Medicare Risk Adjustment
Experience in Quality Assurance
Understanding of databases and Microsoft Access

Coding & Documentation Improvement Educator Resume Examples & Samples

Prior work experience with curriculum presentation delivery
Computer literate (MS Word, Power Point, Excel)
Must be willing to obtain CPC if you do not have this certification
Bachelor's or Master’s Degree

Coding Audit Manager / DRG Validator Resume Examples & Samples

5+ years of Coding experience in an Acute Care Hospital and or Ambulatory setting
Education and training in ICD-9, ICD-10, and/or CPT coding
Microsoft Office/Suite proficient (Excel, Word, PowerPoint, etc.)
Associate's and/or Bachelor's Degree in Health Information Management or Science
CCS, RHIT, or RHIA

Asset Management Gim-guideline Management Coding Associate Resume Examples & Samples

Manage all aspects of guideline management, from sign-off of new mandates, interpretation, coding, quality control and through to review breach information
Interpretation of investment restrictions for Funds (Regulatory, Prospectus and Internal restrictions) and segregated mandates, covering Fixed Income and Currency portfolios
Ensure any agreed upon manual guidelines are identified and recorded
Oversight and coding of investment guidelines into Fidessa Sentinel
Ensure adherence to all Policies and Procedures affecting Guideline Management
Partner with Information Technology and the Business in order to ensure the systems are enhanced to cover ongoing Client and Regulatory requirements
Help implement guideline management control system enhancements and the integration of new systems
Work closely with other guideline management teams throughout the US and Asia in order to establish the best working practises within the industry for guideline management
Create regular MIS and metrics
Adhoc requests from the business
Working knowledge of compliance applications used within the industry for the coding of investment guidelines
Strong decision making skills
Excellent team working and communication skills
Results focus

Temporary Document Coding Technician Resume Examples & Samples

At least one year of experience in document management coding or data entry related experience
Ability to analyze documents to extract appropriate level of information
Typing skills and familiarity with office automation programs, especially data entry
Ability to understand and follow oral and written instructions explicitly and consistently
At least one year of experience using MS Office and/or database applications
Microsoft Word, Excel and typing skills required
Proficiency in workflow mgmt application/evidence tracking module
Thorough understanding of chain of custody procedures and processes

Coding & Reimbursement Consultant Resume Examples & Samples

Perform documentation and coding reviews and provide coding support for clients both onsite and offsite (though most work can be done from our offices)
Prepare and present reports to clients
Perform related research and serve as a resource for clients and Wipfli’s Health Care Consulting team
Maintain a high level of knowledge of Medicare guidelines, other payer rules, and coding changes
At least one of the following credentials and completion of ICD-10 trainer curricula: CPC, CCS, CDIS, CPMA, CCDS, RHIT, RHIA, or Licensed Nurse, with a background in CDI or health information management
5+ years of current coding experience to include auditing expertise and communicating results to providers
Strong knowledge and understanding of medical terminology, anatomy, physiology, and disease process
Experience with the Microsoft Office Suite and proficiency in databases used for clinical documentation (EHR) and coding research (encoders)
Willingness to travel (estimated 20-30% travel)

Bilingual Market Research Coding Clerk Resume Examples & Samples

Ability to effectively read and comprehend English verbatim responses
Abililty to read and then categorize survey responses from surveys completed in German to English
Able to work across multiple projects at the same time in order to meet deadlines
Ability to maintain well organized project information and materials
Able to work under tight deadlines
Skilled and effective in the use of the Internet when researching various project requirements
Ability to monitor, adjust and revise their work to ensure high quality prior to delivery
Effectively create a summary of important points within a file of comments for client review
Support and assist Team Leaders and fellow Coders in a positive proactive manner
Self-motivated, positive attitude
Client service approach
High level of organization
Professional appearance and attitude
Technical knowledge
Strong knowledge of social media platforms including Facebook, Linked in, Twitter, Instagram

M HIS Coding Client Manager Resume Examples & Samples

An Associate Degree or equivalent or higher from an accredited university
Minimum of three or more (3+) years of experience within HIM industry
Minimum of five or more (5+) years of experience in physician professional fee coding
Minimum of one (1) year of experience in CPT, ICD-10 coding guidelines
Minimum of one (1) year of experience with MS Word, Excel, Power Point, and technical applications
Minimum of one (1) year of experience using computer assisted coding, reports and information storage and retrieval
Bachelor's degree from an accredited university
Strong technical understanding and computer skills
Experience in auditing, training, and communicating coding regulations
Radiology specialty coding

M HIS Operations Analyst, Coding Services Resume Examples & Samples

Participates in the development of strategic goals and assures implementation of objectives related to the coding operations business unit
Develop project staffing and capacity analysis
Conduct problem analysis and proper troubleshooting procedures to coding projects
Manages independent contracts and coding business partners
Provide quality customer service to internal coding team
Develops individual coding improvement activities based on coder results
Serves as a project staffing resourced to coding supervisors
Manages independent contractors, outsourced coders, and clients
The coding operations analyst works directly with the coding operations leadership team to develop ongoing coding excellence within operations
Handles special projects as assigned by the manager of coding operations
Serves as a product and coding subject matter expert
Associate’s degree or higher from an accredited university
Minimum of two or more (2+) years of experience within the HIS industry
Experience with MS Word, Excel, Power Point, and technical applications
Previous experience using computer assisted coding, reports and information storage and retrieval
Bachelor’s degree or higher from an accredited university
Previous experience managing clients
Strong technical understanding and computer skills (ability to run SQL reports)
Experience in data mining and generating reports
Experience navigating through Electronic Health Records and paper charts to identify sufficient documentation of billed services preferred
Meeting facilitation skills internal

Clin Coding Appeals Auditor Resume Examples & Samples

Education: Associate's Degree in Health Information Management required
Experience: Five years of coding experience
Licensure: RHIA or RHIT
Skills and Abilities: Demonstrates clinical coding skills. Excellent oral, written and interpersonal communication skills. Ability to write comprehensive, well written appeal letters. Knowledge of statistics, medical terminology, and basic healthcare finance. Ability to effectively manage multiple demands. Knowledge and experience with Health Information Systems, preferably 3M, SoftMed, Streamline and/or EPIC. Experience with spreadsheet and word processing software

Billing & Coding Adjunct Faculty Resume Examples & Samples

Bachelor's degree preferable Health Care-related
Certification and Coding experience preferred
Membership in a professional association tied to area of instruction preferred
Outstanding conflict resolution skills
Ability to develop and complete projects without continued direct supervision
Ability to learn from students' participation, demonstrates fair and consistent behavior in all matters, and shows compassion without being ineffectual

Compliance Specialist Hcc Coding Resume Examples & Samples

70%
Thorough understanding of clinic coding (E/M) documentation requirements and HCC concepts impacting population Health Risk Adjustment reimbursement initiatives
Ability to review documentation and abstract all codes with specific emphasis on identifying the most accurate severity of illness according to CMS HCC guidelines
Medicare Risk Adjustment/HCC Coding
Proficient in Excel, PPT and WORD
Excellent Written and Verbal Communication Skills
Ability to work across a matrix environment
Presentation Instructional/Training Skills
Good Problem Solving and Critical Thinking Skills

Strategic Services Associate Revenue Cycle Project Manager Coding Resume Examples & Samples

Plan activities aimed at improving the hospital's performance in operations or clinical quality
Identify opportunities for improved performance. Analyze data to identify adverse trends and/or undesirable performance
Utilize performance improvement techniques and methodologies
Serve as a project manager for interdisciplinary teams
Establish performance targets
Design and implement strategies for enhancing performance
Evaluate effectiveness of improvement strategy through sustained monitoring of performance
Contribute to the establishment of performance improvement priorities for departments, functional units and for the organization as a whole
Support organization's efforts to maintain compliance with regulations and accreditation standards. Monitor compliance through formal and informal processes. Recognize opportunities for improving compliance
Design and implement strategies for enhancing compliance
Evaluate effectiveness of improvement strategy through sustained monitoring of performance. Increase organizational understanding of performance improvement methodologies and principles and compliance through the support of and participation in formal and informal professional development activities
Serve as an expert resource on performance improvement and compliance as it relates to organizational role
Produce reports and presentations on performance improvement and compliance
Develop, maintains and enhances knowledge through orientation, self- evaluation and professional development
Responsibilities may include varying levels of strategic planning and human and fiscal resource management
Perform other related duties incidental to the work described herein

Coding Coordinator Resume Examples & Samples

Provide direction, assignments, feedback, coaching and counseling to assure outcomes are achieved. Ensure staff achieve and maintain proper certification
Team members could be primarily remote
One or more years of medical coding experience
Knowledge, understanding and experience with CMS regulations or industry standards
Knowledge of anatomy and physiology
Proficiency with standard office computer software applications (i.e. Microsoft Office Suite)
Excellent, professional verbal and written communication skills to provide outstanding customer service and support a "Service Excellence" environment working with a diverse professional and patient population
Demonstrated ability to work effectively in ambiguous and complex situations and to drive for conflict resolutions in positive, professional manner
Ability to prioritize and coordinate inquiries from patients, staff and administration
Excellent analytical skills and a strong attention to detail with accuracy with the ability to achieve or exceed organizational and individual performance goals
Bachelor's degree in Health Information Management (HIM) or related field
Supervisory experience (typically 1 or more years supervising medical coding and/or billing)

Coding Coordinator Resume Examples & Samples

*Please note: Five (5) professional references will be required at a later step during the hiring process
1-3 years of experience in hospital and physician services coding, medical record/compliance auditing, reimbursement analysis and insurance/Medicare issue resolution
Knowledge (3-5 years) of various coding systems used by hospitals and physicians including ICD-9-CM, ICD-10-CM/PCS, CPT, HCPCS
Proficiency with computer software applications (such as MS Office Suite or comparable programs)
Excellent, effective written and verbal communications skills to achieve and provide quality customer service by demonstrating positive professional demeanor at all times
Adaptability, creative problem solving, project management and organization skills
Knowledge of team dynamics and skilled in building consensus. Ability to develop and maintain effective relationships with internal and external partners
At least two years of demonstrated leadership experience
Training and/or teaching experience
Experience in identifying and planning for possible impacts on projects
Maintain a thorough and competent knowledge of PFS & CID business operations
Maintain awareness of healthcare trends and information system technology
Strives for continuous improvement of technical and professional skills

Senior Coding & Reimburs Spec-ob Gyn Pavilion Lbk Resume Examples & Samples

100% chart audits, coding and clearing of provider clinic, lab, radiology and hospital claims specializing by site to include Pavilion (teaching clinic), Grand Expectation, The Center for Reproductive Endocrinology & Infertility, The Center for Perinatal Medicine, Southwest OBGYN Associates at Southwest Medical Center, Gynecological Oncology at SWCC, OBGYN Lab and Embryology Lab
Audit contract logs for timely and accurate reimbursement
Audit Self-Pay accounts, discount, re-bill, appeal and make collection calls
Audit denials, re-bill, appeal accordingly
Audit the Reallocation Payment Report and move money accordingly
Audit the "Did Not Extract" list and bill accordingly
Educate physicians on correct coding and documentation practices. Communicate to physicians any overdue documentation needed to bill
Maintain coding certification(s) by attending professional development events and earning required CEUs

Coding Data Specialist Resume Examples & Samples

Understand CPT and ICD coding
Evaluates the medical record for procedures and diagnoses documented in the medical record and accurately assigns ICD-9, HCPCSs, Modifiers, and CPT codes, based on National Coding Guidelines
Abstract data elements
Assists in the identification and recommendation of system edits
Code within timeframes established by Allina hosptial coding standards
Knowledge of APC classification
Will be reviewing provider dictation and charge entry done by business ops personnel to make certain that correctCPT codes are billed and appropriate diagnoses assigned in accordance with Provider dictation
Reports for coder use are created and maintained in both business software applications and are used for tracking productivity, denials, and level of service changes made by coders
Update education through online information as well as courses available to them in order to maintain strong coding skills and knowledge of legal compliance standards
Knowledge of Medicare/CMS requirement and Allina Policy; will perform the job in accordance with Allina’s Standards of Business Conduct, which include principles of legal compliance, ethics and integrity, confidentiality, protection of assets and avoidance of conflict of interest and inappropriate business relationships

SQL Coding Resume Examples & Samples

Requires a BS/BA degree in related field
3-5 years data analysis or related experience; or any combination of education and experience, which would provide an equivalent background
Experience with relational databases and knowledge of query tools and statistical software is required
Ability to manipulate large sets of data is also required
Strongly prefer advanced SQL coding skills
Strongly prefer experience gathering business requirements
SSRS / SSIS / SSMS experience strongly preferred
Prefer claims and healthcare industry experience

Coding & CDM Analyst Resume Examples & Samples

Assists in the development and integrity of compliance content as needed
Applies coding and compliance knowledge to daily activities
Coordinates, manages, and plans designated projects in collaboration with other departments to ensure that all projected deadlines are accomplished
Evaluates and provides operational improvements in business processes related to billing, chargemaster, and/or clinical coding integrity
Effectively communicates with internal and external clients and staff
Performs and analyzes using coding, billing and other regulatory resources as needed
Provides education in the ever changing world of coding and Medicare compliance including educational webinar conferences, workshops, contribution of articles in newsletters and E-Alerts/Informants as needed
Understands the designated hospital charge structure and develops recommendation for content throughout designated compliance products
Provide support for client service to ensure that any client issues or concerns are resolved appropriately and timely
Maintain quarterly/annual content updates in designated compliance technology products and recommends inclusion of new data and ensures quality and timeliness of data entry
Assists in the success of the compliance help desk and provide accurate, credible and supportive responses within 48 business hours based on teams standardized guidelines and established protocol
Follow all policy/procedure/process documents pertaining to departmental processes and workflows
Actively participate in departmental and Company-wide meetings and adhere to all published and accessible department and company-wide policies and procedures
Contributes to the overall team and company goals
Responsible for reporting violations of the company's policies and procedures, Standards of Business Conduct, governance program, laws and regulations through the company's Help Line or other mechanism that may be available at the time of the violation. Assists with internal control failure remediation efforts
Becomes knowledgeable of internal control responsibilities through training and instruction. Responsible and accountable for internal control performance within their area of responsibility. Participates in the internal controls self-assessment process
BA/BS or 3+ years related experience required, or equivalent combination
Minimum of 3+ years experience in the assessment and integrity of billing, CDM and/or revenue integrity
Hospital and/or physician experience and/or knowledge of hospital and/or physician and Medicare coding & billing guidelines is required including but not limited to usage of medical terminology, CPT/HCPCS, various prospective payment systems, an applicable federal and local regulations
Ability to read, research, analyze, interpret general business periodicals, professional journals, technical procedures or governmental regulations
Ability to write reports and business correspondence and effectively present information and respond to questions from groups of managers, customers and employees
Proven ability to utilize specialty software to complete essential duties and responsibilities
Solid knowledge of all MS Office Products; Access experience preferred
Clinical experience/Coding Accreditation/certification AAPC (CPC, CPC-H) or AHIMA (CCS, CCS-P) preferred

Coding Operations, Senior Consultant Resume Examples & Samples

Responsible for the daily operations of coding division including monitoring quality and quantity of workflow to ensure completion of work assignments
Serves as primary Coding department representative for resolution and improvement of revenue cycle initiatives/issues
Maintains understanding of assignment scope of work and manages performance within the agreed upon scope
Actively works and understands the DNFB/DNFC process. Delegates tasks and leads team in DNFB/DNFC activities to comply with organization and leading practice goals
Communicates with the Director of Health Information Management to support revenue cycle activities and key performance indicators
Assists in the development of coding and abstracting policies and practice standards and communicates all policy changes as requested
Oversees work assignments of system wide coding staff and adjusts work lists to accommodate volume and schedule changes
Identifies need for educational sessions in collaboration with audit team
Provides educational support and training of coding and documentation practices for all of coding and clinical staff
Hires, trains, counsels, disciplines and terminates coding staff (onsite and remote) when necessary
Performs annual and introductory performance evaluations on staff
Provides cost effective management of resources
Authorizes and coordinates payroll
Assesses scanning/coding workflow processes, identifies innovative solutions when improvement is needed and initiates changes
Acts as a liaison to Clinical Documentation Improvement staff to facilitate documentation issues identified by coders
Acts as a liaison to physicians to facilitate any Physician Query questions
Reviews physician queries submitted by coders for leading or non-compliant language
Assists in developing new query forms as needed
Provides weekly reports to client and the Sr. Director of HIM Consulting
Interacts with billing office, physicians, IT, and hospital personnel to resolve coding/billing issues
Works on multiple IT platforms, including patient finance, encoders, as well as Precyse and client IT systems
Participates in the processing of RAC audits as well as all types of internal and external auditing
Stays abreast of the differences in payment processes amongst insurance payers
Possesses a solid grasp of the charge master, revenue codes, processing patient type changes, cancelled accounts, and working multiple edits
Keeps abreast of new legislation and regulations that affect HIM
Participates on all applicable committees and professional organizations and maintains personal and professional education and growth
Makes travel plans timely
Presents on the Precyse HIM Consulting call once per year on a relevant Industry or client topic
Identifies two additional Precyse opportunities per year
RHIT or RHIA. Must maintain credentials through completion of required CE requirements
Bachelor’s Degree in Health Information Management or related field preferred
5+ years as a Coding Manager with oversight of coder performance within an Acute Care hospital
Candidate must be able to code and audit both inpatient and outpatient records
Experience with coding workflow redesign in Acute Care hospital facilities
Possesses a strong grasp of MS-DRGs, APCs, and ICD-10 coding requirements
Requires strong interpersonal skills to work with physicians and staff to implement positive change
Demonstrated customer-oriented management style
Demonstrates knowledge of computer technology and automated system designs for HIM; computer knowledge of MS Office including Word, Excel, and PowerPoint
CCS
Demonstrated ability to speak clearly and concisely while presenting is preferred

Coding Appeals Associate Resume Examples & Samples

Experience in medical coding for oncology and/or hematology
Experience in the research, development of, writing and submission of appeals for denied medical claims required
Knowledge of medical billing process
Knowledge of medical coding (ICD-9, CPT, HCPCS)
Knowledge of Microsoft Word, Excel and Power Point
Critical Thinking, Multi Tasking
Exceptional ability to communicate both in writing and orally on moderate and complex issues to a wide variety of customers and contacts
Excellent overall knowledge of coding
Helps train and/or check work of level 1 coders
Answers questions of other coders

Coding Tech-mmg Brunswick Resume Examples & Samples

Assures that all departmental services performed generate a charge through monitoring of monthly productivity reports and schedules
Assists CPN and HSF patient account representatives with coding questions related to denied and/or claims requiring further information
Performs a comprehensive review of charge forms and medical record documentation for coding accuracy and completeness for assigned specialties to charge entry
Makes coding recommendations to providers to ensure the following: appropriate revenue generation, compliance with Medicare and other third party billing guidelines, and charge capture for all billable services prior to charge entry
Functions as a resource to staff providing assistance with coding concerns as needed
Monitors reimbursement problem areas and works with applicable staff to resolve problems and optimize reimbursement and profitability
Reviews and analyzes denial information from Central Billing Office, Medicare and third party payors on claims filing, coding and the adjudication process

Clinical Coding IV / Acute Care / Arrowpoint Resume Examples & Samples

Demonstrates the technical competence to use the facility encoder as it interfaces with the hospital mainframe and/or EMR in an on-site or remote setting
Reviews charges and Evaluation and Management levels
Stay abreast of coding principles and regulatory guidelines related to inpatient and/or outpatient coding

Clinical Coding Nurse Consultant Resume Examples & Samples

Educate practitioners/clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process. Ensure all Market Leaders are utilizing established tools and are able to downstream this education in their prospective markets
Create a team-oriented work climate that enables professional development and encourages creative solutions and strategies, establishes collaboration and emphasizes quality and cost Provide leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff
Ability to work a flexible work schedule and travel to markets requiring overnight stay
Ability and willingness to travel (locally and non-locally) as determined by business need

Coding & Documentation Improvement Specialist Resume Examples & Samples

Performs concurrent coding quality reviews for newly hired and contracted providers (NP, PA, MDs) of 100% of all records until the provider achieves 95% accuracy rate
Performs 100% Comprehensive concurrent coding quality reviews for providers in each market for all CPM lines of business (NP, PA, MD)
Evaluates documentation to ensure that diagnosis coding is supported and meets specificity requirement to support clinical indicators, HEDIS and STARS quality measures
Queries providers regarding missing, unclear, or conflicting health record documentation by requesting and obtaining additional documentation within the heath record
Provides feedback and works with Clinical Documentation Improvement Educator to develop targeted education and training to improve accuracy
Develops relationships with clinical providers and communicates coding and documentation guidelines and requirements of the Risk Adjustment program to ensure correct coding and documentation
Maintains a 96% quality audit accuracy rate
Performs the minimum number of coding quality reviews consistent with established departmental goals
Takes direction and guidance from Supervisor of the Risk Adjustment Coding and Documentation Improvement Specialist and the Manager of the Risk Adjustment Coding and Documentation Improvement Program
Coding Certification from AACP or AHIMA professional coding association (CPC, CPC-H, CPC-P, RHIT, RHIA, CCS, CCS-P)
3+ years active coding experience with ICD diagnosis and E / M coding
1 year experience as an ICD coding Auditor
Working knowledge of ICD diagnosis coding rules and guidelines
Working knowledge of CPT/Evaluation and Management guidelines
Working Knowledge of CMS Risk Adjustment and HCC Coding Process
Requires strong verbal/written communication and interpersonal skills
Must have the ability to perform in a deadline driven environment
Ability to analyze facts and exercise sound judgment when arriving at conclusions
Ability to effectively report deficiencies with a recommended solution in oral and/or written form
Proficiency with Microsoft Office applications to include Word, Excel, PowerPoint and Outlook

Coding Quality Analyst Resume Examples & Samples

Processes attestation sheets and progress notes out of the DataRap work queue according to department guidelines
Analyzes progress notes and documentation sent by providers for validation following CMS guidelines and ICD-9 / ICD-10 Coding Manual guidelines and enters final results into appropriate tab of the DataRAP database
Provides clear communication, with use of DataRAP application, through query to PCP on documentation not meeting standard as identified by no plan
Associates attestation sheets received into the DataRAP database to provide tracking for all markets
Medical record documentation requirements
High school education or equivalent experience
Certified Professional Coder
Knowledge in HCC Coding guidelines
Technical expertise in ICD-9-CM or ICD-10-CM
Ability to perform in a deadline driven environment
Ability to maintain professionalism and a positive service attitude at all times

Inpatient Coding Trainer Resume Examples & Samples

Responsible for Inpatient and/or Outpatient risk adjustment training program for coding staff
Risk adjustment Inpatient and/or Outpatient coding process controls consulting a/ implementation procedures
Responsible for the effective delivery of training programs across the organization including ICD-10 training
Develop and deliver training program for nurses to obtain coding certification through AHIMA and/or AAPC
Analyze data and develop training programs based on the data
Generally work is self-directed and not prescribed
3+ years of Inpatient Coding experience
1+ year of risk adjustment with Inpatient Coding
1+ year of experience delivering presentations and/or facilitating training/workshops
Must have a current Coding Certification (CPC, CCS, RHIA, RHIT)
Must be able to
Associate’s Degree (or higher)
RHIA or RHIT Certification

Clinical Coding Nurse Consultant Resume Examples & Samples

Educate practitioners / clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process
Ensure all Market Leaders are utilizing established tools and are able to downstream this education in their prospective markets
Bachelor’s Degree in Nursing required (Associate’s Degree or Nursing Diploma from accredited nursing school with 2 or more years of additional experience may be substituted in lieu of a bachelor’s degree)
RN license in good standing
CPC certification or proof that certification has been obtained within 9 months from the American Academy of Professional Coders required
4 years of General Clinical experience required
2 years of clinical coding experience with strong attention to detail and a high level of accuracy
Possess a high tolerance to stress and the ability to handle difficult situations in a confident and diplomatic manner
Additional Quality Assurance auditing experience

Inpatient Coding Trainer Resume Examples & Samples

1+ years of Inpatient Coding experience
1+ years of risk adjustment with Inpatient Coding
1+ years of experience delivering presentations and/or facilitating training/workshops
Experience using Microsoft PowerPoint (create decks importing data, charts, graphs, images, animations), Excel (sorting, filtering, vlook up, pivot table, charts and graphs, manipulate data; basic formulas), and Word (create and modify documents)
Available to travel up to 10% of the time (domestic and international)
Associate’s Degree or higher

Clinical Coding Nurse Consultant for Wellmed Resume Examples & Samples

Educate practitioners / clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process. Ensure all Market Leaders are utilizing established tools and are able to downstream this education in their prospective markets
Work with corporate operations to develop program success metrics and ongoing performance metrics
Provide leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff
Maintain compliance with Optum coding standards and CMS Risk Adjustment guidelines
Bachelor’s Degree in Nursing required (Associate’s Degree or Nursing Diploma from accredited nursing school with 2 or more years of additional experience may be substituted in lieu of a bachelor’s degree) and current RN license in good standing required
Ability and willingness to travel (locally and non-locally) as determined by business nee
Effectively communicates complex ideas clearly and concisely to internal and external customer
Able to create, build and maintain relationships in order to improve performance and establish trust and maintain creditability throughout the organization
Demonstrates effective interpersonal, influence, collaboration and listening skills to address complex situations or issues with a high degree of integrity
Provide leadership, organization and methodology to a project / operations team
Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities and make changes to work as the project needs dictate
Additional Chart Review Experience

Senior Consultant, Risk Adjustment & Coding Resume Examples & Samples

This is a Telecommuter role will be based in the Newark New Jersey area with travel around the State approximately 75% of the time**
Certified Professional Coder (CPC) and ICD10 certification
5 or more years of experience in ICD-9 & ICD-10 coding, reimbursement and health information technology including extensive knowledge of and experience with coding concepts, guidelines, and clinical terminology
Extensive knowledge of what constitutes a complete and accurate record (i.e., complete and thorough clinical documentation beginning with HCC methodology and risk adjustable codes, establishing and meeting medical necessity criteria.)
1 or more years of Provider Relationship experience and/or Network Management, Contracting, Sales or Consulting experience
Knowledge of Managed Care and Medicare programs and guidelines
2 or more years of experience giving presentations
Ability to formulate training materials designed to improve provider compliance
Advanced proficiency in MS Office (Excel, PowerPoint and Word)
Excellent Oral & Written Communication Skills
Bachelors or Master’s degree in a healthcare related field
Experience with HEDIS and CMS Stars Ratings
Current and unrestricted RN license

Coding Product Specialist Resume Examples & Samples

Reviews sales assessment document and any other client information to determine scope of the project and potentially any implementation concerns
Participates in introduction call, scoping visit and discovery visit to review current workflow, analyze operational processes, and determine future workflow and operational processes
Addresses concerns to project manager and product manager to optimize how the product and/or services will best integrate into the client’s processes and systems
Demonstrates A-Life Computer Assisted Coding (CAC)/Encoder software and address client concerns and questions
Participates in weekly or periodic project meetings with members of the implementation team to review the project task plan and evaluate progress; provides input for training plans and go-live activities
Proactively identifies project concerns, and communicates to the project manager
Documents, and verbally communicates as needed, task status and progress to facilitate a smooth implementation
Participates in user acceptance testing (UAT)
Addresses issues to project manager and/or product manager to solve any issues identified
Participates in go live support
Acts as a primary, detailed, hands-on expert for the computer assisted coding/encoder product approximately 90 days post implementation
Ensures the client meets or exceeds their expected return on investment (ROI) while utilizing the computer assisted coding solution
Promptly communicates bugs, client concerns, enhancement requests or application changes to product manager and others as appropriate
Presents reviews and explains standard benchmark customer analysis reports
Liaison between client, product management, and engineering
Acts as a primary, detailed, hands-on expert for the computer assisted coding/encoder product for the Client Relationship Manager Team
Maintains a solid understanding of software products’ functionality and optimal end user application of associated features and functions
Attend various meetings, training and professional conferences
3+ years of experience functioning as a software product and/or domain expert in hospitals, healthcare practice management or the managed care space
3+ years of Health Information Management or Professional Coding experience with a good understanding of Revenue Cycle (Coding Process)
2+ years of experience training/educating coders and physicians on product technology and Professional Coding guidelines
2+ years of experience presenting to C-Suite/Executive Sponsors/Senior Leadership
Full understanding of product life-cycles and project management
Superior analytical skills for assessing market opportunities and competition
Must be willing and able to travel, including overnight, as needed up to 80% of time
BA/BS or Associates degree
A good understanding of ICD10
Understanding of CPT coding
CCA and/or CCS and/or CCS-P and/or CPC certifications
Strong communications skills

Outpatient Coding Team Member Resume Examples & Samples

Demonstrated experience and a proven track record in Coding in a facility of significant size and complexity, hospital business operations, information systems, and coding applications, as typically acquired in 0-2 years of experience performing acute care inpatient, outpatient, and/or emergency department coding
Experience in regional/ shared service environment with multiple/ matrix reporting relationships preferred
Knowledge of medical terminology, disease processes, patient health record content and the medical record coding process
Basic knowledge of anatomy, physiology and pharmacology
General knowledge of Revenue Cycle applications, including Electronic Health Record systems
General knowledge/awareness of all areas related to Coding and how they interrelate
Requires strong accuracy, attentiveness to detail and time management skills for translating complex medical documentation into diagnostic classification system codes
Aptitude to conceptualize, plan, and implement stated goals and objectives
Ability to work concurrently on a variety of tasks/projects in a fast paced environment with identified productivity requirements and with individuals having diverse personalities and work styles
High-level problem identification/ mitigation/ resolution, analytical and financial skills
Ability to recognize the appropriate style, level of detail, and message for the audience
Computer keyboarding skills and experience with computerized coding/abstracting systems and encoders
Ability to use spreadsheet, word processing, statistical, project management, and presentation software applications, preferably Microsoft Suite
14 positions available

Manager, Coding Resume Examples & Samples

Manage daily operations of the coding area to ensure timely, accurate coding of inpatient and out patient encounters as substantiated by the documentation in the medical record, contributing to optimal reimbursement
Oversee and train the coding staff on documentation guidelines, coding principles and conventions and computer systems, and train the medical staff on documentation guidelines as they relate to accurate code, DRG and/or APC assignment
Works as the liason for charge entry by ancillary departments
Oversees charge/billing edits and denials
Monitors and manages Unbilled reports (DNFB) for facility
Monitors physician documentation queries by coding staff
Represents Coding on various multidisciplinary committees and work groups (e.g., meaningful use, 3 day window, 1-2 day stays, case management, and core measures)
Develop HIM coding tools, resources, and education materials
Serves as an expert consultant to physicians, non-physician providers, their office staffs and CBO staff on all issues relating to the accurate and proper coding of patient medical information on bills submitted to Medicare, Medicaid, commercial insurance providers, self-pay or any other third-party payers to ensure the maximum allowed reimbursement and support the revenue cycle. Monitor coding, abstracting and data entry for accuracy with the use of various Meditech reports, and assign ICD-9-CM and CPT-4 codes to discharged inpatient and outpatient medical records
Monitors Medical Necessity and Denials, working with ancillary departments, coding staff, and physician offices for appropriate documentation
Monitors coding productivity and quality
Monitors DRG maximization efforts to ensure optimal DRG and third party reimbursement
Generate and submit monthly reports to the Director of Medical Records
Oversee, train, and mentor coding staff, providing on-going in-service education on updates, revisions, and deletions of codes and coding guidelines, and correct coded information to ensure compliance with Rate Setting and other external data requirements
Conduct routine random audits of coding practices (inpatient and outpatient care) to ensure compliance with various documentation guidelines, coding principles and conventions, and assist in the departmental Quality Improvement/Coding Compliance processes and assisting the Coding Validator in the audit process
Act as a liaison to the Case Management, Patient Access, Patient Finance and Information Services departments to maintain a timely billing schedule, and act as a liaison to the Medical Staff with regards to coding, DRG and denial/appeal issues when necessary
Perform audit appeals process (RAC, MassPRO and Blue Cross), prepare all necessary records, reserve space, obtain necessary documentation for on-site review, appeal denials where appropriate, and maintain summary sheets on cycles
Consistently and fairly implements human resource policies
Maintains effective and appropriate staffing by monitoring employee turnover, overtime and absenteeism, and compliance with established Medical Center staffing standards
Evaluates performance and initiates personnel actions (merit increases, promotions, progressive discipline, termination ) in a timely manner to ensure maintenance of an optimal work force
Completes employee performance evaluations within 14 days of due date
Collaborates with Human Resources on the recruitment and selection of qualified employment candidates following all policies, guidelines and applicable laws
Communicates changes to staff in a clear and concise manner, providing written procedures and inservice education as needed Monitors progress and results of employees, giving constructive feedback and recognizing contributions. Coaches and counsels employees to further develop their job knowledge and skills, and ensures that on-the-job training and related educational programs are available to meet these needs
Perform other projects as assigned
Must have 5-10 years of coding experience in a Medical Records department within an acute care setting, including all areas of coding (Inpatient, outpatient, emergency room, ancillary/clinic coding). - Supervisory experience required
Must have certification as a Certified Coding Specialist (CCS) preferred, and either a RHIA or RHIT is required
Management skills required

Inpatient Coding Team Member Resume Examples & Samples

Demonstrates experience and a proven track record in Coding in a facility of significant size and complexity, hospital business operations, information systems, and coding applications, as typically acquired in 0-2 years of experience performing acute care inpatient, outpatient, and/or emergency department coding
Experience participating in Coding standards, processes, policies, procedures and service level agreements
Knowledge of hospital inpatient, outpatient, and/or emergency department coding rules, Ambulatory Payment Classifications and Diagnosis Related Group assignment logic, National Correct Coding Initiative edits, Coding Clinic and Current Procedural Terminology Assistant coding guidelines
Knowledge of computer based encoder systems and accurate data entry skills
General knowledge/ awareness of all areas related to Coding and how they interrelate
Familiarity with Coding management functions in acute and non-acute settings
Excellent ability to communicate ideas both verbally and in writing to interact with others using on-on-one contact and group discussions
Computer keyboarding skills and experience with computerized coding/abstracting systems and encoders Ability to use spreadsheet, word processing, statistical, project management, and presentation software applications, preferably Microsoft Suite
Ability to read and interpret complex medical records
Ability to comply with Sutter Health policies and procedures

Health Information / Coding Resume Examples & Samples

Leadership - leads individuals and groups toward identified outcomes, setting high performance standards and delivering quality services
Critical thinking - actively and skillfully conceptualizing, applying, analyzing, synthesizing or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning or communication as a guide to belief and action
Building and Maintaining Strategic Working Relationships - develops collaborative relationships to facilitate the accomplishment of work goals. Possesses excellent interpersonal skills in building, negotiating and maintaining crucial relationships
Adaptability - maintaining effectiveness when experiencing major changes in work tasks or the work environment; able to adapt to change in environment and/or circumstances with a positive outlook; and adjusting effectively to work within new work structures, processes, requirements, or cultures
Initiative - independently takes prompt proactive steps towards problem resolution
Effective Decision Making - able to gather facts, assess all perspectives and weigh different possibilities in order to influence positive outcomes
Managing conflict - dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people
Stress tolerance - maintaining stable performance under pressure or opposition; handling stress in a manner that is acceptable to others and the organization
Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
Facilitation - ability to facilitate small to large groups of people at various organizational levels for purposes of planning, problem solving, or strategy development
ICD-9-CM and CPT-4 Technical Coding Skills (applicable to coding support role) - ability to review, apply and educate on inpatient and outpatient coding guidelines
Consulting or proven work experience in areas of process reengineering, shared services, and/or project management required. Multi-Facility and Large Health care system experience required
Minimum 10 years management experience required
Minimum 10 years recent HIM acute care coding experience required

Senior Coding Team Member Resume Examples & Samples

Demonstrated experience and a proven track record in Coding in a facility of significant size and complexity, hospital business operations, information systems, and coding applications, as typically acquired in 3-5 years of experience performing acute care inpatient, outpatient, and/or emergency department coding
In-depth knowledge of hospital inpatient, outpatient, and/or emergency department coding rules, Ambulatory Payment Classifications and Diagnosis Related Group assignment logic, National Correct Coding Initiative edits, Coding Clinic and Current Procedural Terminology Assistant coding guidelines
In-depth knowledge of medical terminology, disease processes, patient health record content and the medical record coding process
In-depth knowledge of computer based encoder systems and accurate data entry skills
Strong working knowledge of anatomy, physiology and pharmacology
Working knowledge of billing functions and the components of a charge description master
Knowledge of Revenue Cycle applications, including Electronic Health Record systems
In-depth knowledge/ awareness of all areas related to Coding and how they interrelate
Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections
Ability to mentor and support staff transitioning to higher skill levels
Ability to manage staff and resolve issues in a virtual environment
Ability to analyze, comprehend, and effectively interpret and translate new coding requirements
Ability to multitask and prioritize work activities

Coding Quality Assurance Specialist Resume Examples & Samples

Demonstrated experience and a proven track record in coding, training, and/or service development in a facility of significant size and complexity, hospital business operations, information systems, and coding applications, as typically acquired in 3-5 years of experience
Demonstrated experience in the fundamentals of auditing and monitoring
Experience executing Coding Quality Assurance standards, processes, policies, procedures and service level agreements
Experience in complex regional/ shared service environment with multiple/ matrix reporting relationships preferred
Experience participating in planning new or expanded services and managing projects
In-depth knowledge of Diagnosis Related Groups, Ambulatory Payment Classifications, ICD-9-CDM, and Current Procedural Terminology Coding systems and related coding issues including charge capture and evaluation and management leveling
In-depth knowledge and understanding of coding compliance and quality assurance
Familiarity with medical terminology and the medical record coding process
Strong working knowledge of anatomy, physiology and pharmacology
General knowledge of Revenue Cycle applications, including Electronic Health Record systems
General knowledge/ awareness of all areas related to Coding and how they interrelate
General knowledge of how to conduct a quality control audit
Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections
Familiarity with Coding management functions in acute and non-acute settings
Knowledge of Patient Management information system applications, preferably EPIC
Ability to quality check other’s work and compile audit reports based on findings
Ability to provide coaching and feedback to Coders if quality assurance results are subpar
Ability to train staff and resolve issues in a virtual environment
Ability to work closely with medical staff and other departments to create a complete and accurate database of clinical and demographic data while ensuring appropriate coding
Ability to run reports needed to improve patient care
Ability to comprehend and retain information that can be applied to work procedures to achieve appropriate service delivery
Requires strong accuracy, attentiveness to detail and time management skills for translating complex medical documentation into diagnostic classification system codes
Aptitude to conceptualize, plan, and implement stated goals and objectives
Ability to manage own schedule and responsibilities. Must have initiative to work effectively without constant supervision and direction, meeting all deadlines
Ability to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles
High-level problem identification/ mitigation/ resolution and analytical skills
Ability to develop effective working relationships/ networks within and outside the organization
Excellent ability to communicate ideas both verbally and in writing to influence others using on-on-one contact, formal presentations, and group discussions
Ability to recognize the appropriate style, level of detail, and message for the audience
Computer keyboarding skills and experience with computerized coding/abstracting systems and encoders Ability to use spreadsheet, word processing, statistical, project management, and presentation software applications, preferably Microsoft Suite
Ability to learn new applications/software systems effectively and efficiently
Ability to comply with Sutter Health policies and procedures
Requires the ability to work with and maintain confidential information
4 positions available

Coding Education Team Member Resume Examples & Samples

Demonstrated experience and a proven track record in coding, training, and/or service development in a facility of significant size and complexity, hospital business operations, information systems, and coding applications, as typically acquired in 3-5 years of experience performing acute care inpatient, outpatient, and/or emergency department coding
Demonstrated teaching and/or training experience
Experience participating in Coding standards, processes, policies, procedures and service level agreements
Experience in complex regional/ shared service environment with multiple/ matrix reporting relationships preferred
In-depth knowledge of hospital inpatient, outpatient, and/or emergency department coding rules, Ambulatory Payment Classifications and Diagnosis Related Group assignment logic, National Correct Coding Initiative edits, Coding Clinic and Current Procedural Terminology Assistant coding guidelines
In-depth knowledge of medical terminology, disease processes, patient health record content and the medical record coding process
In-depth knowledge of computer based encoder systems and accurate data entry skills
Strong working knowledge of anatomy, physiology and pharmacology
Working knowledge of billing functions and the components of a charge description master
In-depth knowledge of Revenue Cycle applications, including Electronic Health Record systems
In-depth knowledge/ awareness of all areas related to Coding and how they interrelate
Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections
Familiarity with Coding management functions in acute and non-acute settings
Knowledge of Patient Management information system applications, preferably EPIC
Ability to develop, plan, and execute a curriculum employing adult education techniques
Excellent ability to communicate ideas both verbally and in writing to influence others using on-on-one contact, formal presentations, and group discussions
Ability to work closely with medical staff and other departments to create a complete and accurate database of clinical and demographic data while ensuring appropriate coding
Ability to run reports needed to improve patient care
Ability to mentor and support staff transitioning to higher skill levels
Ability to train staff and resolve issues in a virtual environment
Ability to manage own schedule and responsibilities. Must have initiative to work effectively without constant supervision and direction, meeting all deadlines
Ability to analyze, comprehend, and effectively interpret and translate new coding requirements
Ability to comprehend and retain information that can be applied to work procedures to achieve appropriate service delivery
Requires strong accuracy, attentiveness to detail and time management skills for translating complex medical documentation into diagnostic classification system codes
Aptitude to conceptualize, plan, and implement stated goals and objectives
Ability to multitask and prioritize work activities
Ability to identify, prioritize, resolve and / or escalate complex problems promptly
Computer keyboarding skills and experience with computerized coding/abstracting systems and encoders Ability to use spreadsheet, word processing, statistical, project management, and presentation software applications, preferably Microsoft Suite

Coding Quality Team Lead-him-sutter Shared Services Resume Examples & Samples

Demonstrated experience and a proven track record in coding, training, auditing and/or service development in a facility of significant size and complexity, hospital business operations, information systems, and coding applications, as typically acquired in more than 5 years of experience performing inpatient, outpatient, or emergency department coding
Demonstrated experience in the fundamentals of auditing and monitoring
Demonstrated experience with computerized coding and abstracting systems and encoder software
Experience managing projects in a Documentation Improvement Program
Experience participating in Coding Quality Assurance standards, processes, policies, procedures and service level agreements
Experience in complex regional/ shared service environment with multiple/ matrix reporting relationships
Experience participating in planning new or expanded services and managing projects preferred
In-depth knowledge of Diagnosis Related Groups, Ambulatory Payment Classifications, ICD-9-CDM, and Current Procedural Terminology Coding systems and related coding issues including charge capture and evaluation and management leveling
In-depth knowledge and understanding of coding compliance and quality assurance
In-depth knowledge with medical terminology and the medical record coding experience
In-depth knowledge of Revenue Cycle applications, including Electronic Health Record systems
Deep Familiarity with Coding management functions in acute and non-acute settings
Familiarity with billing functions and the components of a charge description master
Ability to work closely with medical staff and other departments to create a complete and accurate database of clinical and demographic data while ensuring appropriate coding
Ability to run reports needed to improve patient care
Requires strong accuracy, attentiveness to detail and time management skills
Ability to identify, prioritize, resolve and / or escalate complex problems promptly
Ability to communicate ideas both orally and in writing to influence others using on-on-one contact, provide training in formal presentations, and employ organizational skills to facilitate group discussions
Skills using spreadsheet, word processing, statistical, project management, and presentation software applications, preferably Microsoft Suite

Coding Quality Consultant Resume Examples & Samples

Targeting local providers who would benefit from our Medical Risk Adjustment training
Reaching out to physicians, medical groups, IPAs and hospitals, and building positive, consultative relationships
Educating providers on how to improve their Risk Adjustment Factor (RAF) scores, which measure their patients' health status
Developing comprehensive, provider-specific plans to increase their RAF performance
Training providers on our Risk Adjustment methods and tools, and working toward their compliance with our programs
Collaborating with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment education efforts
Conducts physician chart audits (including research and presentation)
Assesses and interprets whether the coding assigned by the provider was properly assigned based upon review of the medical documentation and application of the coding guidelines
Identify potential suspects through clinical documentation where diagnosis is clinically indicated but not documented, discuss findings with providers for validation
Rely upon independent judgment and decision making while at a provider site, whether conducting an audit or providing training/education, both from historical and/or real time data
Able to field any questions or concerns and provide solutions that will mirror management’s guidelines
Implement education, and provide formal training to Client providers and staff as needed regarding coding compliance, documentation guidelines, HCC education and Medicare/Medicaid regulations by proactively providing solutions to meet the needs of the Client provider
Enhance professional growth and development through in-service meetings, and educational programs
Work independently and rely on professional discretion and judgment; as well as a professional representation of Client/Optum
Utilize management for escalation purposes
Maintain strictest confidentiality based on HIPPA privacy policy
Available to assist other team members in coding, HCC opportunities and act as a resource to less experienced staff
Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10 CM knowledge
Reports to/works with the Associate Director of Clinical Quality & Coding
Provide feedback and present solutions, to the Associate Director of Clinical Coding and Quality, regarding trends or patterns noticed in provider coding
Schedule audits and provide patient lists to practice managers to promote a smooth audit process
Finalizing documentation and providing feedback to team members based on findings
Performs related work and projects as required
Must have completed coding certification course, AAPC/AHIMA, or other accredited certifying body, OR completed college courses with degree in coding OR currently enrolled in program for CPC, COC, CRC, CIMC, CFPC, CPMA, CCS, CCA, CDIP, or RHIT
Must possess a CPC or COC certification or will have it completed within next 90 days of employment
Must have experience auditing charts and consulting with providers on improving documentation and coding
Must have working knowledge of billing systems to understand how to identify potential black holes in claims submissions that might be causing lower risk adjustment scores to be reported inaccurately
Must have an excellent understanding of medical terminology, disease process and anatomy and physiology
Complete Understanding of ICD-10-CM coding classification and guidelines
Must have Computer skills (i.e. MS Office)
Must be task oriented and able to meet designated deadlines, productivity standards and able to work independently
Ability to travel locally to provider practices will be out in field 75% with rare overnight stay required
Supervisory experience
Knowledge of Risk Adjustment HCCs
Previous consulting or sales experience

Supervisor, Coding & Production Resume Examples & Samples

Supervises medical record functions to ensure coding of charts is achieved within Health System targets
Supervises, hires, trains, disciplines and evaluates the performance of staff
Performs new employee orientation including scheduling, training, Kronos set up and submission
Plans, organizes, coordinates and evaluates staffing requirements to meet operational goals
Assigns and schedules direct reports to ensure smooth and efficient workflow
Identifies, evaluates and implements opportunities for efficiencies
Generates department metrics
Reports operational performance, justification and/or corrective action
Builds and maintains collection of reference tools including codebooks, groupers, encoders and other software applications, coding guidelines, dictionaries and texts for health system staff
Collaborate in the selection, implementation and operation of electronic coding and documentation improvement software
Monitors interfaces with billings systems and workflow changes with computer patient information
Ensures integrity of encoder and abstracting systems by maintenance and revision of data
Reviews daily operations backlogs and computer problems; makes recommendations and takes corrective action
Collaborates with Education and Training to identify training needs and schedule training activities, including transition to ICD-10 and EHR
Collaborates with Business offices and HIM operations
Reduce and eliminate account holds
Research, review and evaluates “Best Practices” for implementation throughout Health System
Ensure collaboration and communication between Clinical Documentation Improvement and Coding function
Reviews and monitors Health System contract services, and ensures system-wide and vendor compliance. Reports on issues and makes recommendations for corrective actions
Reviews and approves vendor billing information
Audits patient logs, reports and follows up on inconsistency or accuracy of medical records
Ensures inventory of supplies
At least 2 years of leadership/mentor experience
Minimum of two (2) years progressive Health Information Management or Revenue Cycle Management experience
Knowledge of Health Information Management (HIM)

Coding Research Analyst Resume Examples & Samples

Manages the external Provider Dispute Process by researching and evaluating escalated disputes and supporting the Medical Director review process
Maintains a library of all the existing and retired rules, the source of the rule and the implementation/retire date of the rule (by Market and by Line of Business)
Documents supporting authority for each claim coding rules by Market and by Line of Business (Master Grid)
Administers communication to Markets and collects feedback
Identifies coding error (e.g., upcoding, bundling/unbundling) and recommends correct coding of medical claims
Presents change proposal to committee
Communicates effectively to markets
Advanced Demonstrated written communication skills
Intermediate Demonstrated leadership skills
Advanced Ability to work as part of a team
Advanced Demonstrated problem solving skills
Required Advanced Microsoft PowerPoint
Required Advanced Microsoft Word
Required Advanced Other Advanced user and knowledge of claims payment system
Required Advanced Other Strong knowledge of electronic medical records/billing systems and medical terminology and abbreviations
Required Advanced Other Billing expertise in UB92, 1500 and other healthcare services
LI-KC2

Coding Education & Quality Coordinator Resume Examples & Samples

Analyzes and evaluates highly complex clinical and operational systems relative to inpatient and outpatient reimbursement through chart review and other special study methods
Makes recommendations for data quality improvements and revenue enhancements
Monitors highly complex coding compliance via pre-billing coding, DRG and APC quality audits, case mix analysis, and compliance software reviews and through other methods
Provides feedback to the coding management team and staff regarding highly complex ICD-9-CM/CPT-4 or ICD 10 CM/PCS coding and DRG/APC assignment and related clinical documentation
Develops and maintains inpatient and outpatient electronic coding manuals to support quality coding on the Coding Share Point site
Assists with and/or provides suggestions for continuing education topics and issues for coding staff
Educates groups and individuals within HIM regarding coding, DRG and APC assignment and the reimbursement process
Interacts and educates coding staff
Develops and maintains CCHS facilities coding guidelines in accordance with Official Coding Guidelines
Provides coder education on all relevant issues which will impact technical coding in HIM
Provides orientation and trains Coding staff
Assists with the analysis of highly complex case mix reports and other statistical reports
Provides assistance with highly complex coding as workload permits
Supports coding program initiatives
Promotes good morale and cooperation
Encourages others and values their input
Shares information and seeks ways to add value both to the customer and to the team
Acts as a liaison among all department managers, staff, physicians and administration with respect to coding issues
Anticipates and responds to changing skills requirements
Seeks opportunities to learn new skills
Coaches and encourages team members to do the same
Integrates team into the coding process to promote their development
A minimum of three years of experience in a clinical environment involving the accurate interpretation and coding/abstraction of therapeutic/diagnostic measures and procedures of a diverse patient population
In-depth knowledge of ICD-9-CM (ICD-10-CM) coding principles, DRG assignment, APC assignment, and modifier assignment
Formal coursework in anatomy, physiology and medical terminology in order to accurately interpret the medical record
Must be detail oriented and analytical in nature
A Bachelor's Degree in Health Information Management may substitute for up to one year of required experience

Coding Education & Quality Coordinator Resume Examples & Samples

Analyzes and evaluates clinical and operational systems relative to inpatient and outpatient reimbursement through chart review and other special study methods
Monitors coding compliance via pre-billing coding, DRG and APC quality audits, case mix analysis, and compliance software reviews and through other methods
Provides feedback to the coding management team and staff regarding ICD-9-CM/CPT-4 or ICD 10 CM/PCS coding and DRG/APC assignment and related clinical documentation
Develops and maintains inpatient and outpatient electronic coding manuals to support quality coding on the Coding Sharepoint site
When appropriate, develops and maintains CCHS facilities coding guidelines in accordance with Official Coding Guidelines
Provides coder education on all relevant issues which will impact technical coding in HIM. Provides orientation and trains Coding staff
Assists with the analysis of case mix reports and other statistical reports
Provides assistance with coding as workload permits
Successfully integrates team into the coding process to promote their development
A minimum of two years of experience in a clinical environment involving the accurate interpretation and coding/abstraction of therapeutic/diagnostic measures and procedures of a diverse patient population. In-depth knowledge of ICD-9-CM (ICD-10-CM) coding principles, DRG assignment, APC assignment, and modifier assignment

Coding Operations, Senior Consultant Resume Examples & Samples

Other tasks as assigned
RHIT or RHIA. Must maintain credentials through completion of required CE requirements,
Bachelor’s Degree in Health Information Management or related field
CCS preferred but not required; candidate must be able to code and audit both inpatient and outpatient records
Must possess excellent written and verbal communication skills

Coding Quality Analyst Resume Examples & Samples

Conducts reviews on records that have been identified as suspicious and/or potentially fraudulent, utilizing most current reference materials to include, but not limited to: Current Procedural Terminology (CPT), Internal Classification of Disease (ICD - 9 / ICD - 10) and Healthcare Common Procedure Coding System (HCPCs) guidelines
Documents Decisions on reviews through notations and enters notes in appropriate company systems
Ability to discuss and present on decisions made to appropriate internal and external individuals / groups
Coordinate with team members to understand trends and schemes related to billing issues / coding trends
3+ years of experience in coding and medical billing
Associates degree or related field experience
Clinical and/or coding expertise in a Physician office, SNF, ALF, Hospital setting, and/or billing/office
Strong organizational/time management skills and be able to work independently or as a team
Strong knowledge of CMS 1500 and UB04 data elements
Strong knowledge of ICD, CPT, HCPC and Revenue Codes
Ability to support heavy work load volume and meet unit standards while engaging multiple priorities
Current CPC Certification
Behavioral Health experience
Serves as a resource on moderately complex issues related to coding / billing

Supervisor HIM Coding Resume Examples & Samples

Supervises coding section personnel in daily operational activities
Directs the performance of inpatient coding and outpatient coding for the purpose of accurate patient billing
Supports internal and external coding review and education
Maintains and monitors performance indicators for unbilled inpatient and outpatient accounts receivable and formulates action plans to reduce the number of outstanding cases
Identifies all problem areas and areas of opportunity regarding unbilled accounts
Monitors and maintains data on employee compliance with productivity and quality standards and takes appropriate action
Interacts with downstream departments on Revenue Cycle Management, e.g., PFS, PFSS and ITD, regarding billing related questions and/or accounts receivable
Management-level responsibilities include: hiring, performance appraisals, disciplinary actions, training, work distribution and flow, and employee engagement
Develops and implements efficient systems and work flow to meet both CCF and government regulations
Develops, implements, processes and maintains clinical data computer systems
Protects the interest of the Clinic with HIM vendors. Interacts with ITD in the support of systems and processes in the section
Facilitates/trains coding staff on daily activities. Monitors and ensures time and attendance policy for the section
Interacts with the Coding Quality and Education Supervisor to support Coding Quality and Education initiatives
Interacts with the Supervisor of CDI to support the program initiatives and strategic planning goals
Integrates team into the coding process to promote their development
Minimum two years of managerial/supervisory experience in a Health Information environment

Coding Review Compliance Consultant Resume Examples & Samples

Manages, creates, and maintains client relationships. 0%
In adherence with the KP Compliance Framework, fosters comprehensive compliance management through a series of activities to comply with all applicable regulations and statutes. Activities, under the leadership of more senior team members, include: Planning: participating in the identification of compliance accountabilities; participating in the development of Compliance, Work, and Audit plans; participating on compliance-related committees/work groups. Implementing: participating in the identification of compliance requirements and conducting portions of related analyses; participating in the creation or revision of compliance standards, policies, and procedures; may monitor compliance adherence; prepares reports on compliance efforts and programs. Validating: reviewing compliance programs and content, including participating in risk assessments and/or audits, and participating in the investigation of instances of reported non-compliance
3-5 years of experience coding CPT (including E/M), HCPCS and ICD-9 and ICD-10. Hospital based coding experience preferred
Instruction in ICD-10 may be considered in lieu of ICD-10 experience
Proficient in the use of CPT, ICD9 and HCPCS coding principles
Should be knowledgeable with Hierarchical Condition Categories (HCC) both CMS and HHS
Demonstrated experience conducting Medical Record audits and ability to interpret and apply Federal and State regulations, coding and billing requirements
Provides feedback and audit reports to Leadership from E&M, CPT and ICD9/ICD10 audits conducted by NCAT auditors using all state/federal and 3rd party payor regulatory standards for both inpatient and outpatient
CCS is preferred, CCS-P and CPC, RHIT and/or AHIMA certifications including ICD10 trainers will also be strongly considered

Coding Data Specialist Resume Examples & Samples

Evaluates the medical record for procedures and diagnoses documented in the medical record and accurately assigns ICD-10, HCPCSs, Modifiers, and CPT codes, based on National Coding Guidelines
Will be reviewing Provider dictation and charge entry done by Business Ops personnel to make certain that correct cpt codes are billed and appropriate diagnoses assigned in accordance with Provider dictation
Communicate effectively with Providers
Need to establish and maintain effective communication with providers and management; strong knowledge of Medical Terminology
Knowledge of Medicare/CMS requirement and Allina Policy; will perform the job in accordance with Allinas Standards of Business Conduct, which include principles of legal compliance, ethics and integrity, confidentiality, protection of assets and avoidance of conflict of interest and inappropriate business relationships

HIA Coding Quality Analyst Resume Examples & Samples

75% Data / documentation and coding validation and analysis. Authorized to modify assigned codes based on clinical documentation review and queries / issues requiring clarification by clinician
10% Assists in the design, modification, and implementation of approved best practices / recommendations of coding edit software. Participates with some supervision in test environments as UAT candidates (user acceptance testing). Document and present analysis to leadership on a project basis. Supports specialty-specific training to practitioners on documentation of services, appropriate coding of level of service, diagnosis and procedures code assignments through interpretation of appropriate coding guidelines. Supports training at the department, team, or individual level as needed
10% Maintains up-to-date knowledge regarding professional health information practices, as well as standards and regulatory requirements related to health information management and coding compliance (Federal, State, internal)
5% Participate in task force groups as requested interacts with leadership, practitioners, and staff regarding health information and coding issues
5% Conducts regional and various departmental training sessions
Current credential as one of the following: CCS-P or CCS through AHIMA, CPC through AAPC
Two years of college level courses in health information, business administration, information systems, healthcare delivery or other related field
Working knowledge of medical terminology and pathophysiology
May substitute degree for years of related experience
1-year of outpatient direct coding assignment and validation experience
Strong time management and analytical skills, Ability to meet deadlines
Ability to develop and use spreadsheets (MS Excel)
Ability to write reports summarizing identified trends, analysis of findings and recommendations
Ability to follow appropriate methodology, sample selections, basic interpretation of results and formulation of appropriate recommendations
2 years work experience in an outpatient healthcare setting or completion of an accredited RHIT / RHIA program (degree preferred)
1-year experience directly supporting clinician training needs related to interpretation of documentation and coding guidelines including research, developing and delivering detailed examples in a positive and supportive manner

Coding Technician Resume Examples & Samples

Reviews provider assigned coding of level of service (CPT-4), diagnosis (ICD-9CM), and procedures (CPT-4 and HCPCS) of Kaiser Permanente Commercial encounters, Government payers, and third party billable encounters. Corrects and resubmits claims based on review of the record. Escalates to appropriate staff for further coding review if necessary. Assigns appropriate coding of level of service (CPT-4), diagnosis (ICD-9CM), and procedures (CPT-4 and HCPCS) based on review of the entire clinical record. Provides additional support to the coding staff by resolving complex cases and issues. Maintains a sustained level of 95% coding accuracy and productivity to support auditing and feedback schedules and comply with department standards. Contributes to the development and maintenance of specialty specific education materials
Maintains current knowledge of coding conventions, guidelines, updates, and regulations governing government and third party billing to ensure that Kaiser Permanente Colorado coding and documentation meets regulatory guidelines and audit standards, and results in appropriate reimbursement. Must meet and maintain departmental quality and production standards. Must maintain all certifications required by this position. Collaborates with electronic medical record team to develop and implement strategies to make appropriate documentation, and bill editing as efficient as possible. Participates as needed in the testing and training of new system applications. Collaborates with clinical and non-clinical groups, to develop, implement and communicate specific coding and documentation guidelines that will fulfill the internal needs for complete and consistent clinical data. Serves as coding expert on various committees as requested
Supports compliance and Kaiser Permanent's Code of Conduct by adhering to federal and state laws and regulations, accreditation and license requirements, by policies and procedures. Responds appropriately to observed fraud and abuse
Two (2) years of outpatient or inpatient coding experience using ICD-10, CPT-4, and HCPCS, including Medicare, Medicaid, and third party liability billing required
Working knowledge of electronic medical record systems preferred

Regional Director, Hospital Coding Ops Resume Examples & Samples

Provides the overall direction and oversight of functional area in support of departmental initiatives and goals. Leads the conceptual design and development of action plans that drive strategic initiatives. Actively monitors operational performance to anticipate and meet the needs of leadership. Drives for changes in work products and processes that will improve functional area efficiencies and effectiveness. Fosters a positive and proactive work environment, emphasizing respect for individuals, high standards of quality, customer service, innovation and team work. Fosters strong results orientation within functional area by motivating staff and holding them accountable to meeting customer needs and organizational goals. Facilitates the ongoing learning, well-being, professional satisfaction and development of staff through training, work assignments, increased responsibility and mentoring
Serves as an expert consultant to senior leadership on major and highly complex issues with strategic importance. Collaborates with TPMG, Health Plan, local and regional leadership, colleagues and subordinates to improve the level and quality of revenue cycle decisions that have financial, legal and regulatory implications to the organization. Works in partnership with local and regional leaders of operating units to identify new ways to enhance financial products and services. Partners with organizational leaders to ensure that operations and processes remain consistent and emulate best practices. Analyzes issues to develop recommendations related to resource requirements in order to achieve desired outcomes
Identifies opportunities for process improvement, and implements them by engaging stakeholders throughout the organization. Understands interrelationships among systems and process across functional areas to redesign process, improve efficiency, and ensure optimal results. Applies thorough understanding of key business processes to effectively anticipate and address the longer term implications of decisions/actions. Provides oversight regarding the development of business cases, in conjunction with other relevant SME's, that facilitate local or regional revenue cycle strategies. Coordinates and implements revenue cycle initiatives, including identifying and assembling resources when necessary. Formulates and makes recommendations to leadership on policies and practices relating to revenue cycle improvements
Facilitates compliance with administrative/legal requirements and governmental regulations as they relate to revenue cycle operations. Monitors work unit compliance with internal controls and develops remediation plans to address identified control weaknesses. Accountable for revenue cycle data quality monitoring and related training. Ensures all practices relating to the acquisition and maintenance of information comply with federal, state regulations, policies, and procedures
Minimum of eight (8) years of progressive experience in a multi-facility health system
Minimum of five (5) years of experience directing Revenue Cycle activities for a large hospital, medical group, and/or healthcare system
Minimum of five (5) years of relevant management experience

Coding Business Analyst, Assoc Resume Examples & Samples

Works closely with internal business partners and/or vendors to interpret the test needs as requirements are being developed in order to ensure the standard of testing supports the business need
Works with internal business partners and/or vendors to resolve defects identified during the testing cycle
Responsible for capturing and documenting metrics in support of the user acceptance testing and recommends improvements
Ensure adherence to quality processes and procedures
Required A High School or GED

Coding Audit Project Coordinator Resume Examples & Samples

Responsible for managing the client project and supervising colleagues assigned to the project
Works in conjunction with the Director of Client Audit and/or Manager and designated client(s) to schedule Auditors to a client project and assign to specific client sites
Works with Client to outline project scope; establish expectations and confirm deliverables including obtaining system access requirements for involved auditors
Directs auditors regarding appropriate tool for project based on project scope: current spreadsheet audit tools and future software solutions utilized
Instructs auditors on relevant facility policies, procedures and coding guidelines, specific audit instructions, prior reports, etc
Develops detailed project plan and communicates project plan to all parties involved
Acts as liaison with client HIM Department contact(s)
Maintains ongoing communication with Client(s) through emails and phone contact throughout life of the project
Schedules regular ongoing calls with Client(s) to review status of project
Coordinates and organizes plans for administrative and client coder exit conference(s) with Client
Reviews, explains, and discusses report(s) with Client
Provides subject matter expertize including Auditor support & mentoring as needed during an audit
Tracks and monitors all project timelines and achieves deadlines. Develops and initiates contingency plans when deadlines are at risk. Keeps management informed of any deadline slippage
Defers to management as needed, any situations requiring attention such as inability to meet deliverables as defined in project plan; deadline slippage, etc
Performs quality review of all preliminary and final audit reports providing feedback to Auditors
Ensures consistency with audit approach and recommendations with prior audits and amongst multiple Auditors
Creates report deliverables including detailed and summary roll up reports
Maintains organization and availability of audit information all times
Performs other tasks as needed
Colleague must possess an RHIT/RHIA/CCS/CPC credential
Minimum of 5 years of experience in coding industry with at least minimum of 1 year auditing experience within the last 3 years
Proficiency in using the internet to research coding and regulatory guidelines
Ability to travel less than 5% of the time
Colleague must be proficient in developing and presenting audit results including education materials to small and large groups at various organizational levels remotely and/or face-to-face
Proficiency in computer skills, including MS Office (Outlook, Word, Excel, Power Point)
Combination of any of the above noted credentials
Previous Auditing experience with a consulting vendor
Previous Auditing experience with multiple hospitals, various hospital computer systems and/or a corporate structure auditing program
HIM and/or Coding management supervisory experience
Production coding experience in the past

Lead Coding Data Review Consultant Resume Examples & Samples

Complete medical record reviews to verify accuracy of team members
Provide mentoring and feedback based on accuracy reports
Review and correct biweekly timesheets and approve time off requests via Ultipro
Monitor team member productivity and accuracy daily
Assist team members with technology issues following Inovalon protocol
Monitor daily work flow and assist Quality Manager with prioritization of assignments
Initiate and follow the disciplinary process for team members who perform below departmental standards or for violations of company policy
Maintain communication with team members and others as needed
Prepare complete, accurate and timely reporting for submission to Quality Manager as needed
Recommend improvements to departmental operating policies and procedures
Complete the annual appraisal process for team members
Ensure that team members attend and/or complete mandatory training assignments
Attend or conduct meetings and trainings as needed
Assist with projects as needed
Maintain compliance with Inovalon policies, procedures and Mission Statement; and
Adhere to all confidentiality and HIPPA requirements as outlined in Inovalon's Policies and Procedures
Medical Record Coder (CPC or comparable with at least 1 year of coding experience) or RN/LPN with 3-5 years of work experience and has either: a Certified Coding Credential or able to successfully complete the Inovalon ICD-9/10 coding course/program
Work experience to preferably include medical record review and chart abstraction
Advanced knowledge of Microsoft Office applications including Excel and Outlook
Exceptional problem solving, analytical, interpersonal and communication skills to resolve issues within Quality
Professionally skilled in verbal and written communication; and
Meticulous organization skills, with the ability to multi-task, and the ability to make sound decisions in a timely and independent manner

Lead Coding Data Review Consultant Resume Examples & Samples

Review and coreect biweekly tiemesheets and approve time off requests via Ultipro
Ensure that team members attend and/or complete mandatory trainign assignments
Attend or conduct meetings and tranings as needed
Adhere to all confidentiality and HIPPA requirements as outlined in Invoalon's Policies and Procedures
RN/LPN with 3-5 years of work experience and has either: a Certified Coding Credential or able to successfully complete the Inovalon ICD-9/10 coding course/program

RN Clinical Coding Nurse Wellmed Resume Examples & Samples

Work collaboratively with market physician leadership in the development and management, project governance and detailed project plans as it relates to assigned market
Create a team-oriented work climate that enables professional development and encourages creative solutions and strategies, establishes collaboration and emphasizes quality and cost
Provides educational tools which may include presentations as assigned by management
Perform Quality Audits to ensure error rate remains within industry standard
Knowledge of CMS-HCC model and guidelines along with ICD-9 / 10 and guidelines
Ability to work a flexible work schedule and travel to markets requiring overnight stays

Data Entry & Coding Coordinator Resume Examples & Samples

Supporting the billing activity of the department
Submitting bills to external processors
Ability to create, copy, edit, send and save using Microsoft Word, Excel and Outlook
Previous medical billing experience

Benefit Coding Coordinator Resume Examples & Samples

Must be able to calculate percentages
Knowledge of insurance industry preferred
Medical terminology knowledge preferred
Claims experience preferred

Clinical Coding, / Acute Care Resume Examples & Samples

Reviews low to moderate complexity medical records to identify the appropriate principal diagnosis and procedures codes, and all appropriate secondary diagnoses and procedure codes, Present on Admission, Hospital Acquired Conditions and Core Measures Indicators for all diagnosis codes
Measures Indicators for all diagnosis codes
Facilitates appropriate MS-DRG for inpatient medical records and appropriate APC assignment for outpatient medical records using UHDDS and other facility guidelines
Reviews charges including Evaluation and Management levels
Ensures the accuracy of data input
Stays abreast of coding principles and regulatory guidelines related to inpatient and/or outpatient coding

Coder Specialist Iii Bonus Remote Coding Resume Examples & Samples

Associate Health Information Technologist (RHIT) preferred and/or CCS
Minimum of three years of medical record related health care experience highly preferred
ICD-10, ICD- 9, and CPT knowledge
Knowledge of coding system, DRG assignment, medical terminology
A minimum of two years of inpatient and outpatient coding at an acute care facility

Remote Coding Quality Auditor Resume Examples & Samples

EHR, abstracting systems, encoder, & general computer training: HBOC Star, Horizon Patient Folder, Cerner PowerChart, ChartMaxx, EPIC, andMeditech; TruCode, 3M Coding & Reimbursement software; and Microsoft Office. Must have the technical skills required to learn and navigate a variety of software systems, trouble-shoot computer problems, install periodic updates to software programs, and work efficiently in a virtual environment
Thorough/detailed knowledge of medical terminology, ICD-9-CM , ICD-10-CM/PCS, and CPT coding systems
Advanced knowledge of APC, OCE, NCCI classification and reimbursement structures
Advanced knowledge of disease pathophysiology and drug utilization
Demonstrate initiative and discipline in time management and assignment completion
Advanced personal computing skills including MS Outlook, MS Word, MS Excel, MS Power Point; various encoders and groupers
Advanced problem-solving skills
Great attention to detail is crucial to this position
Three years hospital or physician office coding experience including auditing background
Credentials to include one or a combination of the following: RHIA, RHIT, CCS, CCS-P, CPC, CPC-H, and/or CIRCC

Remote Auditor, Coding Quality Resume Examples & Samples

Extensive knowledge of medical record documentation requirements mandated by client Medical Staff Bylaws, Rules and Regulations
Excellent verbal/written communication and interpersonal skills
Advanced knowledge of MS-DRG and APR-DRG classification and reimbursement structures
Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form. Ability to deal with problems involving several concrete variables in standardized situations
Must have strong interpersonal, written and verbal communication skills
Ability to think/work independently, yet interconnect with manager and teammates
Numeracy and accuracy are essential to the job
Associates degree or higher in Health Information Management preferred or combination of equivalent of education and experience may be acceptable

Director, Profee Coding Operations Resume Examples & Samples

Business Development: Meets or exceeds service line targets for addition and expansion business development opportunities
Strong leadership and communication skills, problem solving abilities; good knowledge of medical records systems (paper, hybrid, and electronic)
Ability to build and maintain team dynamics
Strong computer applications knowledge including Microsoft Word, Excel, and PowerPoint
Must be fluent in general information technologies; significant level of autonomy; must be self-directed
Serve as a resource to Conifer and client contacts
Implement policies and procedures that guide and support the provision of the services
Advanced knowledge of ICD-10-CM and CPT coding principles and rules
Intermediate to advanced knowledge of disease pathophysiology and drug utilization
Intermediate to advanced knowledge of MSDRG classification and reimbursement structures
Intermediate to advanced knowledge of APC, MUE, LCD, OCE, NCCI classification and reimbursement structures
Coding proficiency demonstrated by successful completion of approved coding exercise
Complies with all policies and procedures that pertain to HIPAA including minimum necessary requirements for this position. Must maintain 100% patient confidentiality during the course of work functions
Excellent organizational skills for initiation and maintenance of efficient work flow
Regular and reliable attendance and time reporting per Conifer Telecommuting program requirements
Capacity to work independently in a virtual office setting or at facility setting if required to travel for assignment
Good visual acuity
Able to operate computer keyboard, mouse and other peripherals as appropriate to accomplish coding & abstracting duties
Provides or arranges for training of coding team as appropriate
Abides by the Standards of Ethical coding set forth by AAPC and monitors coding team for violations and reports as areas of concern are identified
Maintains knowledge of current professional coding certification requirements and promotes recruitment and retention of certified staff in coding positions
Develops reports and collects and prepares data for studies involving cases for clinical evaluation purposes and financial impact and profitability
Keeps abreast of new technology in coding and abstracting software and other forms of automation and stays informed about transaction code sets, HIPAA requirements and other future issues impacting the coding function
Demonstrates competency in the use of computer applications and grouper software, medical edits, and all coding and abstracting software and hardware
Demonstrate initiative and discipline in time management and assignment completion
Five (5) years of recent experience in relevant coding or coding staffing leadership work in the field
Documented coding or audit experience. Knowledge of ICD-10-CM, CPT, HCPCS and documentation guidelines
Bachelor/Associate degree in Health Information Management and accredited by AAPC preferred. Relevant Bachelor's degree with 10 years in a comparable position

Remote Coding Coordinator / Auditor Resume Examples & Samples

1 Train associates on coding guidelines, regulatory standards and principles
2 Perform coding and DRG audits
3 Ensure accuracy and timely coding for patient services
4 Coordinate schedules and follow-up on edits
5 Utilize effective training skills, ethical practices, official coding guidelines, and regulatory standards to train new and existing associates in principles of ICD-9-CM and CPT coding
6 Monitor effectiveness of training to ensure accuracy and completeness. Re-trains as necessary
7 Apply official coding guidelines and regulatory standards to performance of coding medical records so that CHN meets the ethical and legal standards set by regulatory and governing agencies
8 Review medical record documentation so that coding substantiates appropriate reimbursement of accounts receivables. Meet CHN coding quality standards
9 Maintain coding pre-bill exception dollars in accordance with CHN goals
10 Meet CHN coding productivity standards to achieve and maintain coding pre-bill accounts receivables so that cash flow goals and billing deadlines are met on a continuous basis
11 Research and initiate activity to resolve complex charge processing and coding issues
12 Coordinate completion of billing reminders to ensure timely resolution of coding/billing issues. Recognize potential for additional coding revenues and recommend procedures for implementation
Level 2 Proficient (in addition to above duties)
1 Enter information on computer to track or maintain department information
2 Provide assistance with special events and/or projects as requested
Level 3 Subject Matter Expert (in addition to above duties)
1 Assist the Manager/Director as requested in review and update of department functions and procedure revisions
2 Participate in quality improvement measures

Coding RN Resume Examples & Samples

Knowledge of CMS-HCC model and guidelines along with ICD-9 10 and guidelines
Ability to work a flexible work schedule and travel to markets requiring overnight stays
MS Office Suite, moderate to advanced EXCEL and PowerPoint skills
Additional Chart Review Experience

Corporate Coding Denials Auditor Resume Examples & Samples

Thorough knowledge of the related inpatient prospective payment systems (IPPS)
Experience in working DRG coding denials and writing appeal letters to government and non-government payers
Experience preserving coding integrity based on Coding Guidelines, Coding Clinic and appropriate coding references and resources
Broad knowledge of pharmacology indications for drug usage and related adverse reactions
Knowledge of anatomy, physiology and medical terminology
Understanding of coding practices and official guidelines
Experience with PC, mainframe applications, and encoding systems
Auditing skills for coding quality and compliance
Strong process management skills

Coding Research Analyst, Assoc Resume Examples & Samples

Participates the external Provider Dispute Process by researching and evaluating escalated disputes and supporting the Medical Director review process
Participates in the research of claims coding rule initiatives including the development of detail work plans
Participate in cross-functional teams to address key claims coding rule issues facing the organization
Researches CMS/State laws and AMA guidance
Develops relationship with claims coding rule software vendors
Receives, researches, and determines appropriate action steps for escalated provider disputes from Correspondence, PRT, Claims, and the Markets
Support claims, configuration, PRT, and/or appeal & grievances teams as necessary
LI-JL1
Required A High School or GED
Required 2+ years of experience in medical coding field with a facility, provider or payer organization
Intermediate Demonstrated written communication skills
Beginner Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
Intermediate Ability to work independently
Intermediate Demonstrated problem solving skills
Preferred Intermediate Microsoft PowerPoint
Preferred Intermediate Microsoft Excel
Preferred Intermediate Microsoft Word
Preferred Intermediate Other Knowledge of CMS/State laws and AMA guidance
Preferred Intermediate Other Advanced user and knowledge of claims payment system
Preferred Intermediate Other Knowledge of 3M Encoder
Preferred Intermediate Other Strong knowledge of electronic medical records/billing systems and medical terminology and abbreviations
Preferred Intermediate Other Knowledge of one or more of the following: SQL, Xcelys, CES, iHT

Team Lead-coding Resume Examples & Samples

At least two (2) years recent coding experience required with at least one (1) year leading teams experience in a health care setting preferred
AHIMA or AAPC Coding Certification required (CCS-P, CPC, COC, or CPC-P) required. Knowledge of Epic Resolute and Ambulatory, PowerPoint, Excel, including charts and pivot tables
ICD-10, CPT, and HCPCS coding knowledge inclusive of associated billing edits such as NCCI. Ability to review, analyze, and interpret billing guidelines and state and federal regulations

Coding Quality Analyst Tennessee Resume Examples & Samples

Performs the minimum number of validations consistent with established departmental goal
Provides clear communication, with use of DataRAP application, through query to PCP on documentation not meeting standard of basic administrative components to a progress note
Ensures accuracy of entry by comparing to outcome of diagnoses on eAttestation post validation entry
Identifies and reports quality concerns and errors to DataRAP Clinical Process Quality Analyst for review and education
Coding certification (CPC or CCS or RHIT or RHIA)
3+ years ICD-9 Coding experience
Intermediate (or higher) MS Office (Word, Excel & Outlook)
Outpatient Coding experience
Physician's office/hospital experience

Coding Data Spec-telecom Resume Examples & Samples

Code medical records, understanding CPT and ICD coding
Abstract data element
Evaluates the medical record for procedures and diagnoses documented in the medical record and accurately assigns ICD-10, HCPCs, Modifiers and CPT codes based on national coding guidelines
Will be reviewing provider dictation and charge entry done by Business Ops personnel to make certain that correct cpt codes are billed and appropriate diagnoses assigned in accordance with provider dictation
Communicate effectively with providers
Need to establish and maintain effective communication with providers and management

Regional Director of Coding Resume Examples & Samples

Manages a 4 day DNFB for the region
Identifies training needs for staff; designs, develops, schedules, and implements training activities as needs are identified
Provides leadership throughout the region in regards to coding and chargemaster inquiries
Works with CBO to eliminate all holds on all accounts utilizing Xactimed/Emdeon software
Responsible for the development and monitoring of the Clinical Documentation program throughout the facilities
Creates, reviews, and submits all monthly corporate reports to Vanguard Health System for Corporate Compliance Initiative
Develops and implements policies and procedures to assure clear and consistent operation of coding areas while encompassing departmental and organizational needs
Works with hospital directors throughout the Market to identify and address any missed opportunities regarding revenue and corrections to daily charges
Implements data collection for all JCAHO indicators in accordance with hospital needs
Conducts quality review on clinical database for accuracy
Provides monthly coding education to all coding staff
Coordinates Corporate Education Sessions
Coordinates internal and external compliance audits, including insurance and RACs
Performs all management functions, including interviewing, hiring, training, evaluating, and disciplining for all direct reports
Ensure integrity of Audit Expert/ARMS databases by maintenance/revision of data as necessary
Demonstrates competency in the use of 3M software, including multiple groupers as well as all computer applications in area of responsibility
Assigns and schedules the work of direct reports and manages to insure a smooth and efficient workflow. Identifies opportunities for efficiencies, reviews, and implements as approved
Participates in the development and implementation of market goals, policies, procedures and budget
Remains abreast of all developments in the Medical Record field, especially as they apply to coding, reimbursement, and clinical database developments/changes
Maintains all assurance and improvement activities for managed functions
Establishes, maintains and updates job descriptions, job standards, and procedures for supervised areas
The analytical abilities necessary to formulate policies and procedures, prepare various reports and records, assists in the development of department budgets
The interpersonal skills necessary to interact with all levels of department personnel, other departments, physicians and individuals from outside the Hospital
Level of knowledge equivalent to an Associate or Bachelor’s Degree in Health Information Management Administration, certification as a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS)
3-5 years of progressive Medical Record supervision. Five years of inpatient and outpatient coding experience. Should be an active member of the American Health Information Management Association and Local Health Information Management Association

Coding Reimbursement Coordinator Resume Examples & Samples

Researches and resolves claim denials, pre-bill edits, and pre-bill errors
Provides feedback to the coding management team and staff regarding denial type errors
Applies LCD and NCD (local and national coverage determination) rules
Develops and maintains outpatient reimbursement manuals to support quality coding on the Coding SharePoint site
Assists with and/or provides suggestions for continuing education topics and issues for coding staff
Educates groups and individuals within HIM regarding coding denials, modifier assignments, and the reimbursement process. When appropriate, assists in developing and maintaining CCHS facilities' coding guidelines in accordance with Official Coding Guidelines
Acts as a liaison among all department managers, staff, physicians and administration with respect to denials issues
Assists with the development of denial reports and other statistical reports
Works with department supervisors, managers, and physician offices
Supports coding program initiatives, promotes good morale and cooperation
Encourages others and values their input
Shares information and seeks ways to add value both to the customer and to the team
Anticipates and responds to changing skills requirements
Seeks opportunities to learn new skills
Actively coaches and encourages team members to do the same
Complies with CCHS and departmental policies and procedures consistently
A minimum of two years of experience in a clinical environment involving the accurate interpretation and coding/abstraction of therapeutic/diagnostic measures and procedures of a diverse patient population
In-depth knowledge of ICD-10-CM coding principles, APC assignment, and modifier assignment
Formal coursework in anatomy, physiology and medical terminology in order to accurately interpret the medical record
Working knowledge of both personal computer applications and mainframe computer systems
Must be detail oriented and analytical in nature
A Bachelor's Degree in Health Information Management may be substituted for up to one year of required experience

Specialist, Regional Coding, Remote Resume Examples & Samples

Successful completion of at least one AHIMA (American Health Information Management Association) certified program with achievement of the correlating professional credential (RHIA, RHIT, CCS, etc.); active and in good standing, preferably a combination of two or more credentials
Minimum of four years of Medicare inpatient and outpatient coding experience (both preferred) in an acute care setting
Thorough knowledge of ICD-10-CM and CPT coding principles and rules, Coding Clinic guidelines, coding compliance, etc
Coding proficiency demonstrated through successful completion of the Tenet coding exercise
Working knowledge of disease processes, MS-DRG and APC classification and reimbursement structures, applicable coding (NCCI or other standardized) edits, and general knowledge of both Local Coverage Decisions (“LCDs”) and National Coverage Decisions (“NCDs”) as it relates to coding/billing
Effective written and verbal communication skills; ability to meaningfully engage other coding professionals, provide feedback, take direction, teach or lead by example, etc
Experience with encoder technology, computerized abstracting systems and electronic health record applications
Organization and prioritization skills for effective workload and time management
Capacity to work independently as well as incorporate a team approach to work activities
Ability to exercise discretionary judgment and effectively problem-solve
Physical Demands - visual acuity with ability to work in a seated position at a computer screen/keyboard for extended periods of time, hand/wrist dexterity with regular keyboard/mouse use, etc
Supervisory or team lead experience preferred

Coding Compl Auditor Resume Examples & Samples

Assure compliance of operational processes and outpatient encounter data capture throughout Southern California Kaiser Permanente making determinations with respect to appropriateness of documentation, adherence to Federal, State and local regulations
Partners with ECS DQS's to review regional and local audit findings to identify coding risk areas, and ensure that medical center training activities are addressing these areas
Identify through focused audits operational and regulatory issues related to coding, documentation, and compliance requirements, ensuring that appropriate documentation is maintained to comply with Federal and State requirements
Partner with Compliance Analyst, DQSs and other local analytical workgroups to identify audit trends and risk areas based on audit findings and data analysis - formulate recommendations for future training and areas of education and focus based on findings
Using independent judgment and sensitivity, review with individual physicians their audit findings and make suggestions for coding improvements
Monitor coding performance to ensure lasting improvement
Monitor corrective actions for audit review findings
Conduct confidential audits for specific providers who represent a risk due to special circumstances or prior audit issues - work with medical center leadership to provide confidential feedback on an "as needed" basis
Actively participate in local ECS Oversight Committee and ECS champion physicians to work to resolve local coding issues, ensure compliance with local and regional audit plan and act as communication link regarding changes to federal and state government billing and coding guidelines
Prepare and/or perform regional and medical center auditing analysis and/or special projects as assigned. Assists in developing and implementing policies and procedures/Compliance Audit Standards to ensure compliance with Federal, State and other regulatory requirements
Research skills including knowledge of automated analysis tools and on-line research tools to resolve complex healthcare issues

Coding & Audit Specialist Resume Examples & Samples

Develop and maintain expertise relative to CMS-HCC Risk Adjustment payment methodologies. Communicate these requirements to Soundpath Health and lead efforts to develop tactics to meet requirements
Manage vendor relationships as related to CMS-HCC Risk Adjustment payment methodology, proper chart documentation and diagnosis coding to revenue
Conduct physician chart data validation audits to determine whether documentation supports the coding billed, including traveling to physician’s office sites when required
Provide education and consultation to Physician offices regarding Soundpath Health compliance, revenue issues and HCC Risk Adjustment
Assure delegate compliance with Soundpath Health data submission requirements
Support the Soundpath Health Compliance Program by demonstrating adherence to all relevant compliance policies and HIPAA Privacy and Security Regulations, including identification of potential Fraud, Waste, and Abuse claims practices
Oversee development of reports in order to analyze information for trends. Communicate information to Soundpath Health and delegates. Distribute reports to delegates and educate parties on results, providing suggestions to ensure compliance and appropriate reimbursement without appeals. Report all auditing results to Soundpath Health
Maintain a current understanding of coding standards, government regulations, and billing guidelines, to ensure compliance. Develop and distribute claims payment procedures, as required. Perform audits of delegated claims for adherence to regulatory standards, payment accuracy, and data integrity standards, at least once a year and more often when a corrective action plan is required
Develop and manage CMS reporting submission processes and procedures for quarterly and annual report submissions
Review high dollar or other ad hoc claims for appropriateness
Work with Finance and Medical Management to submit reinsurance findings
When capacity exists, support medical management during HEDIS season, including chart retrieval and data validation
Requires at least 2 years of direct experience in data auditing
Extensive knowledge of coding guidelines with knowledge and demonstrated understanding of CMS HCC Risk Adjustment coding and data validation
Experience and expertise in HCC coding highly preferred
Knowledge of ICD-9, ICD-10, CPT-4, HCPCS, DRG and APC, and ICD-9-CM coding is required
Experience with Medicare claims processing guidelines
Government billing regulations, including; Medicare, Medicare Managed Care, and Medical Terminology
Knowledge of HEDIS and quality measurement concepts preferred
Managed health care experience preferred

Supervisor, Claims Coding Rules Resume Examples & Samples

Manages claims coding rule initiatives including the development of detail work plans
Receives and logs requests of changes and appeals to committees ruling
Maintains a library of all the existing and retired rules, the source of the rule and the implementation/retire date of the rule (by Market and by Line of Business)
Documents supporting authority for each claims coding rules by Market and by Line of Business (Master Grid)
Participate in cross-functional teams to address key claims coding rule issues facing the organization
Administers communication to Markets and collect feedback
Evaluates change proposal from Clinical perspective, Financial perspective, and Claims operational perspectives; Prepare analysis of claims coding rule changes
Seeks professional feedback from Health Services, Finance, and Claims on claims coding rule changes
Identifies coding error (e.g., upcoding, bundling/unbundling) and recommend correct coding of medical claims
Researches CMS/State laws and AMA guidance
Presents change proposal to committee
Communicates effectively to markets
Develops relationship with claims coding rule software vendors
Provides mentoring and guidance to Specialists
Train less experienced staff
Support claims and/or appeal & grievances team
Support claims configuration team
Discuss coding issues with finance and vendors to optimize payment
Accurately code records for appropriate reimbursement

Coding Education & Quality Coordinator Resume Examples & Samples

Develops and maintains CCHS facilities coding guidelines in accordance with Official Coding Guidelines as appropriate
Provides coder orientation, training and education on all relevant issues which will impact technical coding in HIM. Assists with the analysis of case mix reports and other statistical reports
Anticipates and responds to changing skills requirements. Seeks opportunities to learn new skills. Actively coaches and encourages team members to do the same
A minimum of two years of experience in a clinical environment involving the accurate interpretation and coding/abstraction of therapeutic/diagnostic measures and procedures of a diverse patient population

Healthcare IT Business Analyst \ Prior Healthcare Coding Needed Resume Examples & Samples

Gather and evaluate business requirements
Work closely with Developers and Quality Assurance Analysts to ensure requirements are completely understood
Communicate business concepts and application designs to all stakeholders and varying levels of the organization
Act as the liaison between Business stakeholders, Users, Systems Analysts, Developers, and project management groups
Work closely with business teams to strategize solutions that support long term business objectives
Ensure IT deliverables align with business requirements with measurable results
Collaborate with QA teams to ensure testing efforts align with system deliveries and business processes
5+ years of experience in all phases of Software Development Life Cycle $SDLC$ / System Development Life Cycle
3+ years of experience as a Systems or Business Analyst, including gathering, interpreting, and documenting business requirements
3+ years of experience in Healthcare IT
1+ years of experience with a Healthcare claim editing or processing system
Proficiency with MS Word, Excel, Visio, PowerPoint
CPC Certification or equivalent work experience
Experience facilitating Joint Application Design $JAD$ sessions
Experience with business process modeling

Director, Coding Operations & Production Resume Examples & Samples

Directs a four day Discharge not Final Billed (DNFB) target for all hospitals within the Health System
Plans, organizes, coordinates and evaluates staffing requirements to meet operational goals
Bachelor’s Degree in Health Information Management or related field, required. Master’s Degree, preferred
Minimum of 7 years progressively responsible health information management, program management
Knowledge of coding software and computer skills in Microsoft Office and products Word, Excel, Power Point, and Access
Certified Coding Specialist (CCS), Certified Coding Professional (CPC), Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) certification

Coding Data Specialist Resume Examples & Samples

In-Patient Coding
Evaluates the medical record for procedures and diagnoses documented in the medical record and accurately assigns ICD-10 codes and MS-DRG, based on National Coding Guidelines
Code medical records, understanding ICD coding
Will be reviewing Provider dictation and assigning codes in accordance with Provider dictation

Coding Support Coordinator Resume Examples & Samples

3 years Health Information Management experience in an acute care facility
Preferred data entry and basic office skills, i.e.; fax, copy machine, printer, computer
Preferred knowledge of, but not limited to the following systems
Cerner process and workflow, Synapse radiology system, Allscripts Clinic notes, and Aria/Varian radiation oncology notes

Supervisor, Outpatient / Provider Coding Resume Examples & Samples

Utilize various reporting functions to analyze, resolve and implement departmental and team improvements
Weekly review of reports to monitor current status of edit volumes to assist office management in determining the appropriate work volumes for variety of staff
Facilitate educational meetings with departmental and internal staff
Meet with multiple provider types, payers, and staff for education regarding coding, compliance, and reimbursement issues
Distribute information from meetings to appropriate people
Continual assessment of appropriate daily work volume capabilities for each employee
Recognize trends and identify options for process improvements for review by UMB Directors and Managers
Monthly review of professional medical coders and support personnel for use of internal policies and quality assessments to ascertain the progress of understanding complex coding scenarios in the University setting
Manage work volume and education with remote staff
Supervise employee deadlines with current assignments and monitor the volumes of outstanding projects to be delegated to appropriate staff
Assist with developing efficient methods to ensure that all billable charges are being captured by each department
Assist with identifying and resolving technical problems with editing software
Continual education and training of staff to increase knowledge base and problem solving skills for use in daily duties
Ongoing review of existing edits created to verify information is still valid and appropriate for department and payer claims

100

Coding Associate Resume Examples & Samples

HS grad or equivalent with medical terminology and some coding knowledge and training
Graduate of an accredited coding program and/or two years of medical billing experience
CCS, CCS-P, CPC, CPC-A, CCA, RHIT, and/or RHIA Certification achieved within 12 months
Able to interpret and understand medical content, including knowledge of CPT and ICD-9-CM coding
Ability to use computer and medical billing systems
Highly detailed and organized; demonstrated time management skills and ability to multi-task
Flexible; able to take direction

101

Coding Research Analyst Resume Examples & Samples

Advanced demonstrated written communication skills
Intermediate demonstrated leadership skills
Intermediate demonstrated interpersonal/verbal communication skills
Advanced ability to work as part of a team

102

PRN Coding Resume Examples & Samples

Performs ICD and CPT coding of provider (professional) services and verifies that all requisite charge information is entered
Appends limited modifiers, e.g., -24, -25, -59
Codes minor surgical procedures
Assigns Evaluation and Management (E/M) codes
Performs reconciliation process to ensure all charges are captured
Processes automated or manually enters charges into applicable billing system
Researches, answers, and processes all edits associated with claim and coding submission
Processes charges on a timely basis and communicates with team members to be sure department guidelines regarding timeliness are met
Communicates with providers related to coding issues that are of low to intermediate complexity
Assigns E/M codes from provider documentation

103

Coding Reimbursement Specialist Resume Examples & Samples

Performs ICD and CPT coding of provider (professional) services and verifies that all requisite charge information is entered
Appends all modifiers
Ranks CPT codes when multiple codes apply
Assigns Evaluation and Management (E/M) codes
Performs reconciliation process to ensure all charges are captured
Processes automated or manually enters charges into applicable billing system
Researches, answers, and processes all edits associated with claim and coding submission
Adheres to department guidelines for timeliness of processing charges and communicates with team members and practice management on an ongoing basis to ensure these guidelines are met
Communicates with providers related to coding issues that are of mid to intermediate complexity. Including face to face interaction and education with providers
Applies modifiers and appropriate ranking to encounters with multiple codes

104

Clinical Coding IV / Acute Care Resume Examples & Samples

Reviews medical records of high complexity to identify the appropriate principal diagnosis and procedure codes, all other appropriate secondary diagnoses and procedure codes. Assign and present on Admission, Hospital Acquired Condition and Core Measure Indicators for all diagnosis codes
Demonstrates proficiency with Microsoft Office Applications and in using required computer systems with minimal assistance
Abstracts coded data and other pertinent fields in the hospital electronic health record
Meets established quality and productivity standards
Facilitates peer review and training for all Acute Clinical Coders in the coding department. Provides support to management

105

Coding Director Compliance / Education Resume Examples & Samples

Guides the development and implementation of short and long-range goals and objectives for the designated business entitys coding and abstracting programs. Provides leadership and expertise in the development, implementation, oversight, and evaluation of coding/data abstraction programs for the system. Incorporates best practices and responds to emerging trends to enhance operations, programs, and/or services. Implements and evaluates strategic programs, develops effective tools to measure performance, analyzes related data, prepares reports, and makes recommendations to senior leadership based on findings
Directs, supervises, and evaluates the work of staff and managers. Holds staff accountable for achieving plans and performance targets. Works with staff to identify and resolve the most complex issues and problems impacting health management coding operations. Supports development and continued professional growth to meet company and individual goals for long-term success. Demonstrates an expectation for continuous quality improvement utilizing processes that include consideration of all stakeholders
Builds and supports effective relationships with internal and external stakeholders and organizations. Develops partnerships, coordinates activities, reviews work, exchanges information, and/or resolves problems related to coding and abstraction programs and/or services
Directs and participates in the development, implementation, and consistent application of effective organizational policies, procedures, and practices. Develops and supports internal controls to ensure that assets are safeguarded, policies and operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved
Develops and oversees the department budget to meet corporate goals and objectives. Meets annual budgetary goals. Translates organizational plans, goals, and initiatives into assumptions for annual operating and/or capital budgets. Negotiates contracts with external vendors for products and/or services and monitors/evaluates quality and/or performance. Manages and reports expenditures
Communicates the department vision, translating it into actionable projects and activities. Maximizes management staffs contributions and assures timely decision-making reflecting the mission, vision, and values of the system
Reviews, prepares, analyzes, and presents reports and recommendations to senior leadership regarding operations, programs, services, and/or other applicable areas of interest in order to provide concise and accurate information that aids in decision-making
May lead or facilitate task forces, teams, and/or councils to plan, implement and coordinate coding related programs, services, and/or educational opportunities for the organization

106

Manager, HIM Coding Resume Examples & Samples

Bachelor’s degree in Health Information Management, Business, or 6 years of related work experience
Applicable coding certification (RHIA, RHIT or CCS)
Three years of coding experience
Bachelor’s degree in Health Information Management, Business, or other healthcare-related field
Registered Health Information Administrator plus applicable coding certification
Five years of coding experience and two years of management experience

107

Auditor, Coding Quality Resume Examples & Samples

Coding: Uses discretion and specialized coding training and experience to accurately assign ICD-9, CPT-4 codes to patient medical records. 10%
Coding Quality: Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC & CC) and procedures. Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by SOW. 10%
CDI: Identifies and communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to appropriate personnel for follow-up and resolution. 10%
Professional Development: Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-9-CM and CPT coding. Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding. Quarterly review of AHA Coding Clinic. Attends Quarterly Coding Updates and all coding conference calls. 5%
Must successfully pass coding test
Computer knowledge of MS Office
The coder must be able to work in a virtual setting under minimal supervision
Intermediate knowledge of MSDRG classification and reimbursement structures
Associates degree in relevant field preferred or combination of equivalent of education and experience
Duties may require driving an automobile to off- site locations
Must be able to efficiently use computer keyboard and mouse to perform coding assignments

108

Coding & Documentation Educator Resume Examples & Samples

Expert working knowledge of CPT-4, ICD9, ICD-10-CM and HCPCS codes
Strong understanding of coding and documentation issues facing the healthcare industry
Knowledge of and ability to apply billing compliance program rules, regulations, policies and procedures
Ability to communicate coding concepts to medical staff and management and work independently
Must have a high school diploma or equivalent. Associate’s degree in related field preferred
Completion of college level courses in medical terminology, anatomy and physiology, disease processes and pharmacology highly desirable
Required certifications
Must be certified through the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC), Preferred
Must be certified through the American Health Information Management Association (AHIMA) as a Certified Coding Specialist Physician Based (CCS-P)
5+ years of coding experience

109

Claims Coding Coordinator Production Support Resume Examples & Samples

Acts as a liaison and as a subject matter expert between the business partners, IS, Claims Department and external coding vendor in analyzing current processes and determining changes needed for new or modified processes and procedures relating to professional claims and facility pricing using DRG, APC, ASC and other software used to process and edit facility claims
Assists in the development of test plans and test conditions; coordinates activities, tests, implements and monitors projects relating to facility pricing using the DRG, APC, ASC and other software used to price and edit facility claims
Analyzes the claims department’s business requirements; participates in the documentation of requirements for new or enhanced manual or automated systems and work with IS and other departments through the design, testing, implementation and post implementation of the systems changes
Responds to internal and external audits relating to professional and facility claims payments and DRG assignments
Conducts research for recommending coding rules related to bundling software
Works with vendors to ensure timely receipt of files for ICD9 diagnosis and procedure codes, DRGs, APCs, ASCs and other software needed for facility pricing
Oversees the receipt, testing and implementation of file loads for the ICD9 diagnosis and procedure files, DRGs, APCs and ASCs to QCare to ensure information is updated accurately and timely; tests new rules/policies for professional claims
Provides production support to claims staff relating to discrepancy reporting and resolution regarding professional and facility claims
Coordinates issues, reporting and updates with Grievance & Appeals department and external vendor (I-Health team), assists in reporting and trouble-shooting and attends meetings as needed to maximize savings
Excellent knowledge of claims coding initiatives
Strong claims processing knowledge
Associate’s degree; Bachelor’s degree preferred
ART or RRA license required
Minimum six years of prior related work experience in Claims and HMO benefits administration
Knowledge of medical terminology, ICD/CPT coding, per diem and DRG reimbursement and EDP testing procedures
Knowledge of automated systems and claims processing sufficient to prepare specifications and documentation for IS systems development staff
Knowledge of health/managed care insurance claims which reflect knowledge of institutional/professional claims and Correct Coding initiative. Knowledge of ICD-9, CPT, HCPCS coding and DRG review
Proficiency Legends

110

Quality, Coding, & Risk Specialist Resume Examples & Samples

Contact and visit physician provider offices regularly to review charts and ensure proper coding of all current medical conditions to the highest specificity according to Medicare requirements for the Hierarchical Condition Category (HCC) risk adjusted payment model
Educate providers and staff about HCC based guidelines and updates
Ensure that billing staff understand the importance of correctly adding diagnosis codes to claims
Conduct training sessions for physicians and/or staff as needed
Develop and maintain coding reference sheets by specialty
Update the HCC manual on a yearly basis to reflect any changes
Review reports and take appropriate actions accordingly
Communicate with providers and staff in case of any changes, updates and deadlines
Identify HCC conditions that require patient outreach, chart review or physician education
Manage retrospective chart reviews with vendors and health plans
Manage home health assessment programs with vendors
Work with health plans on achieving project goals
Other duties as assigned to support the success of HCC risk adjusted payment model program
ICD-10 Certified Professional Coding Certificate
Minimum 2 years coding and/or billing experience
Minimum 1 year experience with HCC coding and risk adjustment
Knowledge of ICD-10 codes and taking courses as necessary to maintain certification
Proficiency in Excel and Word software programs
Ability to effectively communicate with physicians, and provider office staff
Ability to research clinical and non-clinical issues
Ability to become technically proficient in Access Express and Ascender as well as reading reports
Ability to research and multi-task utilizing critical thinking skills
This position requires driving to Santa Clara County
Medical Billing certificate or equivalent years of experience
Knowledge of ICD-10 Codes
Knowledge of medical terminology and anatomy
Ability to prioritize tasks and work in a high volume production environment

111

Central Coding Resource Management Manager Resume Examples & Samples

Coding Technical Skills‐ extensive regulatory coding (ICD‐9‐CM/ICD‐10‐CM, CPT‐4, MS‐DRGs, POA Assignment and where applicable APR‐DRGs and PPCs) and associated reimbursement knowledge
Leadership ‐ leads individuals and groups toward identified outcomes, setting high performance standards and delivering quality services
Critical thinking ‐ actively and skillfully conceptualizing, applying, analyzing, synthesizing or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning or communication as a guide to belief and action
Building and Maintaining Strategic Working Relationships – develops collaborative relationships to facilitate the accomplishment of work goals. Possesses excellent interpersonal skills in building, negotiating and maintaining crucial relationships
Effective Operational Decision Making ‐ relating and comparing; securing relevant information and identifying key issues; committing to an action after developing alternative courses of action that take into consideration resources, constraints, and organizational values
Managing conflict – dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people
Stress tolerance – maintaining stable performance under pressure or opposition; handling stress in a manner that is acceptable to others and the organization
Planning and Organization ‐ proactively prioritizes initiatives, effectively manages resources and keen ability to multi‐task
Communication ‐ communicates clearly, proactively and concisely with all key stakeholders
Customer orientation ‐ establishes and maintains long‐term customer relationships, building trust and respect by consistently meeting and exceeding expectations
Work Independently – is self‐supporting; not needing to rely on others to complete a job
Facilitation – ability to facilitate small to large groups of people at various organizational levels for purposes of planning, problem solving, or strategy development
PC skills ‐ demonstrates proficiency in Microsoft Office applications and others as required
Policies & Procedures ‐ articulates knowledge and understanding of organizational policies, procedures and systems
Project Management ‐ assesses work activities and allocates resources appropriately
Undergraduate degree required. Bachelor’s degree strongly preferred
Minimum 3 years' health care management/leadership experience required
Minimum 3‐5 years' inpatient/outpatient hospital coding experience strongly preferred
Experience managing a large coding pool or coding review pool strongly preferred

112

Regional, Physician Coding Director Resume Examples & Samples

Current nationally recognized professional coding certification required. Bachelor degree in Business Administration or Healthcare Administration or related field strongly preferred
Coding program development and management experience - 5 years strongly preferred
Regulatory and compliance experience
Experience in the development and delivery of communication and education programs, varying groups and delivery methods, including billing & clinical staffs, physicians and management teams
Experienced and effective with physician communication
Previous experience in leading teams
Previous experience with process, systems, organizational development and improvement

113

Coding Account Resolution Specialist Resume Examples & Samples

Coding Technical Skills – regulatory coding (ICD‐9‐CM (inpatient and outpatient CARSs), CPT‐4 (outpatient CARSs), ICD‐10‐CM (inpatient and outpatient CARSs on or before 10/1/15), ICD‐10‐PCS (inpatient CARSs on or before 10/1/15), MS‐DRGs (inpatient CARSs) and associated reimbursement knowledge
Customer Orientation – establishes and maintains long‐term customer relationships, building trust and respect by consistently meeting and exceeding expectations
Policies and Procedures – articulates knowledge and understanding of organizational policies, procedures and systems
Initiative – independently takes prompt proactive steps towards problem resolution
Organization – establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and keen ability to multi‐task
Communication ‐ communicates clearly, proactively and concisely with all key stakeholders
Customer orientation ‐ establishes and maintains long‐term customer relationships, building trust and respect by consistently meeting and exceeding expectations
Work Independently – is self‐supporting; not needing to rely on others to complete a job
PC skills ‐ demonstrates proficiency in Microsoft Office applications and others as required

114

Coding / Correspondence Clerk Resume Examples & Samples

Keeps abreast of the industry/field ethical coding guidelines and consistently adheres to those standards
Verifies batch carries over properly to billing system. Reviews and addresses rejects
When necessary follows up with the physician/provider for clarification
Investigates claim denials, collaborating with patient financial services and as necessary involving the physician/provider
Participates in quality and other audits as requested

115

Coding Quality Analyst Resume Examples & Samples

Develops rapport with providers
Performs audits of clinical documentation to ensure all assigned ICD codes are accurate and supported based on coding guidelines
Queries provider when documentation is conflicting, ambiguous or incomplete
Identifies issues and trends in coding and documentation
Responsible for communicating with physicians to provide valuable feedback on medical record review findings
Provides education on proper clinical documentation, compliance, and coding guidelines
Associate’s degree or higher - significant relevant work experience may substitute for degree
3+ years of experience ICD - 9 / 10 coding / auditing, preferably in a Managed Care setting, with strong attention to detail and high accuracy rate
2+ years of recent Medicare Risk Adjustment / HCC Coding experience
Proficient knowledge of CMS - HCC model and guidelines
Coding Certification required (CPC, CCS, CCS - P, or RHIT; CPC - A or CCA designation is not acceptable)
2+ years of recent Provider education experience
Compliant Physician query experience
Must be local to the Farmington, CT area – or within reasonable driving distance. Will primarily work remotely, but will be required to attend on - site meetings or travel to provider offices as needed
Up to 25% travel (locally and non - locally to provider offices) as determined by business need
ICD - 10 proficient
Previous experience using diagnosis coding data and trends to identify training opportunities
Excellent time management, organizational, and prioritization skills with ability to balance multiple priorities and make changes to work as the project needs dictate
Microsoft Office proficiency (Word, Excel & Outlook)
Must be able to continuously meet the requirements for a telecommuter, i.e. live in a location that can receive a UnitedHealth Group approved high speed internet connection, have a secure designated office space to maintain PHI, meet or exceed all performance expectations
CRC (Certified Risk Coder) in addition to required coding certification
1+ years HEDIS / STARS experience
Previous experience with WebEx or similar virtual meeting tools

116

Coding Application Analyst Resume Examples & Samples

Assist with identification of coder applicants to include coder testing, manager selection for interview, and follow-up with coders/recruiters. May be required to assist with new user requests, order/ship equipment, & validate access to systems per defined turn around times
Facilitate and track new coder audits. Provide feedback to managers at completion of audit
Back-up Coding Data Analyst for routine reports
Develop expertise in the coding applications to support troubleshooting and user questions
Identify process improvement opportunities and work with corporate coding director(s), and manager(s) to document and implement
Learning Center Administrator to assist with assignment of additional coder education courses and creation of coding courses
Experience identifying appropriate resources required to expedite resolution of questions/issues
Ability to communicate in cross-departmental teams
Proven experience in process improvement improving business outcomes
Strong presentation skills via remote delivery and in person
Experience with 3M computer assisted coding and encoder products preferred
Familiarity with coding and/or hospital revenue cycle preferred
Strong Microsoft Excel skills required
Experience with PC & mainframe applications
Exceptional written and verbal communication skills required

117

Manager, Physician Practice Coding Resume Examples & Samples

Serve as coding SME including but not limited to basic E&M, specialty specific surgery coding and ICD-9/ICD-10 -CM for practices within his/her individual market
Work with providers, coders, billers, clinical and non-clinical office staff to answer coding questions and provide guidance, as needed
Monitor market bill hold reports and market new provider start dates to ensure the pre-bill clearance process is performed for all new providers
Monitor compliance central for remediation plans, etc. for individual market coders and/or biller, as necessary
Collaborate with Coding Educator, is applicable, to develop provider education, as needed, based upon these reviews
Oversee the day to day coding operations of the market by monitoring pending charges, kept appointments with no charges and task reports, etc. to ensure coders and/or billers are clearing their work ques in a timely manner. Keep Regional Coding Operations Manager informed of any issues that prevent timely submission of claims
Assist individual market coding staff with day-to-day coding duties, as needed, including but not limited reviewing provider documentation to ensure assignment and sequencing of procedural and diagnostic codes to ensure accurate and timely submission of claims
Participate with special projects and other duties as assigned
Expert working knowledge of CPT-4, ICD9, ICD-10-CM and HCPCS codes as well the National Correct Coding Initiative (NCCI) edits
Strong understanding of coding and documentation issues facing the healthcare industry
Remains current on reimbursement regulations and coding guidelines and keeps the market informed of changes
Ability to convey information in a clear, concise and accurate manner
Obtains necessary CEU’s to maintain required competencies, licenses and certification
Demonstrates proficiency using Microsoft products (Excel, Word, PowerPoint) and a medical management system
Adheres to the “Coders Code of Conduct”
Works with all team members to promote a harmonious work environment and encourages an open and honest exchange of ideas with all internal and external customers
Demonstrates the ability to gather and analyze data in order to solve problems and develops an alternative course of action and/or alternative solution, when necessary
Maintains a strong work ethic and demonstrates a high level of professionalism; and
Ability to work independently, prioritize work and complete projects/tasks in a timely manner
Must have a high school diploma or equivalent. Associate’s degree in related field preferred
Completion of college level courses in medical coding/billing, medical terminology, anatomy and physiology, highly desirable
Required certifications
Must be certified through the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC), Preferred OR
Must be certified through the American Health Information Management Association (AHIMA) as a Certified Coding Specialist Physician Based (CCS-P)
5+ years of progressive coding and management experience

118

VAT Coding Associate Resume Examples & Samples

Responsible for executing transactional processes
Check and review invoices for VAT coding compliance, according Cargill internal policy
Daily communication with Tax personnel, Business units on questions arising within VAT coding issues
Participate trainings and process improvement projects within Global Business Services
Ensure all internal controls are in place and monitored according Cargill policies
Respond to BU to deliver error free process
Bubuilding supportive relationships with peers and colleagues
This role will report to the Indirect Tax Supervisor, Finance Shared Services in Sofia, Bulgaria
Bachelor degree in Accounting or Finance
Problem-solving skills with an ability to identify and resolve problems in a timely manner
Demonstrate commitment to internal control
Strong sense of ownership and follow-through
Strong listening and communication skills
Ability to adapt to change and learn quickly
Good working knowledge of MS Office (Word / Excel)
Working Knowledge of ERP (JDE/SAP) would be preferred

119

Coding Quality Manager Resume Examples & Samples

Coding Technical Skills - extensive regulatory coding (ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT-4, Modifiers, MS-DRGs, POA assignment and where applicable APR-DRGs and APCs) and associated reimbursement knowledge
Leadership - leads individuals and groups toward identified outcomes, setting high performance standards and delivering quality services
Critical Thinking - actively and skillfully conceptualizing, applying, analyzing, synthesizing or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning or communication as a guide to belief and action
Building and Maintaining Strategic Working Relationships - develops collaborative relationships to facilitate the accomplishment of work goals. Possesses excellent interpersonal skills in building, negotiating and maintaining crucial relationships
Building Trust - interacts with others in a way that gives them confidence in one’s intentions and those of the organization
Effective Operational Decision Making - relating and comparing; securing relevant information and identifying key issues; committing to an action after developing alternative courses of action that take into consideration resources, constraints, and organizational values
Adaptability - maintaining effectiveness when experiencing major changes in work tasks or the work environment; able to adapt to change in environment and/or circumstances with a positive outlook; and adjusting effectively to work within new work structures, processes, requirements, or cultures
Initiative - independently takes prompt proactive steps towards problem resolution
Managing Conflict - dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people
Energy - consistently maintaining high levels of activity or productivity; sustaining long working hours when necessary; operates with vigor, effectiveness, and determination over extended periods of time
Stress Tolerance - maintaining stable performance under pressure or opposition; handling stress in a manner that is acceptable to others and the organization
Planning and Organization - proactively prioritizes initiatives, effectively manages resources and keen ability to multi-task
Communication - communicates clearly, proactively and concisely with all key stakeholders
Customer Orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
Work Independently - is self-supporting; not needing to rely on others to complete a job
Facilitation - ability to facilitate small to large groups of people at various organizational levels for purposes of planning, problem solving, or strategy development
Quality Orientation - accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time
PC Skills - demonstrates proficiency in Microsoft Office applications and others as required
Policies & Procedures - articulates knowledge and understanding of organizational policies, procedures and systems
Project Management - assesses work activities and allocates resources appropriately
Coach, Mentor and Educate - provides timely guidance and feedback to help strengthen the knowledge/skill set of others to accomplish a task or solve a problem
Undergraduate degree required. Bachelor’s degree strongly preferred
Minimum 3 years' health care management/leadership experience required
Minimum 7 years' recent inpatient/outpatient hospital coding experience required
Experience managing a large coding team or coding review team strongly preferred

120

Coding Rn-sign On Bonus Resume Examples & Samples

Provide leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff
Bachelor’s Degree in Nursing required (Associate’s Degree or Nursing Diploma from accredited nursing school with 2 or more years of additional experience may be substituted in lieu of a bachelor’s degree) and current RN license in good standing
More than two years coding experience

121

Senior Medical Data Specialist Coding Resume Examples & Samples

A graduate of allied health care related course with commensurate experience in data management
Minimum of 5 years coding experience required
At least 2 years of Coding in Clinical Research/Data Management
Strong knowledge of ICH guideline, or adequate background and have attended seminars for MedDRA and WHODD use
Knowledge of coding tool Central coding, INFORM a plus
Proficiency on all related regulations, GCP, and Good Clinical DM Practice
Computer proficiency and knowledge of medical terminology
Expertise on use of Excel

122

M HIS Business Unit Manage, Facility Coding Resume Examples & Samples

Develop and execute business unit strategy, plans and programs, both short and long range, to ensure profit growth and expansion
Drive P&L performance of top and bottom line targets
Set product strategy and execute on sales targets (multi-million dollar sales targets) for the facility coding product line
Manage a diverse staff of resources
Analyze activities, costs, operations, and forecast data to achieve business unit goals and objectives
Recognize the achievement and contributions of others
Evaluate individual performance including holding team members accountable to agreed-upon deliverables
Provides direct supervision to assigned employees through leadership, coaching, training and development, allocating work assignments, review of progress in achieving objectives, managing employee compensation, performance appraisals, diversity, disability, all relevant employee data, etc. Understands and enforces corporate/location policies and procedures. Takes appropriate action to address policy violations
May manage workforce vendors and contracts
Minimum of seven or more (7+) years of experience in Healthcare
Minimum of five or more (5+) years of demonstrated experience collaborating across organizational boundaries (influence not direct reports) to complete projects
Minimum of five or more (5+) years with software development and delivery
Entrepreneurial experience: working in small and large companies/business units
Experience Scaling a Business Unit
Experience in hospital based revenue cycle leadership and operations
Proven leadership, organization and planning ability
Experience with managing solutions that include both software and professional services
Proven ability to delegate effectively
Must have good work/life balance skills accompanied by the ability to recognize one's own signs of stress and manage them well

123

Coding Tech Resume Examples & Samples

Minimum of 1 year work experience in a medical office, HIM department, or equivalent healthcare setting
Minimum of 1 year work experience of outpatient of Emergency Department (ED) ICD-9-CM/ICD-10 and CP/HCPCS coding/abstracting, and APC assignment
Ambulatory Surgery Center (ASC) or acute hospital outpatient/inpatient coding work experience
Successful completion of academic courses in medical terminology, anatomy, physiology, ICD-10-CM and CPT coding
Certified Coder
AHIMA coding credential (CCS, CCS-P, or CCA) or AAPC coding credential (CPC, CPC-H), or RHIT credential

124

Coding Quality Consultant Resume Examples & Samples

Must have completed coding certification course, AAPC/AHIMA, or other accredited certifying body, or completed college courses with degree in coding or currently enrolled in program for CPC, COC, CRC, CIMC, CFPC, CPMA, CCS, CCA, CDIP, or RHIT
Must possess a CCS, CPC or COC certification or will have it completed within next 90 days of employment
Ability to travel locally to provider practices will be out in field 75% with rare overnight stay

125

Supervisor Coding / Reimbursement Resume Examples & Samples

Assigns E/M or other procedural codes from provider documentation
Conducts quality assurance reviews to determine where additional training opportunities should be implemented
Monitors productivity and redirect workflow as volumes require for assigned teammates
Oversees reconciliation processes to ensure complete

126

Coding & Analysis Specialist Resume Examples & Samples

Bachelor’s degree in sociology or related discipline
Experience coding qualitative interviews for sociological research
Experience conducting research with limited resource communities or communities of color

127

Benefits Coding Advisor Resume Examples & Samples

Validating, configuring, maintaining, implementing and communicating the benefit plan design additions and changes
Analyzing, interpreting and comprehending complex client benefits requirements, commitments and contracts
Building and maintaining relationships with clients, test centers of excellence, benefit coding teams and account management teams

128

Coding Documentation Educator Resume Examples & Samples

Assists in determining educational needs based on documentation reviews, provider/staff feedback, data analysis (bell curves)
Performs a minimum of an annual review of each clinician and specialty to identify clinical documentation and coding areas that require improvement and additional education
Prepares necessary reports and communicates results of audits to management, clinicians, and committees as appropriate
Reports areas of risk directly to the Coding Integrity Manager/Supervisor
Maintains a high level of competency related to clinical documentation and coding in assigned specialty and other areas and compliance with government regulations by attending appropriate workshops and seminars

129

Clinical Coding Documentation Manager Resume Examples & Samples

Collaborates with ACO leadership to develop an annual operational plan for the ACO clinical coding and documentation strategy Mercy ACO’s strategic plan and related departments/operational plans in order to efficiently provide services
Develops, implements and periodically reviews all policies and procedures that guide and support the assigned services. These include, but are not limited to JCAHO requirements, federal and state regulations, regulatory standards, payer regulations, etc
Develops and maintains staffing plans, detailing appropriate employee classifications and qualifications consistent with the clinical coding and documentation plan, and other relevant indicators
Provides onsite/remote education, orientation and support to the ACO Chapters and Providers
Maintains expertise in HCC coding and RAF (Risk Adjustment Factor) methodology
Participates in national professional and related organizations to ensure current knowledge of documentation and coding needs
Maintains open and positive communication with staff, physicians, chapter liaisons, and other ACO Participant organizations
Counsels and monitors performance of ACO Clinical Coding Documentation staff
Conducts interviews with prospective employees; works with Human Resources in hiring new personnel
Provides ongoing evaluation of staff members
Provides back up to CDI staff in the event of staffing gaps due to extended PTO or illness to ensure sustained process
Develops policies pertaining to compliance documentation to assist physicians in appropriate documentation that reflects the patient’s condition and can be captured by coders
Presents and communicates policies regarding compliance documentation to management, physicians, and other appropriate personnel
Manages implementation of clinical coding documentation conventions with ACO Participant organizations, physicians and appropriate personnel in conjunction with the Chapter Liaison
Identifies, develops and analyzes benchmarks for comparing Mercy ACO’s participant organization’s performance with like institutions and practices
Coordinates completion of the medical record with the respective Medical Records Department in conjunction with the Chapter Liaison
Develops and maintains databases related to compliance documentation
Gathers, analyzes and utilizes data to support strategic developments and improvement activities related to appropriate coding and compliance documentation
Registered Nurse with BSN or other Healthcare related Bachelor degree and with a broad clinical knowledge base required, Master’s degree preferred
Certified Risk Adjustment Coder, certification required, or be obtained within 6months of hire
Inpatient CDI experience, strongly preferred
Knowledge of HCC and RAF Methodology preferred
Previous project management experience desirable
Strong communication, written, interpersonal, and presentation skills
Two years management experience strongly preferred
Extensive knowledge of coding ICD-9, ICD-10, DRG payor issues, documentation requirements and strategies, and referral policies and procedures
Excellent computer skills and experience: word processing, spreadsheet and database
Travel required to Mercy ACO Regional Chapters, estimated +/- 20%

130

Payment Integrity Ideation Lead, Coding Resume Examples & Samples

Establish strong matrixed relationships with internal stakeholders to define, align, and deliver payment integrity initiatives in support of assigned clients
Influence senior leadership to adopt new ideas, approaches, and / or products
Lead concepts / projects from conceptualization to completion
Self - managed, self - starter with the ability to support multiple concurrent projects and meet tight delivery timelines
Strong computer skills: Excel, Visio, PowerPoint
3+ years of experience auditing, billing, and / or coding claims
Advanced degree in health care or medical field
Coding certification through AAPC or AHIMA
5+ years of experience in health care informatics and / or performing analysis on health data metrics
2+ years experience working in a matrix and highly adaptive environment handling tight deadlines
Proficiency with SQL, SAS and / or other statistical programs

131

Supervisor, Coding Resume Examples & Samples

Assists in the selection, responsible for the orientation, training, counseling, and mentoring of coding staff. Closely monitoring the work of new coding staff member to ensure the quality and quantity of a new employees work meets department's expectations. Schedules staff to ensure adequate coverage of the coding function. Assists in the completion of performance evaluations
Assists in the development, implementation, monitoring, and maintenance of any coding compliance programs set for Steward and/or Morton that supports sound and compliant coding practices by employed and contract coders
Works collaboratively with providers and other caregivers to obtain complete documentation to support the assignment of MS-DRGs. Provides knowledge related to the assignment of ICD-10-CM and CPT codes and DRG Rules when requested. Effectively works with finance and revenue management when required. Ensures appropriate workflow to ensure discharge unbilled accounts do not exceed Steward and /or Morton policy
Responds to requests for data/information, such as outstanding queries, denials due to coding, staff productivity monitoring and reporting, coding accuracy rates etc. in a timely manner
Provide support to the Revenue Enhancement Coordinator and coders when identifying and correcting claims that have failed coding edits
Review claim denials and rejections pertaining to coding and medical necessity issues
Ensures the appropriate dissemination and communication of all regulation, policy, and guideline changes to affected personnel
Monitoring of unbilled accounts with Steward goals and communicates any/all issues with revenue cycle initiatives
Reads and interprets health record documentation to identify all diagnoses and procedures that affect the inpatient/outpatient stay/visit
Assesses the adequacy of health record documentation to ensure that it supports all diagnoses and procedures to which codes are assigned
Applies knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to assign accurate codes to diagnoses and procedures
Applies knowledge of current approved coding guidelines (as published in Coding Clinic for ICD10-CM) to assign and sequence the correct diagnosis and procedure codes for hospital inpatient services with a 95% accuracy rate
Applies knowledge of current coding guidelines and regulatory agency guidelines to assign the correct diagnosis and procedure codes for hospital outpatient services with a 95% accuracy rate
Applies knowledge of CPT format, guidelines and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequence them correctly
Applies Uniform Hospital Discharge Data Set (UHDDS) definitions to select the principal diagnosis, principal procedure, complications and cormorbid conditions, and other diagnoses and significant procedures which require coding and follows Steward Coding Policies and Procedures
Applies knowledge of the Prospective Payment System to confirm DRG assignment which ensures optimal reimbursement
Refuses to fraudulently maximize reimbursement by assigning codes that do not conform to approved coding principles/guidelines
Applies knowledge of the Outpatient Prospective Payment System to confirm APC/APG assignment which ensures optimal reimbursement
Applies knowledge of ICD10-CM instructional notations and conventions to locate and assign the correct diagnostic and procedural codes and sequence them correctly
Attaches modifiers to procedure or service codes when applicable, monitors and corrects issues with any billing edits
Accurately codes for the professional vs. technical component when needed
Clarifies conflicting, ambiguous, or nonspecific information appearing in the record by consulting the appropriate physician
Participates in quality assessment to ensure continuous improvement in ICD10-CM and CPT coding and collection of quality health data
Demonstrates the ability to recognize potential coding quality issues from an array of data
Accurately enters into Meditech, verifying any existing information
Is cooperative in interactions, treating customers with courtesy, respect and compassion
Is patient when responding to questions and answers questions appropriately
Responds to requests in a timely manner
Handles interruptions in a skillful way
Maintains a professional appearance and demeanor
Strives to prevent/resolve customer concerns to the customer's satisfaction
Is responsible for ongoing development of his/her work skills through the use of available resources (i.e.: in-services, formal educational programs, other work groups and on-the-job training)
Attends and participates in staff meetings and in-services and/or reviews documentation as required
Assists in the orientation of others and actively participates in mentoring
Performs analytical and decision making functions with minimal supervision
Recognizes and seeks assistance/consultation when appropriate
Demonstrates an understanding of relative Hospital and all-departmental policies and procedures including safety issues
Possesses awareness of programs/services provided by Hospital and where they are located
Three to Five years coding experience in a health care setting (Inpatient/Ambulatory setting)
Working knowledge of ICD10-CM and CPT-4 coding systems
Certification/licensure/registration: RHIT or RHIA preferred and Certified in Coding required (CCS)

132

Supervisor, Coding Resume Examples & Samples

5-7 years experience required
Monitor coding, abstracting and data entry for accuracy with the use of various Meditech reports, and assign ICD-10-CM/PCS and CPT-4 codes to discharged inpatient and outpatient medical records
Monitor Medical Necessity and Denials, working with ancillary departments, coding staff, and physician offices for appropriate documentation
Monitor DRG maximization efforts to ensure optimal DRG and third party reimbursement
Generate and submit monthly reports to the Director of Health Information Management
Oversee, train, and mentor coding staff, providing on-going in-service education on updates, revisions, and deletions of codes and coding guidelines, and correct coded information to ensure compliance with Rate Setting and other external data requirements
Conduct routine random audits of coding practices (inpatient and outpatient care) to ensure compliance with various documentation guidelines, coding principles and conventions, and assist in the departmental Quality Improvement (QI) program by monitoring QI forms and assisting the Coding Validator in the audit process
Act as a liaison to the Utilization/Care Management, Patient Access, Patient Finance and Information Services departments to maintain a timely billing schedule, and act as a liaison to the Medical Staff with regards to coding, DRG and denial/appeal issues when necessary
Perform audit process (Lavanita and Blue Cross), prepare all necessary records, reserve space, obtain necessary documentation for on-site review, appeal denials where appropriate, and maintain summary sheets on cycles
Consistently and fairly implements human resource policies
Maintains effective and appropriate staffing by monitoring employee turnover, overtime and absenteeism, and compliance with established Medical Center staffing standards
Evaluates performance and initiates personnel actions (merit increases, promotions, progressive discipline, and termination) in a timely manner to ensure maintenance of an optimal work force
Completes employee performance evaluations within 14 days of due date
Collaborates with Human Resources on the recruitment and selection of qualified employment candidates following all policies, guidelines and applicable laws
Communicates changes to staff in a clear and concise manner, providing written procedures and in-service education as needed Monitors progress and results of employees, giving constructive feedback and recognizing contributions
Perform other projects as assigned
Must have Supervisory experience
Thorough knowledge and significant experience in ICD-10/CPT4 coding, DRG assignment, APC assignment, PPS payment systems and CMS compliance issues
An active member of the American Health Information Management Association
Experience with coding software, including groupers, editors, optimizers and encoders
Strong leadership, technical, analytical, and communication skills are required

133

Clinical Appeals & Coding Rn-telecommute Resume Examples & Samples

*This is a work from home/telecommute position. The shift is Monday-Friday from 8:30am - 5:00 pm.***
Coaches, provides feedback and guides others
Active, unrestricted RN licensure in your state of residence
Experience in reviewing coding edits and reimbursement issues
Strong critical thinking, analytical and research skills
Experience working in a managed care environment (insurance company or medical group)
CPC (Certified Professional Coder)
Knowledge of Milliman guidelines

134

Coding Quality Analyst Resume Examples & Samples

*This is a telecommute role but preference will be given to those whose primary residence is on the East Coast***
Performs audit of clinical documentation to ensure all assigned ICD codes are accurate and supported based on coding guidelines
Enters supplemental data related to HEDIS / 5 Star Measures
Provides education to Providers on proper clinical documentation, compliance, and coding guidelines
Assists with concurrent chart review for ProHealth CT as needed
5+ years’ experience ICD - 9 / 10 coding / auditing, preferably in a Managed Care setting, with strong attention to detail and high accuracy rate
1+ year recent Medicare Risk Adjustment / HCC Coding experience
Coding Certification ( CPC, CCS, or RHIT; or CRC with RN / LPN license)
2+ years’ recent Provider education experience
Knowledge of HEDIS / 5 STAR Measures
Able and willing to travel about 25%, as determined by business need
Able and willing to work a flexible schedule to meet business needs (however normal business hours are Monday - Friday 8:00AM - 5:00PM)
Continuously meet the requirements for a telecommuter, i.e. live in a location that can receive a UnitedHealth Group approved high speed internet connection, have a secure designated office space to maintain PHI, meet or exceed all performance expectations
Local to the Farmington, CT area or within reasonable driving distance

135

Senior Manager, Coding & Auditing Resume Examples & Samples

Consistently exhibits behavior and communication skills that demonstrate Davita Medical Group’s (DMG) commitment to superior customer service, including quality care and concern with each and every internal and external customer
Manages team working on ICD Coding Audits, RADV, CPT Coding audits and overall education and general support of Corporate Coding & Auditing activities
Collaborates with Medical Management on key physician activities and provider relations and Clinical Network Liaisons on Coding & Auditing activities
Interprets, provides feedback and acts as subject matter expert of CMS regulations, Documentation guidelines, Health Plan Guidance and HCC reimbursement methodologies
Generates various analytical reports and prioritization and other analytical schedules related to corporate programs
Assists in the designs and maintenance of the Auditing databases related to efficient and effective processes and utilizes and integrates data warehouse data as appropriate
Provides administrative oversight of the chart review program
Participates in quality assurance programs: generates and reviews reports; produces executive summaries and areas for improvement
Participates in process improvement of CHAPs Programs
Works with Dept. Manager to orient new teammates and provides training on work processes
Uses, protects, and discloses DMG patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Creates and Maintains departmental Policies and Procedure
Proficient user of Microsoft Word and Excel
Strong understanding of the principles governing healthcare reimbursement including ICD/ CPT coding
Basic to intermediate knowledge of encounter flow process
Ability to effectively interface with staff, clinicians and management

136

Manager Coding & Reimbursement Resume Examples & Samples

Supervise and coordinate all activities of Coding Specialists
Acts as a resource for the Coding Specialists
Lead or participate in cross-functional workgroups/committees as needed to represent coding and charge entry issues
Manage projects as assigned to ensure that DMG meets relevant goals and objectives
Develop reports and presentations on projects for senior management
Effectively utilize ICD, CPT/HCPCS and related materials to investigate coding issues and produce accurate results
Understands Medicare billing rules (i.e. LCD/NCD, CCI, Medical Necessity, and ABN) and communicates this information to staff, management and physicians
Serves as a resource to providers and clinical staff on coding questions and documentation requirements/guidelines
Monitors services performed to assure all encounters are captured (charge capture reports), coded and billed within timeframes established by DMG
Assists with pay or denials, patient questions related to billing issues, and makes decisions on whether to appeal claims for payment
Keeps abreast of current changes in coding and reimbursement requirements for government programs and other third party payers
Conduct system testing, provide feedback, and support conversions/implementations on coding and charge entry issues
Actively participates in meetings and/or seminars and disseminates the information to peers to enhance the knowledge and skills of the department
Demonstrates the ability to educate/train others as needed
Conducts billing audits to ensure the accuracy of the codes assigned
Evaluates and implements processes to ensure accurate reimbursement
Assists with interviewing potential candidates for hire
Processes payroll and resolve any payroll issues
Perform yearly performance reviews
Approve time off requests for employees
Strong working knowledge of physician coding rules and guidelines
Knowledge of physician payment system
Ability to interpret, analyze and abstract data/documentation
Ability to work in a continuously changing environment, flexible
Customer Service – interacts positively with all customers and takes immediate action to meet customer needs
Interpersonal/Communication/Relationships – builds effective working relationships and treats others with respect
Information Management – accesses, uses and presents information as relevant to position; demonstrates knowledge of HIPAA privacy and security rules and uses medical information as appropriate to position
Makes decisions that consider the impact on other areas of the organization
Initiates collaboration with others outside of department as needed
Demonstrates commitment to the principles and ethics of the organization
Facilitates and supports change within MPAS
Experience in multi-specialty physician coding is highly preferred
Minimum of 3 to 5 years of previous coding and billing experience
Minimum of 2 years of supervisory experience is highly preferred

137

Coding Account Resolution Speciaist Resume Examples & Samples

Quality Orientation – accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time
Building and Maintaining Strategic Working Relationships – develops collaborate relationships to facilitate the accomplishment of work goals. Possesses good interpersonal skills in building, negotiating, and maintaining crucial relationships
Effective Decision Making – relating and comparing; securing relevant information and identifying key issues; committing to an action after developing courses of action that take into consideration resources, constraints, and organizational values
Managing conflict – dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people
1 year acute care inpatient and/or outpatient coding experience required with 3 years’ experience strongly preferred

138

Analyst, Securities Coding X Resume Examples & Samples

Ensure the data integrity of all asset information
Research asset information on vendor terminals and websites ensuring accurate set up
Communicate with data and valuation vendors, brokers, and requestors etc. to obtain information regarding assets
Work on projects as required, meeting set deadlines
Should be in a position to demonstrate the following attributes

139

Medical Billing & Coding Resume Examples & Samples

Communicate with patients, clients and insurance companies
Possess Excellent customer service and communication skills
MUST have Excellent written and verbal communication
MUST have medical terminology knowledge
Experience in Medical Collections and/or Coding is required
Bi-lingual is a plus

140

Pricing & Coding Clerk Resume Examples & Samples

Evaluate and price merchandise that is being shipped overseas
Provide these valuations to ensure proper tariffs are assigned
Experience inspecting and pricing goods
Familiarity with international standards

141

Coding Coordinator Resume Examples & Samples

Monitor physician and/or facility coding and billing activities performed for the centralized departments with CID through QA and productivity reviews to ensure compliance with all rules and regulations in a timely manner. Provide education and training when deficiencies are identified or new processes are implemented
Prepare reports to assure quality and productivity expectations are being met
Review medical record documentation and assign appropriate ICD-10-CM/PCS, CPT and/or HCPCS codes in accordance with coding/compliance policies, official coding, payor and regulatory guidelines as needed
Incorporate initiatives that improve compliance and reduce risks to the institution
Act as a liaison for the department coding activities to the clinical department administration, physicians/providers, PFS billing staff, JOC and others
Serve as resource and technical expert for complex coding/billing issues
Work with staff to suggest additional avenues to resolve coding issues
Communicate with coding staff, third party payors, clinic staff and patients to address and resolve patient account issues. Advise staff and management regarding claim edits, denials and payment trends

142

Coding Representative Resume Examples & Samples

Review medical records to assign CPT/HCPCS and/or ICD-10-CM/PCS diagnosis and procedure codes consistent with coding compliance policies, ICD-10-CM/PCS Official Coding Guidelines and regulatory guidelines
Monitor compliance/coding standards and policies to ensure UI Health Care receives full and accurate reimbursement for services that comply with HIPAA as well as coding and payment rules/regulations
Communicate with physicians, residents, staff and other providers to resolve situations where the recommended coded service is not supported in the health record documentation and/or not consistent with coding and regulatory guidelines
Communicate with physicians, residents, staff and other providers when additional information is needed for accurate code assignment
Meet targets regarding volume and accuracy of codes assigned
Adopt and incorporate initiatives that improve compliance and reduce risks to the institution
Assist in providing and analyzing reports related to documentation issues, coding patterns, physician productivity, reimbursement trends, etc
Meet targets set by Coding Supervisor and/or Management regarding volume and accuracy of codes assigned
Participate in internal coding and development training when needed
* Please Note: Five (5) professional references will be required at a later step during the hiring process
Familiarity with medical coding and/or billing
Proficiency with standard office computer software applications (i.e. Microsoft Office Suite)
Medical terminology knowledge
Basic knowledge and understanding of HIPAA laws and regulations
Excellent, effective written and verbal communication skills to achieve and provide quality customer service by demonstrating positive professional demeanor at all times
Demonstrated ability to work with a diverse professional and patient population including the ability to prioritize and coordinate inquiries from patients, staff and administration
Strong attention to detail with accuracy to achieve or exceed organizational and individual performance goals
1-3 years experience with medical coding preferred, will consider applicants with less experience
Knowledge, understanding and/or experience with CMS regulations or industry standards
Knowledge of anatomy and physiology
Completion of ICD-10 training curriculum

143

Mgr Radiology Coding / Billing Resume Examples & Samples

Location/Facility –Baylor Scott & White Temple, Texas
H.S. Diploma / GED Equivalent
Certified Professional Coder required
5+ years of experience required

144

Iis-coding Clerk Resume Examples & Samples

Ability to effectively read and comprehend English verbatim responses
Able to work across multiple projects at the same time in order to meet deadlines
Ability to maintain well organized project information and materials
Able to work under tight deadlines
Skilled and effective in the use of the Internet when researching various project requirements
Ability to monitor, adjust and revise their work to ensure high quality prior to delivery
Effectively create a summary of important points within a file of comments for client review
Support and assist Team Leaders and fellow Coders in a positive proactive manner
Other projects as assigned
Self-motivated, positive attitude
Client service approach
High level of organization
Professional appearance and attitude
Commitment to the team environment
Technical knowledge
Strong knowledge of social media platforms including Facebook, Linked in, Twitter, Instagram
Fluency in English and any of the following languages would be considered an asset – German, Mandarin, Cantonese and Portuguese

145

Coding Pool Team Lead-work From Home Resume Examples & Samples

Coding Technical skills - extensive regulatory coding (ICD-9-CM, CPT-4, MS-DRGs, POA Assignment and where applicable APR-DRGs and PPCs) and associated reimbursement knowledge
Case Mix Index Analytical skills - ability to analyze trends in CMI and determine root cause and address as appropriate
Effective Decision Making - relating and comparing; securing relevant information and identifying key issues; committing to an action after developing alternative courses of
Action that take into consideration resources, constraints, and organizational values
Initiative - independently takes prompt proactive steps toward problem resolution
Organization - establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and keen ability to multi-task
Communication – communicates professionally, clearly, proactively, and concisely with all key stakeholders, both individually and in group settings
Leadership - guides individuals and groups toward desired outcomes
Policies & Procedures - articulates knowledge and understanding of organizational policies, procedures and systems
PC skills - skilled in all Microsoft Office applications, Business Objects, Cactus, familiar with Crystal Reports
Quality Orientation – accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time
Work Independently – is self-supporting; not needing to rely on others to complete a job
Building and Maintaining Strategic Working Relationships – develops collaborative relationships to facilitate the accomplishment of work goals. Possesses good interpersonal skills in building, negotiating, and maintaining crucial relationships
Managing conflict – dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people
Mentor and Educate – provides timely guidance and feedback to help strengthen the knowledge/skill set of others to accomplish a task or solve a problem
Undergraduate degree in HIM/HIT required
Equivalent work experience may substitute degree requirement
Management/Supervisory experience in healthcare related field preferred
Minimum of 5 years' acute care inpatient/outpatient coding experience required
Minimum of 3 years' coding auditing/monitoring experience strongly preferred

146

Manager, Coding Operations Resume Examples & Samples

Provide direction for the division
Promote and emulate a patient-centric and customer service focus within the division
Develop the division operating budget and goals
Responsible for the financial, service and productivity performance of the division. Proactively monitor, analyze and manage reports and all related documents
Ensure the division is integrated with other departmental areas
Develop the division's operational policies, procedures standards and expectations, providing clear opportunities to meet or exceed the entity balanced scorecard objectives
Conduct performance reviews of direct reports; develop and mentor direct reports and staff
Participate in community and agency events

147

Supervisor Coding Resume Examples & Samples

Ensure accuracy and consistency of coded data for outpatient records to include day surgery, emergency room, clinic treatment room procedures and observation records
Identify areas of high risk in coding and documentation practices
Perform ongoing coding quality reviews of outpatient records to validate ICD-9-CM and CPT procedural coding
Validate accurate capture of APC assignment
Conduct ongoing quality reviews on outpatient HIM coding staff utilizing the official coding guidelines as published in the AHA Coding Clinic, -AMA CPT Assistant, AHA Coding Clinic for HCPCS, and CMS publications
Interpret coding conventions, formats, instructional notations, and definitions to accurately select diagnoses and procedures
Provide training of HIM Outpatient Coding Staff
Communicate coding updates to the HIM outpatient coding staff
Resolve billing edits utilizing the National Correct Coding Initiative and the Local and National Coverage Determinations
Facilitate billing issues with PFS and informs PFS when charges need to be moved on outpatient accounts
Monitor the work flow of the hospital clinic treatment room cases
Serve as a resource to other department and coding staff to answer coding and documentation related questions
Associate Degree or Equivalent Experience
At least 4 years’ experience
Requires one of the following certifications: CCS, CCS-P, CPC, RHIT or RHIT

148

Director for the Program for Computing Systems & Coding Strategies Resume Examples & Samples

Contribute to key projects as a programmer or task lead of programming work
Develop a system for storing and sharing our knowledge of major systems at CMS (e.g., CCW, IDR) and within RTI (e.g., FIPS moderate environment, SAS Grid), with an emphasis on identifying the best coding practices within each environment
Work with program managers to plan and organize programming tasks and allocate staff
Oversee program managers to promote leadership and professional development opportunities for staff
Identify and develop new partnerships and areas for growth that are consistent with the Center’s mission
Establish standards for programming and quality assurance within the program
Represent the program to our clients and at various levels throughout RTI; and Contribute to proposals writing sections and forecasting labor
Bachelor’s Degree in Computer Science, Statistics, Health Policy or related degree and 12 years of SAS programming experience. Advanced degree in Computer Science, Statistics, or Health Policy and 6 years experiene is desirable
At least 5 years of experience in managing a diverse group of technical staff or in directing project work
Experience in working with relational databases is desirable
Research experience in contract work with the Center for Medicare & Medicaid Services (CMS)or in a health related field is highly desirable
Excellent communication skills, written and verbal, and a demonstrated ability to interact effectively with senior executives, management, and technical staff
To qualify, applicants must be legally authorized to work in the United States and not require sponsorship now or in the future

149

RN Coding Nurse Resume Examples & Samples

Educate practitioners / clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process; ensure all Market Leaders are utilizing established tools and are able to downstream this education in their prospective markets
Partner with business owners to identify methods to execute upon the key strategic visions and lead the initiative to completion
Review and update educational materials as approved by Leadership
Bachelor’s Degree in Nursing required (Associate’s Degree or Nursing Diploma from accredited nursing school with 2 or more years of additional experience may be substituted in lieu of a bachelor’s degree) and current RN license in good standing
CPC certification or proof that certification has been obtained within 9 months from the American Academy of Professional Coders
Two years of clinical coding experience with strong attention to detail and a high level of accuracy
Knowledge of CMS-HCC model and guidelines along with ICD-9/10 and guidelines
Effectively communicates complex ideas clearly and concisely to internal and external customers
MS Office Suite, moderate to advanced EXCEL and PowerPoint skills

150

Coding Quality Auditor Resume Examples & Samples

Consulting: Consults facility leaders and staff on best practices, methodology, and tools for accurately coding
Chart Analysis IP, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or MS-DRG assignment. Adheres to Standards of Ethical Coding (AHIMA). Reviews medical records to determine accurate required abstracting elements (facility/client/payer specific elements) including appropriate discharge disposition
IP, OP Coding: Reviews medical records for the determination of accurate assignment of all documented ICD-9-CM codes for diagnoses and procedures.Abstracts accurate required data elements (facility/client specific elements) including appropriate discharge disposition
CDI: Identifies and communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to appropriate personnel for follow-up and resolution

151

Coding Team Leader Resume Examples & Samples

Responsible for the daily operation of the coding function and staff including monitoring the quality and quantity of workflow to ensure the completion of work assignments
Design and implement work flow processes to support continuous improvement
Provide cost effective management of resources for the coding team
Identify and implement improvement measures that will enhance department operations and customer service
Monitor and report all required performance measures to include the development of department goals and assist in the assessment of goal attainment
Conduct and recommend trainings to improve team performance
Ensure management is informed of any employee personnel issues
Function as a resources to employees for questions and additional training
Assist management in determining staff hours and schedules
Audit team members work to ensure quality of department
Train new and existing team members and evaluate performance
Ensure proper allocation of work to team members
Actively participate in the daily work load within the coding department
Safeguards medical records and preserves the confidentiality of personal health information through the observance of physician network policies pertinent to the release of medical record information, record retention, and HIPAA privacy and security
Associate's degree in Health Information Technology or related business degree or equivalent amount of education and experience
3 years' experience in medical billing/office procedures
Certified Professional Coder preferred
Requires detailed working knowledge of full revenue cycle and demonstrated proficiency in medical billing, collections processes and month end closing
Requires thorough knowledge of medical terminology and CPT/ICD10 coding
Must have strong leadership, supervisory, communication, decision-making/ analytical skills with ability to motivate/lead team and address personnel matters
Ability to multitask and manage multiple projects within team. Attention to detail a must

152

SQL Coding Resume Examples & Samples

Requires a Bachelor's degree in a related field
2-4 years related operational and/or data analysis experience; experience in database structures, and standard query and reporting tools; or any combination of education and experience, which would provide an equivalent background
Ability to manipulate large sets of data, preferably healthcare data
Strongly prefer proficiency with SQL and MS Excel
Prefer managed care / healthcare industry experience

153

Director Billing & Coding Svcs Resume Examples & Samples

9+ years of medical claims experience along with strong leadership experience. Experience with patient information/claims system processes
Current coding certification (CPC, CCS-P or ROCC) with excellent coding skills with thorough knowledge of CPT-4 procedural coding methodology with ICD-10, ICD-9 diagnosis and HCPCS coding
Experience in medical oncology, radiation oncology and surgery coding, medical records and reimbursement
Knowledge of government and non-government regulations, guidelines and applicable reimbursement laws and regulations
Direct supervisory experience coaching, developing, and managing a remote staff
Four (4) years’ experience working directly with and training Physicians and staff
Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint)
Instructional educational experience with a CPC-I, CHC or like credential, preferred
Previous experience in a training environment and as an educator, preferred
Influencing skills of senior leaders to gain acceptance of best practices
Strong analytical, written, verbal and communication skills

154

Coding Pool Coordinator Resume Examples & Samples

Communication ‐ communicates clearly and concisely, verbally and in writing
Organization – establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and a keen ability to multi‐task
Customer orientation ‐ establishes and maintains long‐term customer relationships, building trust and respect by consistently meeting and exceeding expectations
PC skills ‐ demonstrates proficiency in PC and Microsoft applications as required
Policies & Procedures ‐ demonstrates knowledge and understanding of organizational policies, procedures and systems
Analytical skills – effective evaluation, synthesis and use of information gathered
Initiative – independently takes prompt proactive steps toward problem resolution
Basic skills ‐ able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately
Work Independently in a remote environment – is self‐supporting; not needing to rely on others to complete a job
Prior scheduling experience preferred
Minimum 1 year acute care hospital HIM experience preferred

155

Senior Coding Quality Auditor Resume Examples & Samples

Minimum of 4 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing
One of the following is required: CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician)
CRC certification is a plus
2 years minimum of experience with ICD- codes required
Experience with Medicare and/or Medicaid Risk Adjustment process required
Experience with Microsoft Office products (Word, Excel, Project, PPT)

156

Analyst, Coding Resume Examples & Samples

Detects potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns
Performs medical record audits in order to validate coding accuracy
Performs, as required, non-medical record review audits to validate billing accuracy
Generates and provides accurate and timely written reports for internal and/external use detailing audit findings
Renders provider coding education as appropriate based on coding guidelines, contractual, and/or regulatory requirements

157

Coding Product Specialist Resume Examples & Samples

Collaborates with product management and the development team on the impact of long term trends related to new coding guidelines, quality reporting, pay-for-performance and new technology
Suggests CAC product enhancement ideas based on subject matter expertise in hospital coding and billing
Defines requirements for ICD-10-CM, ICD-10-PCS, CPT and HCPCS code development for periodic releases of the LifeCode engine
Collaborates with the NLP (Natural Language Processing) team on coding development
Provides detailed coding feedback on regression and functional tests using Windows based quality assurance software
Specifies requirements for document filtering to optimize performance of the LifeCode engine for ICD-10-CM, ICD-10-PCS, CPT and HCPCS coding
Analyzes coded data and clinician documentation to provide relevant examples for the NLP development team
Analyzes coded data and clinician documentation to provide feedback for customer service
Analyzes coded data and clinician documentation to provide feedback for sales prospects
Applies coding principals and guidelines in the assignment of diagnosis and procedure codes
Applies knowledge of medical terminology, anatomy, physiology and pathophysiology in the assignment of appropriate codes
Acts as a resource for coding questions and related issues internally
Maintains all certification CEU's
Uses pertinent data and facts to identify and solve a range of problems within area of expertise
Must have at least one of the following: CPC, CPC-H, CCS or CCS-P
5+ years of continuous coding / abstracting experience. Must have recent experience within the last 2 years
Must satisfactorily complete an outpatient coding assessment including E / M
A working knowledge of healthcare, billing companies, medical record coding and auditing
Demonstrate ability to understand clinical content of a health record
Must have Strong Technical Knowledge of: Evaluation and Management coding
Demonstrated ability to manage and prioritize deliverables
Strong computer proficiency with MS Word and Excel
Ability to work effectively within a team
Ability to communicate effectively with linguists and other coders to clarify development output of diagnoses / procedures and sequencing of same
Associate’s / Bachelor's Degree
RHIT and / or RHIA accreditation
Microsoft Access experience

158

Revenue Integrity HIM Coding Coordinator Resume Examples & Samples

Educates and provides professional consultation services to Physicians, Nurses, Fellows, Medical Residents, Physician Extenders and other staff in reference to medical documentation & coding
Educates medical team regarding to coding, charge capture, denial, & claim filing limits, process, procedures, concerns & issues. Provides coding guidelines & completion of physician queries
Oversees physicians’ dictated and clinician notes for audit compliance and compares those notes to additional sources of clinical records
Educates and directs clinical and office staff on medical necessity for procedures and documentation requirements of the patient type
Manages the physician professional fee coding vendors and ensures performance, production, turnaround times and accuracy levels
Ensures coding documentation related questions are responded to on the professional fee side in a timely manner
Ensures professional fee Discharged Not Final Billed (DNFB) levels are at required levels and any issues or variances are reported to the appropriate parties
Manages the timely review of patient records in order to identify an appropriate selection of codes which will accurately reflect the reason for admission, extent of care received and level of severity of illness
Manages coding audits for surgical and non-surgical procedures as needed for the physician offices and reports findings to the HIM Leaders
Develops PowerPoint or VISIO presentations & presents material at physician department meetings. Provides revenue integrity & coding compliance presentations to physician practices & Leaders
Manages coding management reports to ensure coding productivity and accuracy are being met by Coding Vendors
Manages and resolves documentation and coding issues and concerns in a timely manner
Acts as a resource to MCH Leaders regarding documentation& coding processes. Remains current with health care and professional trends including quarterly Medicare coding updates
Reviews reference material to maintain coding knowledge (CPT Assistant, etc.)
Presents and participates in Revenue Cycle meeting and shares experiences with additional hospital departments that may benefit from audit results, department reviews or coding reviews
Participates and assist in CDM creation and review, monitor CDM use to ensure compliance and communicate results back to clinical department or Physician Practice Director
Informs & educates the PFS department when there are missed opportunities in revenue generating in order to maximize reimbursement within accepted standards of practice & reimbursement guidelines
Works with a staff on various projects being managed simultaneously and implementing change with minimal disruption of business and departmental operations
Instructs and coaches employees with charge entry and documenting audits
Researches and analyzes compliance and billing concerns that may affect the fiscal health of the hospital
Creates, manage and implements HIM Department coding policy and procedures
Bachelor's Degree or Associate Degree in Health Information Management preferred
ICD-10 certification is preferred
Ability to communicate clearly and courteously (verbal and written) with internal and external customers
Good organizational skills and adaptability to frequent changes in assignments
General knowledge of revenue cycle including physician office or clinical hospital experience in revenue or charge capture projects preferred
Maintain active membership in national association with required C.E. hours
Proficiency in presentation skills
Proficiency in Microsoft Excel, Word, VISIO & PowerPoint a plus
Knowledge of managed care regulations regarding patient type criteria and appropriateness of patient type statuses by healthcare professionals when admitting patients as OP, OBS, or IPs
Outstanding analytical and organization skills with attention to detail
Demonstrable problem solving skills
Ability to interface with compliance and outside auditors

159

Clinical Coding Nurse Consultant Resume Examples & Samples

Knowledge of CMS-HCC model and guidelines along with ICD-9 10 and guidelines
90% travel
This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor’s diagnosis of disease

160

Costing & Coding Coordinator Resume Examples & Samples

Set up new suppliers and new products; research and analyze current product and supplier data files for set up decisions
Validate new supplier legal documentation for adherence to current guidelines
Validate new product certificates for product claims
Communicate with supplier and/or broker for needed documentation or questions relating to the completion of new item set up
Establish system wholesale and SRP based on margin guidelines for product category or group
Create new brands, headers and sub headers as needed for UNFI publications and web site product listings
Create new product promotional form and distribute
Maintain and save new supplier and product information to assigned locations
Update department spreadsheets with new supplier information and price/freight information
Process cost and freight changes following company margin guidelines
Process pack, UPC and product changes
Distribute supplier and product documentation
Research and resolve cost discrepancies and product issues with inventory control, customer service and SRM
Communicate completed items and current issues to SRMs
Fax, photocopy, scan and run reports from the business system and MRS
Perform other administrative and clerical functions as needed
Create and distribute reports as assigned
Thorough knowledge of Company products and services
Understanding of related computer applications
Knowledge of advertising, printing, and print production processes
One to two years of experience in marketing communications, sales, advertising, or related fields
Excellent proofreading skills and command of the English language
Solid writing skills
Outstanding communication abilities
Well organized and able to meet deadlines
Ability to work in a team environment without supervision
Excellent Microsoft office skills
Ability to use office equipment such as fax, copier and scanner

161

Coding Operations Manager Resume Examples & Samples

Problem solving
Work flow or process assessment
Monitoring, continuous quality improvement
Timely and accurate delivery of coding services
Support of technical functions
A minimum of 5 years of experience in hospital, healthcare operations
Coding Certification
Coding supervisor or management experience with either Inpatient, Outpatient, Radiology, or Emergency Department coding
A technical understanding of healthcare industry information systems (EMR and Encoder systems)
Proficiency with MS Office Products
Must be able to travel up to 20% for this role
Experience working for a 3rd party coding vendor and personnel management

162

Coding / Reimbursement Specialist Resume Examples & Samples

Subject matter expert in at least one specialty, e.g., oncology, gynecology, surgical coding (not including primary care procedures) and infusion coding including chemotherapy and infusions involving multiple drugs
Assigns CPT and ICD codes in cases of moderate to high complexity
Reads, interprets and assigns CPT codes from provider documentation, e.g., infusion record or operative report
Performs ICD and CPT coding of provider (professional) services and verifies that all requisite charge information is entered
Appends all modifiers
Ranks CPT codes when multiple codes apply
Assigns Evaluation and Management (E/M) codes
Performs reconciliation process to ensure all charges are captured
Processes automated or manually enters charges into applicable billing system
Researches and analyzes coding and payer specific issues
Processes charges on a timely basis and communicates with team members and practice management on an ongoing basis
Communicates with providers related to coding issues that are of moderate to high complexity. Including face to face interaction, explaining coding rationales, and education with providers

163

Coder Apprentice Hims-acute Care Coding Resume Examples & Samples

Learns to analyze, evaluate and abstract data elements from patients electronic records
Learns to assign applicable ICD diagnoses and ICD & CPT procedure codes for all inpatient and outpatient encounters, following all written coding policies and procedures in accordance with Coding Clinic, CPT Assistant and all regulatory CMS compliance regulations
Works as a member of the HIMS team on a variety of assigned projects and tasks

164

Director Coding & Revenue Cycle Resume Examples & Samples

Experience in physician practice operations specifically as it related to patient access, time-of-service (TOS), and coding operations
Experience in evaluating accounts receivable and net collection rate status via relevant metrics and also creating action plans based on available accounts receivable metrics and information
Experience in management of revenue cycle operations with a minimum of $75 million in net revenue
Advanced management and communication skills and other skills required to interact with a variety of contact on the telephone, via e-mail and in person. Must work well independently and be prepared to make crucial decisions without asking questions

165

Analyst, Securities Coding Resume Examples & Samples

Review new asset information, applying knowledge of various security types to interpret and record the security on the asset file
Industry Knowledge - Knowledge of financial instruments, valuations business & regulations
Awareness of securities data, corporate actions, pricing or funds
Working knowledge of Bloomberg, Reuters, FT Interactive Data and Telekurs
Excellent PC skills especially MS Excel
Business or financial services qualification (Advantageous)

166

Coding Quality Consultant Resume Examples & Samples

Conducts physician chart audits (including research and presentation). Assesses and interprets whether the coding assigned by the provider was properly assigned based upon review of the medical documentation and application of the coding guidelines
Ability to travel locally to provider practices, will be out in field 75% with rare overnight stay required
Must reside within a commutable distance (50 miles or 50 minutes) of Los Angeles or Orange County areas

167

Director, Coding Program Resume Examples & Samples

Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer
Serves as subject matter expert for the organization on the coding function
Develops and implements processes and workflows to ensure clear, consistent and efficient operation of coding function
Works with key departments to educate on the links between coding functions, daily operations of HCP and profitability
Stays abreast of industry coding issues and changes that will impact coding and charging patterns
Reviews reimbursement levels to determine when changes are required
Proactively disseminates coding updates and information to the Business Office management team and the organization
Ensures medical chart audits meet minimum documentation standards
Assesses coding needs of the organization and develops and implements specialty coding class training and content
Ensures new clinicians are oriented with an emphasis on HCC coding
Attends regional clinician and hospitalist meetings to review coding issues
Develops, maintains and documents standardized processes and maintains appropriate references for the department
Serves as content administrator for the Coding News SharePoint Site
Drafts coding and chart documentation articles for various publications and postings
Publishes coding communication for the Business Office indicating coding updates
Develops new EF’s and rounding logs and revises existing EF’s and rounding logs using the most current codes
Collaborates with Materials Management department to determine best coding resources and pricing
Participates in various committees requiring coding and FFS reimbursement expertise
Works with operations management teams to assure communication of information necessary to insure efficient processes are understood and implemented in accordance with HCP policies and procedures
Manages staffing resources including training and performance management
Develops departmental duties, responsibilities, budgets and goals and disseminates progress toward goals to management and staff
Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Computer literate.Proficient in Word, Excel, PowerPoint, Multi-media projector
Knowledge of CMS coding guidelines
Computer literate with medical billing software
Excellent verbal and written communication skills in the English language
Must be able to work independently to carry out work efforts
Bilingual/Spanish preferred

168

Medical Oncology Coding Education Resume Examples & Samples

Conduct regular practice site visits and provide face-to-face education and support as a subject matter expert in Medical Oncology
Works with Providers and practice management to identify areas of opportunity
Educate and provide guidance related to ICD-10-CM, ICD-9-CM, CPT, HCPCS coding systems
Consults with Providers and practice management to set long term coding and billing strategies
Research, prepare, develop and deliver Medical Oncology program material to The Network practice physicians, clinical team and business staff via on-site, web based, and other methods of training
Develop action plan to ensure ongoing tools alignment for ongoing training
Research related to government regulations and commercial payer policies. Prepares and disseminates monthly newsletter
Develops Medical Oncology Program for large network
Current CPC, CCS-P certification required
Five (5) years in Medical Oncology, Evaluation and Management (E&M), Chemotherapy Teaching, and Infusion Therapy coding
Experience maintaining compliance and regulatory guidelines for network practice communication
Four (4) years direct experience in coding, medical records and reimbursement
Four (4) years experience working directly with and training physicians and staff
Three (3) years direct supervisory experience coaching, developing, and managing staff
Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint) required
Instructional educational experience with a CPC-I or like credential preferred

169

Coding Clerk Resume Examples & Samples

Performs KPHC Professional Billing system coding charge entry and coding data abstraction
Performs limited coding review of level of service (CPT-4), diagnosis (ICD-9CM), and procedures (CPT-4 and HCPCS). Initiates coding review if necessary
Maintains knowledge of coding guidelines, updates, and regulations governing government and third party billing. Ensures coding and documentation meet regulatory guidelines and audit standards resulting in appropriate reimbursement
Collaborates with department coding analysts and management to communicate specific coding and documentation guidelines to fulfill internal needs for complete and consistent clinical data collection
Identifies patterns, trends and variations in code editing and documentation practices
Provides clinical data collection as assigned
Retrieves and photocopies documents/charts for professional services coding
Identifies non-plan patients. Registers patient into professional billing system. Builds guarantor shell
Develops and implements plans/projects to improve operational efficiency and effectiveness. Monitors and reports status and progress to supervisor
Minimum six (6) months of data entry experience
Post high school coursework in computer data entry
Demonstrated knowledge of and skill in word processing, spreadsheet and database applications

170

Coding Senior Manager Physician Practice Resume Examples & Samples

Previous management and provider training/teaching experience and customer service education experience
Creativity and knowledge of adult learning principals
Selects, trains, coaches, motivates, conducts performance evaluations, and directs the workflow for staff assigned to coding function. Develops goals and performance expectations for staff in targeted areas, such as unbilled accounts receivable, quality and timeliness of clinical coding assignments, data integrity and reimbursement with third party payors. Provides for the education, development and shared leadership of staff
Drives organization performance improvements by refinement and monitoring of the coding scorecard which includes: unbilled A/R; Medicare second reviews; RAC denials; first time submission acceptance for the state; coding accuracy; % clean claims; staff stats; etc. Participates in the improvement of processes and programs
Works collaboratively with other leaders to establish coding quality, productivity and best practices. Monitors goals and benchmarks productivity and quality standards in conjunction with industry trends. Identifies potential improvements and moves team to achieve next level of performance with regards to coding quality, productivity and best practices
Participates in developing standard coding policies/procedures/guidelines to ensure compliance with federal, state and local regulatory guidelines to minimize risk for the organization. Supports coding infrastructure to ensure regulatory compliance in all aspects of coding and abstracting of clinical data to support patient care processes
Monitors data integrity on regular basis to ensure abstracted data elements meet requirements, performs staff training and education, communicates with associated departments including semi-annual data submission to state health departments. Supports software testing by providing staff to ensure proper functionality of applications when requested
Keeps abreast of new medical technologies, procedures and pending regulatory changes which impact the organization. Proactively analyzes potential impact to the organization to minimize adverse impact. Participates as a key member for ICD-10 planning and implementation

171

Netview Coding Support Officer Resume Examples & Samples

Ensure that classification for NetView is compliant with current guidelines and is completed within the agreed deadlines
Maintain close communication with the entire NetView classification team, as well as the Coding Manager
Providing support within the NV domain discovery for the assignation of parent, brands and channels to weekly domain discoveries
Monthly NetView QA where relevant
Assisting in conducting full NV Audits for key parents where required
A minimum of 2 years of classification experience, preferably with a market research background
Candidates with Bachelor Degree in any field; Information Technology/Computer Studies preferable
Education or training in computer operations preferable
Marketing, media or advertising background would be an added advantage

172

Coding Coordinator Resume Examples & Samples

Manage, lead and assist with the implementation of projects to completion
* Please Note: Five (5) professional references will be required at a later step during the hiring process
Knowledge of Anatomy and Physiology
Medical Terminology knowledge
Bachelor’s degree in Health Information Management (HIM) or related field
Experience (typically 1 or more years) supervising medical coding and/or billing
Demonstrated project management experience (minimum 6 months)
Experience with healthcare software applications (i.e. Epic and/or Cirius)
Experience managing vendors

173

Coding & Research Compliance Specialist Resume Examples & Samples

Current permanent U.S. work authorization required
Nationally recognized coding certificate, or equivalent professional experience
Knowledge of Common Procedural Terminology (CPT) coding
Experience in interpreting and applying Medicare Clinical Trials Policies, National Coverage Decisions, Local Coverage Decisions, limitations on coverage, medical claims coding practices and/or general clinical processes

174

Coding Team Lead-wfh Resume Examples & Samples

Coach, facilitate, solve work problems, and participate in the work of the team
Assists the Coding Manager in verifying and reporting coding staff productivity
Assists in ensuring coding staff adherence with coding guidelines and policy
Assists in ensuring coding compliance and reports status to the Coding Managers and Coding Director
Assures accounts that cannot be coded are held for valid reasons and documented accurately utilizing
Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
(Coding Technical skills‐ extensive regulatory coding (ICD‐9‐CM, ICD‐10‐CM, ICD‐10‐PCS, CPT‐4, MS‐DRGs) and associated reimbursement knowledge
Case Mix Index Analytical skills – ability to analyze trends in CMI and determine root cause and address as appropriate
Effective Decision Making – relating and comparing; securing relevant information and identifying key issues; committing to an action after developing alternative courses of action that take into consideration resources,
Minimum of 5 years acute care inpatient/outpatient coding experience required

175

Medicare Risk Adjustment Coding Front Line Leader Resume Examples & Samples

Coordinates and deploys MRA training policies/objectives to the local team
Use detailed analysis/consideration of financial and operational implications to make recommendations to the MSO and physician groups
Knowledge of HCC/Risk coding
Professional coding certification such as CPC or CCS-P
Demonstrated experience partnering with senior leadership on strategic initiatives
HEDIS experience
Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance

176

Supervisor / Coding & Reimbursement Resume Examples & Samples

Reviews ICD and CPT coding of provider (professional) services and verifies that all requisite charge information is entered
Supervises coders and makes sure department guidelines for timeliness of processing charges are met and communicates with team members and leadership team management on an ongoing basis
Monitors daily edits/work queues related to charge entry,
Assists Manager in completion of Employee Reviews and Individual Development Plans.li>

177

Director Clinical Documentation Coding Integrity Resume Examples & Samples

Bachelor's Degree required. Degree in Health Information is preferred
CCS, CCS-P CCDS required
Minimum of 6 years of related experience in Clinical Documentation Improvement and 10 years related experience coding with ICD-9 and CPT
Previous management experience required
Expertise knowledge of ICD-9/ICD-10 and CPT coding principals and guidelines Knowledge of MS, AP, and APR DRG systems APG, EAPGs Knowledge of multiple hospital reimbursement methodologies, federal, state and payer specific regulations, policies and compliance standards Excellent written verbal and communication skills Excellent critical thinking skills

178

Coding & Reimbursement Specialist Medigold Corporate Service Center Day Resume Examples & Samples

Review and respond to post-payment inquiries from providers in a timely and professional manner, in accordance with department standards, policies and procedures
Proactive identification, through auditing and internal reporting, of trends and subsequent report to Director, Delegated Claims, COO/CFO, and Medical Director
Assist in the development of tools and presentations on documentation, coding, billing, and other topics of interest to our provider community. Attend coding and billing conferences, workshops and in-house education sessions to stay current with coding and billing regulations
Associate Degree
Licensure / Certification: CPC, CPC-P or equivalent required
Minimum of 5 years' experience in claims auditing, billing and/or coding
Must possess an in-depth knowledge of current Medicare coding and billing requirements. Must be knowledgeable in multi-specialty coding and billing requirements. Must possess extensive knowledge of auditing concepts and principles

179

Risk Adjustment Coding Spec, Days Resume Examples & Samples

Minimum of two years of experience in medical coding and billing required
Must have successfully completed CPC course and applied and been accepted to the AAPC. Must complete and maintain Certification in Procedural Coding exam within one year of hire
Certified Risk Adjustment Coder certification within one year of hire required
Must maintain AAPC certification/membership
Understanding of various medical claims formats
Working knowledge in medical terminology, CPT and ICD-9/10 coding, and subsequent ICD versions
Expanded knowledge of Risk Adjustment and HCC coding
Knowledge of payer contracts and reimbursement
Thorough working knowledge of Federal, State and Private payor regulations
Problem identification and problem solving skills
Customer service oriented attitude/behavior
Ability to participate in and attend off site meetings/seminars
Ability to interact with patients in a pleasant/neat poised demeanor
Polite and courteous speaking manner and excellent telephone etiquette
Intermediate computer skills with an emphasis on typing, 10-key, Word, Excel, and Outlook
Detail oriented with the ability to complete tasks in a timely manner
Ability to work well as a team member
Meets Health System's Guiding Behaviors and Caring Standards including interpersonal communication and professional conduct expectations with all coworkers, other departments, and with patients and visitors
Reviews patient record prior to appointment to determine Gaps in Care, then communicates Gaps to provider
Educates and assists Coding Specialists to accurately code ICD-9/10 to highest level of specificity
Follows current industry standards of ethical coding
Recognizes opportunities for documentation improvement and educates providers and staff of suggested improvements
Works collaboratively with providers to completely reflect patient's clinical status and care; works with providers to develop documentation improvement plans
Collaborates with providers to formulate appropriate modifications to clinical documentation to reflect the appropriate use of clinical codes and documentation
Submits appropriate claim adjustments to Billing Department for submission of corrected claims
Reviews Payor data for Gaps in Care and RAF Scores
Completes and submits Medicare Patient Assessment Forms and maintains accurate database of submission and payment
Ensures medical documentation and coding compliance with Federal, State and Private payer regulations
Participates in seminars and continuing education activities pertinent to areas of job responsibility
Maintains patient confidentiality

180

Outpatient Coding Coordinator Resume Examples & Samples

Coordinates OP coding workflow, monitoring account and claim edit work queues and reassigning coding professionals as needed, including contract coding professionals when utilized
Provides clarification to outpatient coding professionals regarding coding rules/principles and application to ensure consistency within the department
Research and address coding questions and provides query development support for outpatient coding professionals
Assists with research of diseases and new technologies for appropriate diagnosis and procedure code assignment
Provides training of new outpatient coding professionals, working with them to meet/exceed department coding accuracy and productivity standards
Collaborates with network coding manager in the development, implementation and maintenance of coding department policies and procedures
Identifies educational opportunities and provides feedback on these areas to the Network Coding Manager and/or Network Director, CDCI
Monitors productivity for OP network coding professionals providing weekly and monthly reports to both the staff and the coding leadership team
Processes PHC4 reports on a quarterly basis
Collaborates on employee performance assessments, manages employee timecards, and coordinates vacation and holiday scheduling
Performs data quality reviews on outpatient records to validate the ICD-10-CM diagnosis & procedure codes, CPT-4 procedure codes, APC appropriateness, missed secondary diagnoses and procedures, and ensures compliance with all reporting requirements
Codes and abstracts information from medical records according to ICD-10-CM, CPT-4, UHDDS and CMS guidelines. Utilizes the 3M Encoder to verify and assign ICD-10-CM and CPT-4 codes, and APC assignment
Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding assignment
Maintains a 95% coding accuracy rate as measured through quality reviews
Maintains productivity as outlined in the CDCI Departments’ performance improvement plan: ER Coding – 13 charts p/hour ambulatory coding - 5 charts p/hour
Minor Procedure Coding – 9 charts p/hour
Responsible for maintaining up-to-date knowledge of coding and APC principles and guidelines. Maintains a working knowledge of prospective payment systems as it relates directly to coding procedures
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and monitors coding staff for violations and reports to the Coding Manager when areas of concern are identified. Concerns involving compliance issues are also forwarded to the Coding Manager for further action

181

IT Systems Manager, Centralized Coding Resume Examples & Samples

5+ years work experience within a hospital or clinic setting
Strong knowledge of the Virtual Portal, Citrix, VPN environment, as well as, the business and clinical applications
Strong IT analytical skills

182

ICD Coding & Hipaa Compliance Partner Resume Examples & Samples

Provide regular reports detailing audit results, regulatory violations, the status of investigations, corrective or preventive actions underway and any recommendations for compliance program improvements, to include
Assist in developing an annual HIPAA audit program including
Assist in developing an annual coding audit program including
Perform coding audits
Develop, track and ensure adherence to corrective action plans
Manage coding audit data
Assist operations in developing a corrective action plan to resolve deficiencies
Respond to specific questions that affect the coding compliance implementation plan, with recommendations that are supported by applicable regulatory and/or ESI policy guidance

183

Coding & Reimbursement Specialist Resume Examples & Samples

Prepares program specifications and diagrams and develops coding logic flowcharts
Analyzes and evaluates existing or proposed systems and devises computer programs to process data. Prepares charts and diagrams to assist in problem analysis and submits recommendations for solution
Formulates and defines system scope and objectives for assigned projects. Prepares detailed specifications from which programs will be written. Responsible for program design, coding, testing, debugging and documentation
Serves as a project resource for installation of new information systems processes or of modifications/enhancements to existing information systems. This includes: following defined procedures regarding the installation software and hardware, providing feedback to others responsible for monitoring project status, assuring system integrity, and preparing status reports for department management and all other Associates involved
Education: High School Diploma required. Associate or Bachelor's degree preferred
Licensure / Certification: Certification: CPC, CPC-P or equivalent required
Experience: Minimum of 5 years' experience in claims auditing, billing and/or coding
Advanced knowledge of current ICD-9, CPT-4, and HCPC coding principles and documentation guidelines. Advanced knowledge of current medical terminology, anatomy and physiology required
Must possess excellent organizational and planning skills, including the ability to prioritize multiple tasks and perform them both accurately, timely, and simultaneously

184

Coding Quality Analyst Resume Examples & Samples

Audit pre-bill charts for accurate entry of CPT/ICD-10 assignment and other coder e-form entries, ensure that coding guidelines and processes were followed
Assists with monthly internal audits of the entire billing system
Resolve issues by communicating with other department personnel
Analyze audit data and results
Provide detailed audit feedback to ensure understanding of error(s) identified
Maintains knowledge of current coding guidelines and regulations relevant to the industry
Performs and assists with other department duties as needed including but not limited to attending and/or presenting at department meetings and training sessions, reading department literature, and other special projects
Audit internal processes as assigned
Take active role in dispute process by preparing and presenting at monthly meetings
SOP development
Expertise in CPT and ICD-10 coding
Knowledge of coding guidelines and requirements
Knowledge of and skill in using personal computers and terminals in a Windows environment
Ability to identify, research and solve problems and discrepancies
Ability to communicate with coworkers and management in a courteous and professional manner
Ability to process assigned duties in an organized manner
Ability to perform basic mathematical calculations such as adding, subtracting, multiplying and dividing

185

Manager, Coding & Business Operations Resume Examples & Samples

Research and communicate government coding/billing regulations, third party payor policies, and prospective payment systems for hospitals. Proactively educate departments, as well as understand and communicate the financial impact to the organization
Oversee analyses of medical records, EOBs, payor coverage and reimbursement policies for coding and billing accuracy
Work collaboratively with the Chargemaster, Hospital Operations, and Medical Group Revenue Cycle for revenue integrity opportunities (including identifying missed charges and documentation improvement)
Identify hospital coding/billing opportunities and trends for Hospital Operations, Billing, HIRS, Denials Managements, and Customer Service
Communicate any questions or issues to CMS, NGS, or third party payors
Determine appropriate education based on audits performed by Corporate Compliance
Work in conjunction with HIT to develop pre-billing edits and review existing edits on an ongoing basis
Manage the Coding & Billing operations department
Bachelor's Degree required/Master's Degree preferred
Minimum of 5-7 years of related project management experience in coding compliance, outpatient/inpatient hospital coding, chargemaster compliance or the hospital revenue cycle
RHIA or RHIT certification preferred
Experience with Epic preferred
Extensive knowledge of government regulations and/or third party payor policies that impact hospital coding, billing, or revenue cycle

186

Document & Coding Education Development Specialist Resume Examples & Samples

Creates and implements provider educational programs in documentation & coding, including (but not limited to) classes, online modules, and curricula, which adhere to Instructional Design and Adult Learning best practices
Creates and maintains documentation & coding presentations, tip sheets, newsletters, and other educational material as identified, which adhere to departmental quality and branding standards
Researches governmental and payer-specific rules and regulations for coding and documentation compliance and creates training materials to facilitate education regarding these changes
Works with HFHS Compliance to facilitate education and resource development on regulatory and compliance related issues
Develops, maintains and presents new resident and new provider orientation programs in documentation & coding
Assists in the development, implementation, and monitoring of special projects
Accountable for achieving service level agreement standards and providing excellent internal customer service
Proactively seeks revenue opportunities
Proactively communicates issues or potential issues to leadership
Maintains active awareness of regulatory requirements to ensure HFHS revenue cycle solutions are in compliance with local, state and federal regulations
Maintains appropriate attendance, promptness, professionalism, the ability to pay attention to detail, cooperativeness with co-workers and supervisors, and politeness to customers, vendors, and patients
Other duties or special projects as assigned
Associate’s Degree in Education, Business Administration, Health Care Administration or related field is required or four (4) years of curriculum development, instructional design, adult learning, or program development may be considered in lieu of education requirement
Three (3) years of experience directly related to documentation & coding for hospital and/or physician services
Two (2) years of experience with curriculum development, instructional design, adult learning, or program development
Must have competency, tact, diplomacy and communication skills necessary to professionally interact with peers, department personnel, administration and physicians
Proficient with Epic Electronic Health Record and Billing systems
Experience in governmental and 3rd-party payer contract language and payment methodologies
At least one of the following certifications: CPC, CCS, CCP, CCA, RHIT, RHIA, or RN

187

Senior Video Coding Researcher Resume Examples & Samples

Ph.D. in Electrical Engineering, Computer Science, or related field (MSEE with 3+ years of experience may also be considered)
Deep knowledge of and passion for video coding algorithms
Demonstrated ability to create novel algorithms and solutions
Expertise in C and/or C++ in both Linux and Windows environments
Working Knowledge of state-of-the-art video coding standards, such as HEVC and H.264/MPEG-AVC
Knowledge of the MPEG and ITU-T standardization processes
Experience with patent creation and prosecution activities
Experience quantifying hardware and implementation requirements
Exposure to emerging video application areas, such as 360 degree video, virtual reality, and/or augmented reality content

188

Senior Coding Quality Auditor Resume Examples & Samples

4+ years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing
CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required
Experience with ICD-9 codes required. ICD-10 preferred
Experience with Microsoft Office products (Word, Excel, PowerPoint)

189

Manager Coding Resume Examples & Samples

Advises senior leaders and staff on best practices, methodology and tools for accurately coding
Update and maintain the coding compliance manual. Monitor industry publications and implement changes as necessary
Gives input regarding section needs in preparation of annual budget and monitors expenditures for budget compliance. Monitors and controls departmental expenditures
Facilitate completion of outstanding physician queries through interaction with Coding Audit and Operational team members, clinical managers, and other leaders
Attend meetings within and outside the facility as needed to provide input and act as a coding information resource
Responsible for the monitoring of monthly and completion of performance and metric reports
Enforces departmental policies, practices, procedures and work rules in accordance with approved department and hospital policies and assists in the development and implementation of new policies
Directly impacts DSO, overall A/R and monthly revenue collection
Manages, develops and implements systems for documentation, storage and retrieval of health record information in accordance with accrediting and regulatory requirements
Develops and enforces procedures to assure maintenance of medical, legal regulations and confidentiality of health record information including medical records and peer review/quality assessment/improvement
Coordinate development and implementation of systems necessary for timely and accurate collection of outpatient billing data and statistical information. Direct processes to ensure appropriate coordination of special study/research project requests consistent with departmental activities/goals and objectives
Plan, develop and implement systems for government and other carrier audits. Develop and implement ongoing reviews to ensure regulatory compliance.
Oversees personnel management of the department including employment decisions, counseling, personnel actions, manpower distribution and productivity, career development and performance appraisals
Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10 coding. Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding. Quarterly review of AHA Coding Clinic. Attends Quarterly Coding Updates and all coding conference calls as well as any required CDI education
Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10 coding. Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-10 and CPT updates) for outpatient coding. Quarterly review of AHA Coding Clinic. Attends or facilitates Quarterly Coding Updates and all coding conference calls
Minimum 6 – 8 years’ of experience coding and/or billing- including hospital and consulting background
Minimum 3+ years of supervisory/leadership experience
Proficient in outpatient diagnosis coding guidelines
Extensive knowledge of medical record documentation requirements mandated by Medical Staff Bylaws, Rules and Regulations
Thorough/detailed knowledge of ICD-10 and CPT coding systems
Skilled in formulating and writing statistical reports

190

Coding Research Analyst Remote Resume Examples & Samples

Manages research of claims coding rule initiatives including the development of detail work plans
Receives and logs requests of changes and appeals to committees ruling
Seeks professional feedback from Health Services, Finance, and Claims on claims coding rule changes
Trains and/or provides guidance to Claims Coding staff
Preferred An Associate's Degree in a related field
Required 4+ years of experience in medical coding field with a facility, provider or payer organization
Preferred Other Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) OR Certified Coding Specialist (CCS)
Required Advanced Microsoft Excel
Required Advanced Other Knowledge of CMS/State laws and AMA guidance

191

Coding & Education Spec Resume Examples & Samples

Demonstrated knowledge of Professional Fee Coding and Billing and Collection Activity
Demonstrated knowledge of EPIC EMR
Demonstrated knowledge of GE/IDX
Demonstrated knowledge of third party reimbursement policies and procedures related to

192

Coordinator, Coding Reimbursment Resume Examples & Samples

Ensures complete and accurate coding by conducting periodic auditing for all billing providers
Follows a Physician Practice Coding and Compliance Program including controls and compliance measurements consistent with corporate policies/ procedures to prevent illegal, unethical or improper coding conduct
Utilizes GECB and related modules to obtain, analyze and interpret coding, denial and other reimbursement data to support compliant billing and practice management activities
Communicates, educates and trains Providers on identifying coding and/or documentation issues or updates as identified via record review and/or regulatory guidance
Follows the internal audit schedules and performs all level of coding reviews in accordance with the Physician Practice Chart Review Program
Provides Shadow training for Providers in extended level of chart review requiring one on one training for extended periods of time
Works collaboratively with Practice Revenue Managers of various clinical departments to ensure correlation of information on superbills with rendered clinical services. Works on complex assignments requiring research and recommendation of coding reimbursement department. Makes recommendations for coding/reimbursement improvement to physician practices as necessary
Works collaboratively with Physician Practice Management to create, support, and maintain committees related to Coding/Reimbursement and Regulatory activities
Performs Quality Audits on peers and/or billing vendors to assure compliance with Departmental guidelines and accuracy of results
Maintains coding credential through attainment of designated number of CEU’s. Attends regular AAPC chapter meetings. Attends and summarizes Coding Reimbursement sponsored webinars and education sessions
Leads and mentors Coding/Reimbursement Specialists
High School Diploma or equivalent, required. Knowledge of Health Information Administration or related field, as normally acquired through the completion of a Bachelor’s Degree
Credentials in one or more of the following

193

Coordinator, Coding Reimbursement Resume Examples & Samples

Ensures accurate coding by conducting periodic auditing
Implements a Coding and Compliance Program including controls and compliance measurements consistent with corporate operating policies and procedures to prevent illegal, unethical or improper conduct
Utilizes IDX and/or 3M related modules to obtain, analyze and interpret coding, denial and other reimbursement data to support compliance and practice management activities
Utilizes Stockamp tools to address work denials, develop trending reports and report findings to Revenue Cycle Management within Cardiology
Executes coding of procedural reports and enters corresponding charges into Invision
Partners with administrative leadership within the department of Cardiology to ensure correlation of information on billing forms with rendered clinical services. Works on complex assignments. Makes recommendations for improvement to physician and hospital practices as necessary
Partners with Revenue Cycle Management to create, support, and maintain policies related to coding compliance activities
Creates physician and staff education around findings and/or trends in denials or other significant metrics in conjunction with internal audit initiatives
Monitors the work of department Coders for accuracy and compliance
Guides Coding and Charge Capture staff
Knowledge of Health Information Administration or related field, as normally acquired through the completion of a Bachelor's Degree
Credentials in one (1) or more of the following

194

Coding & Audit Program Manager Resume Examples & Samples

Hold and maintain CPC, CCS-P or CMC coding certification
A minimum of 5 years health care experience in a physician group practice or other ambulatory care setting
A minimum of 5 years of coding experience for a multi-specialty group
A minimum of 2 years of experience conducting provider education and audits
Hold or obtain and maintain ACS E/M or CEMA or CPMA CRC auditing certification within 6 (six) months of hire
HCC hierarchal coding experience
Bachelor’s degree or equivalent experience in health care related field

195

Coding Team Lead Remote Resume Examples & Samples

Coding Technical Skills- extensive regulatory coding (ICD-10-CM, ICD-10-PCS, CPT/HCPCS,, MS-DRGs, APR DRGs) and associated reimbursement knowledge
Case Mix Index Analytical Skills – ability to analyze trends in CMI and determine root cause and address as appropriate
Organization – establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and keen ability to multi-task
Quality Orientation – accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time
Mentor and Educate – provides timely guidance and feedback to help strengthen the knowledge/skill set of others to accomplish a task or solve a problem

196

Spec Clinical Coding Resume Examples & Samples

Perform ongoing chart reviews of targeted physician offices in a timely manner for HCC data extraction to meet CMS sweep deadlines
Perform ongoing chart audits of targeted physician offices to ensure HCC data is validated in preparation for health plan internal audits and/or CMS RADV audits
Responsible for the data collection of medical records as requested by the plans for chart audit/review purposes
Responsible for preparing chart audit findings and communicating this back to physicians in timely manner
Responsible for presenting chart audit findings as well as physician performance trends to management
Develop physician group training utilizing data and findings from chart reviews to help ensure proper documentation elements are in place
Provide risk adjustment in-services to physician offices as needed
Responsible for the development of content for monthly fax blast, quarterly provider newsletter, and website
Assist in developing strategic initiatives related to HCC score improvement for physician and IPA
Responsible for the development of risk adjustment tools as needed and/or as requested by physician offices
Annual update of PCP and Specialist superbills
Perform audits of HCC patient data as reported by health plans for purposes of reconciliation of payment
Participate in tele-conferences and off site conferences as needed to be informed of current CMS requirements
Provide training to appropriate internal staff related to HCC documentation and coding
Perform other assigned duties / special projects on an as-needed basis
Foster positive interaction and relationships with all internal departments as well as cultivating positive working relationships with external contacts
Prevent and avoid harassment and discrimination. Respond promptly to any complaints in accordance with policy in employee handbook
Prefer 1 year of healthcare coding experience
Current Certified Professional Coder license or higher equivalent
Strong knowledge of CMS Risk Adjustment requirements
Ability to travel locally
Requires comprehensive knowledge of medical, administrative, ethical and legal requirements and standards related to healthcare delivery and privacy of protected patient information

197

Health Care Coding Senior Consultant Resume Examples & Samples

Working knowledge of: ICD-10-PCS, facility coding, ProFee coding, DRG, HCC and APS
Ability to audit inpatient and/or outpatient medical records using ICD-9/10-CM and CPT-4 coding rules and guidelines
Current coding certificate
Understanding and ability to apply anatomy and physiology as related to medical coding
Ability to manage multiple projects and meet deadlines
Report writing skills preferred, advanced skills with Microsoft applications (Word,excel, access)

198

Coding Trainer, Senior Resume Examples & Samples

Develops, implements and maintains a training program for new Revenue Cycle Specialist and Revenue Recovery Analyst staff
Consults with operational leaders regarding the development of the Revenue Cycle Specialist and Revenue Recovery Analyst training program
Develops instructional objectives, based on the skills and knowledge, which make up the course content for new staff or changes to existing systems/processes
Develops and delivers direct training to new and existing employees
Analyzes organizational, learner and job needs to determine performance requirements
Designs and develops competency measurements to ensure skill and knowledge base of staff meets standards. Creates training evaluation tools, analyze feedback and implement changes as appropriat
Develops tools for measuring the effectiveness of training programs
Consults with operational leaders to determine specific retraining needs based on quality audit metrics
Develops and maintains training records for Revenue Cycle Specialist and Revenue Recovery Analyst staff via a learning management system
Recommends cost-effective training alternatives, such as process/workflow redesign, system modification or documentation, when appropriate
Maintains, enhances, updates, and customizes Revenue Cycle Specialists and Revenue Recovery Analysts documentation/resources with the support of the operational leaders
Maintains all Revenue Cycle web-based sites (e.g., Coding Services intranet, HealthPartners.com revenue related information) including creation of documents, updating documents, updating site look & functionality, creating new sites, etc
Coordinates with the Systems Analysts to ensure training on major system initiatives
Assists with system testing and provide feedback for system enhancements
Manages process for New Provider Orientation, material preparation, reporting and training
Analyzes, develops strategy, communicates plan and monitors Annual Provider Review process for both Specialty and Primary Care departments
Performs additional duties, attends meetings and assumes projects as assigned by Supervisors, Managers or Director
4 year college degree or equivalent work experience
5 years demonstrated knowledge of coding
Certified Professional Coder (AAPC) or Certified Coding Specialist certification (AHIMA) or RHIT/RHIA
5 years’ work experience in the design and delivery of training programs which includes some technical training
Must demonstrate a thorough understanding of the front and back end revenue cycle components in a physician practice
Understanding of physiology, medical terminology, and disease process is required
Must understand and be able to apply the following regulations
CMS Evaluation and Management Documentation Guidelines
CMS Teaching Physician Guidelines
CMS Correct Coding Initiative
Third Party Payer Reimbursement Policies and Procedures
Ability to tailor information to various audiences
Organize and present complex, technical information clearly and logically both verbally and in writing for one on one and group settings
Demonstrated ability in critical thinking, self- initiative, and self- direction
Ability to manage training program within budget requirements
Ability to evaluate employee development activities to ensure that they meet company business needs
Working knowledge of training equipment and materials
Demonstrated skill in planning, organizing and time management
Strong computer skills with MS Office Suite
Two years previous experience in medical record chart documentation review
Trainer certification
ICD-10 CM certified trainer
Professional coding program instructor experience

199

CPB Client Support Services Tax Coding Resume Examples & Samples

Ensure timely set up of all new security set up requests from Business and Operational partners and coordinate requests for user cusips with ICG partners to support Trust and Custody Business
Conduct 3rd party custodian pricing oversight (Pershing) and related reporting
Research and resolve pricing and reference data inquiries from various business partners
Escalate to send site manager any transactional issues that are “at risk”
Production of monthly pricing reports to business partners with respects to stale pricing, quality and metric reporting

200

Coding Coordinator Resume Examples & Samples

Review coded medical records for coding and DRG accuracy by verifying that the principal diagnosis, secondary diagnoses, principal procedure, secondary procedures and disposition have been assigned accurately and ensure the highest level of reimbursement to which the facility is legally entitled. This shall be completed according to established coding guidelines and rules for reporting
All coding staff shall have quality audits performed on a consistent basis, the results of which are incorporated into their performance reviews
BA or BS required; preferably in Health Information Management, Nursing or related field
RHIA or RHIT preferred
Certified Coding Specialist-CCS (AHIMA) required
Minimum of four years previous work experience coding inpatient medical records
Extensive knowledge of medical terminology, human anatomy and physiology, and clinical disease processes required
Extensive knowledge of ICD-10-CM/PCS and/or CPT-4 classification systems
Working knowledge of federal, state, and third party payer documentation requirements
Familiarity with computerized encoders preferred

201

Senior Coding Project Specialist Resume Examples & Samples

Oversee and manage Risk Adjustment projects as assigned by the Director of Coding, Risk Adjustment
Audit and assign ICD coding to chart notes and ensure compliant clinical documentation as per Official ICD-10 Coding Guidelines
Support short and long term operational/strategic business activities through analysis
Develop recommended business solutions through research of coding data
Provide coding education to primary care physicians and specialists within the network
Travel to various offices in Orange County and Long Beach, CA
Certified Coder with AHIMA or AAPC
5 years coding experience in either an Inpatient or Outpatient setting
3 years of Risk Adjustment / HCC payment methodology experience in a Healthcare setting
Experience with Project Management
Intermediate skill level with Excel
Reliable automobile transportation (20% of travel)
Managed Care experience
Excellent organizational and communication skills
Ability to problem solve and identifying issues within data flow

202

Coding Coordinator Resume Examples & Samples

A "community first, company second" culture based on Core Values that really matter
Associates degree in related field preferred
2-4 years' coding experience required
Billing & collections experience required
Coding certification with AHIMA or AAPC required
MLN Part B Certification preferred

203

Coding Coordinator Resume Examples & Samples

At least three years of experience within the health information department of a hospital
CCS certification
RHIA/RHIT certification
College degree in a relevant field
Working knowledge of ICD-10 and CPT-4 coding practices and standards
Strong communication, interpersonal and computer skills to deliver excellent customer service

204

CDI Inpatient Coding Data Analyst Resume Examples & Samples

Collects data from a variety of sources to update reports on a daily, weekly, monthly and quarterly basis
Creates and manages ongoing MS Access databases. Provides technical support, training, and guidance to application end-users
Manipulates and analyzes data retrieved from databases and other sources using MS Access and MS Excel
Presents analyses of data projects, explaining trends and areas of opportunity to management
Assists in collection of results and financial data from DRG Coding Auditors into a useful tool for education and training of CDI and Coding staff
Collects and analyzes data for departmental needs, special projects, and financial/management reports
Maintains and generates reports from the Microsoft Access database for PSI and HAC quality reports
Assists in development of reports from Epic, 3M and PSI/ HAC access data bases as requested
Generates reports for providers and leadership to demonstrate individual performance levels and for bench-marking against other program/departments which will enable action planning, process improvement, and education
Bachelor’s degree in statistical analysis, health information management, health informatics, computer science/systems, health care administration, nursing, or related field
Two (2) years’ experience in a health information management department, clinical documentation improvement and/or hospital coding in an electronic health record environment
One (1) year of experience with MS Excel and MS Access Work experience with 3M as well as Epic systems and applications
An approved equivalent combination of education and experience
Preferred Master degree in health informatics or similar RN, CCDS, CDIP, RHIT, RHIA
Working knowledge of MS Office products, especially Word, Excel and
Access
Ability to analyze reports, communicate findings and provide
Recommendations to managers
Working knowledge of project management functions and techniques
Strong communication skills and troubleshooting capabilities
Ability to comprehend work flow and integration of electronic applications Basic understanding of database design and data management concepts
Health informatics and management reporting 3M HDM and CDIS knowledge and or experience

205

Supervisor Coding Denials Resume Examples & Samples

Supervises coding denials and charge capture personnel in daily operational activities
Directs the performance of coding denial management and charge capture for the purpose of accurate patient billing and maximum reimbursement
Supports internal and external coding denial and charge capture review and education
Maintains and monitors performance indicators for accounts receivable and formulates action plans to reduce the number of outstanding cases
Identifies all problem areas and areas of opportunity regarding coding denials and charge capture
Interacts with upstream and downstream departments on Revenue Cycle Management
Administers corrective action for areas of responsibilities
Protects the confidentiality of patient information per HIPAA regulations
Protects the interest of the Clinic with RCM vendors. Interacts with ITD in the support of systems and processes in the section
Promotes good morale and cooperation: encourages others, values their input, shares information and seeks ways to add value both to the customer and to the team
Anticipates and responds to changing skills requirements
Seeks opportunities to learn new skills and actively coaches and encourages team members to do the same
Integrates team into the coding denial and charge capture process to promote their development

206

Coding Documentation Review Specialist Resume Examples & Samples

Assists providers with documentation templates in the electronic health record Supplies providers with documentation requirements for the services rendered
Review documentation and coding for both inpatient and outpatient (hospital and office) professional services prior to the release of charges
Informs providers of items in the chart that need to be reviewed or corrected as it relates to the coding selected
Responsible for monitoring regulatory changes as they apply to billing and coding in the inpatient and outpatient setting
Serves as resource and staff educator for data mining and coding to ensure reimbursement accuracy
Identifies coding issues related to billing denials, prepare appeals and implementation of programs to prevent future coding/billing issues.? Accurately code diagnosis and documentation of medical conditions of patients.?

207

Manager of Coding Resume Examples & Samples

Five years experience in medical record setting required with at least three years at management level preferred
Experience in an academic medical center preferred
Knowledge of JC, DOH, CMS and other regulatory standards
Excellent ability to communicate effectively (in writing and verbally) with internal and external customers
Three years coding, encoder, grouper, abstracting, registration and bill systems experience required

208

Cardiology Coding Coordinator Resume Examples & Samples

Strong Experience in Microsoft Outlook required
Strong Experience in Microsoft Excel required
Proficient in Microsoft PowerPoint
Strong Experience in Medical Terminology
Strong, proven customer service skills required
High attention to small detail required
Kronos experience a plus
Billing and coding experience preferred
Crystal reporting experience preferred
Background in supply chain a plus
Experience with Lawson a plus
1 year experience in a medical field preferred. Will consider other receptionist or clerical experience
Strong Microsoft Outlook, Excel required. Then PowerPoint
Experience in a Cardiac Cath Lab or Heart Center preferred
Experience using computers, telephone, copy machine, fax machine, printers and scanners
All duties as listed in job summary

209

Manager, Coding Validation Resume Examples & Samples

Direct all activities associated with a full agenda of an operating department’s day-to-day production regimen
Participate in the development of the department’s strategic direction and objectives
Responsible for overall staff administration, including Permanent or Temporary employee staffing models, recruiting, performance management, salary administration, with oversight of exempt and non-exempt staff
Responsible for assisting in the development of the department’s budget and ensuring adherence to the budget
Determine and maintain appropriate organizational structure and staffing levels, achieve production goals and financial goals, and coordinate with other operational departments as needed
Provide training, coaching, mentoring to staff as appropriate and provide development opportunities to meet the organization’s future needs
Acts as an escalation point for teams, supporting all customers to ensure a high level of customer satisfaction
Design, implement, and manage necessary operational workflows; meet internal and external SLA’s (Service Level Agreements)
Prepare, produce, and deliver numerous management reports on a daily, weekly, or monthly frequency
Meets contract deliverables related to turnaround times for completion of
Preadmission screening cases
Establishes performance metrics and quality control standards for the department and individual team members
Remains the expert on the preadmission screening process and fills in for staff as needed
Responsible for all aspects of the retrospective review department and processes (prepayment and post payment)
Liaison to project team members and participants involved in the project
Performs internal quality control for each direct report and ensures that staff is maintaining production goals and quality standards, while meeting deadlines in a fast-paced environment
Prepares outcome reports that show findings from project/contract activities and effectively communicates findings
Coordinates reviews with medical director and physician reviewers as appropriate
Serves as a resource to participants in project/contract activities in order to achieve effective quality improvement activities
Facilitates benchmarking, networking, and “best practice” sharing among project participants
Meets with clients as required
Performs other functions as assigned
Working knowledge of basic health care data analysis and clinical review
Ability to provide customer service and public relations skills
Ability to provide direction and control; exhibit high
Initiative to get things accomplished; high organizational ability to juggle multiple priorities; proven leadership experience as a leader in charge
Ability to effectively manage multiple priorities and multi-level tasks
Ability to operate with strong personnel management skills to motivate staff and take corrective actions when necessary
Ability to function under pressure and with deadline oriented project demands as well as manage multiple initiatives
Ability to apply existing knowledge of health care marketplace including commercial and government insurance health plan organizations and HIPAA guidelines with their associated security requirements
Ability to work proficiently with Microsoft Word, Excel, Power Point and Access
Ability to work independently to meet predefined production and quality standards
Working knowledge in and successful application of basic level of health care data analysis and clinical review
Ability to work proficiently with Microsoft Word, Excel, Power Point & Access
Ability to be careful and thorough about detail
Ability to analyze information and use logic and process to address work-related issues and problems
Working knowledge of HIPAA privacy and security rules
Ability to travel 3-5%
RHIA, RHIT, RN, CCS, CPC, or other licensed/accredited health care professional specific to scope of contract
7+ years of clinical coding experience with >5 years of audit experience
Experience in operational & project management preferred
Background in cost containment strategies preferred

210

Coding Data Specialist Resume Examples & Samples

Education: Associates or Bachelor Degree (In Health Information Management preferred)
Experience: ICD-9 CM and/or CPT coding experience preferred
Licensure: RHIT or RHIA eligible/required. Must obtain RHIT or RHIA within 6 months of employment
Skills & Abilities: Basic knowledge of human anatomy, physiology, and medical terminology. Effective oral and written communication skills. Basic computer skills and excellent ability to concentrate

211

Adjunct Medical Billing & Coding Instructor Resume Examples & Samples

Highly organized and detail oriented
Interacts effectively and professionally with students, staff, faculty, and external customers of Carrington College including Advisory Board members and externship and other off campus sites
Exceptional customer focused skills. Ability to address student needs and resolve issues with diplomacy and tact
Interpersonal skills including questioning, listening and showing concern and respect for others
Solid writing skills to communicate effectively in memos, letters, and via email
Excellent verbal communication skills including ability to project voice and be clearly understood when speaking in front of a group
Possess a high degree of integrity and commitment to comply with policies, regulations, and codes of conduct governing all aspects of job responsibilities
Commitment to the success of the students and the school
Computer literacy skills including working knowledge of Word, Excel, PowerPoint, and Outlook
AA or AS Degree required
3 years recent hospital billing experience
Must demonstrate competency in the assigned teaching field, such as academic or vocational training and credentials, related work experience, licensure, or certification
Teaching and/or supervisory experience desirable

212

PM Coding Spec Resume Examples & Samples

Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guidelines to outpatient diagnoses and procedures
Interprets progress notes, operative reports, discharge summaries, and charge documents as necessary to determine services provided and accurately assign CPT-4 and ICD-10 coding to these services
Performs initial charge review to determine appropriate ICD-10 and CPT-4 codes to be used to report physician services to third party payers
Enters appropriate data into the Billing System by selecting the appropriate codes, diagnosis, modifiers, Anesthesiologist, CRNA, and Referring Physician information to complete the charge process
Contacts physicians through management regarding procedures and other services billed as necessary to ensure proper coding
Responsible for reviewing patient logs and other reports of clinical activity to ensure billing is captured for all patients
Monitors and follows up to ensure all services that can be billed are captured and coded for billing in a timely manner
Responsible for ensuring the batch processes for all coded charges on a daily basis
Utilizes batch-logging systems to comply with internal audit standards
Reviews all physician documentation to ensure compliance with third party and regulatory guidelines
Works in conjunction with the Reimbursement staff to answer all inquiries regarding coding and billing for physicians’ services
Works in coordination with other members of the Physicians’ Practice and/or Billing Office as necessary
Must maintain knowledge of coding latest updates, rules and guidelines
Interact with and provide a high-level analysis of trends to Management and others about Coding related issues. Acting as a resource for staff who have questions about coding
Demonstrates an analytical mindset, with great attention to detail
Is Self-motivated, with proven ability to code with speed and accuracy
Communicates clearly, concisely and professionally
Team player with positive interpersonal skills
Meets and exceeds short and long term goals as established for the department
Performs duties and job functions in accordance with the policies and procedures established for the department
Reports to work, meetings and professional obligations on time
Participates in administrative staff meetings and attends other meetings and seminars
Assists in evaluation of reports, decisions, and results of department in relation to established goals
Recommends new approaches, policies, and procedures to influence continuous improvements in department’s efficiency and services performed
Serves as a member of the Clinical Operations Department. Performs duties necessary to ensure the team’s projects/goals are completed
Takes ownership of special projects, researches data and follows through with detailed action plans
Actively participates in problem identification and resolution and coordinates resolutions between appropriate parties
Performs other related duties as required and assigned
Adheres to MEDNAX, Department and HR policies and procedures
Coding Certification by a nationally recognized coding and accreditation program that requires CEU submission for renewal, preferably CPC or CCS, is required for this position, clinical background; or minimum of three years related experience and/or training; or equivalent combination of education and experience
Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents
Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community
Ability to write speeches and articles for publication that conform to prescribed style and format
Ability to effectively present information to top management, public groups, and/or boards of directors
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry
Ability to interpret an extensive variety of technical instructions in mathematical or
Coding Certification by a nationally recognized coding and accreditation program that requires CEU submission for renewal, preferably CPC or CCS, is required for this position
Coding Experience Required: 1 – 2 years minimum

213

Coding / Education Liaison Resume Examples & Samples

Education: Associate’s degree required; in lieu of associate’s degree minimum of two (2) years of progressive practical experience in outpatient clinical setting. Bachelor’s degree preferred
Experience: Five years of progressive practical experience in an outpatient clinical setting and a minimum of 2 years specifically in a multi-specialty practice environment
Licenses/Certifications: CCS-P, CPC, CMC or CPC-H certification required
Advanced working knowledge of CPT, CMS, ICD, HCPCS and other payer documentation, compliance, reimbursement and coding requirements. Experience with Medicare Advantage and other HCC risk adjusted plans are required
Expertise in risk factor calculations and risk-based payer incentive programs
Exposure to healthcare finance
Possess computer skills, operating systems and EMRs
Demonstrate a high level of organizational and planning skills with the ability to work independently
Requires excellent observation skills, analytical thinking, problem solving and possess superior verbal and written communication skills with the ability to adapt style and tone according to situation and audience. Experience in adult learning principles to be able to provide adult education and training
Provide coding education to physician and their support staffing in their designated clinics
Reviews EMRs to ensure physician template or phrases reflect accurate coding
Conducts research to update education materials for providers
Actively participates with consulting services providing physician education (currently MediSync CodeRite)
Interprets changes in external regulatory environment and coding updates
Plans and conducts on-going training with providers and support staff
Provides coding expertise and serves as subject matter expert to respond to questions from providers, managers, billing office and others relating to procedural coding and ICD-9 coding, regulations, reimbursements and documentation requirements
Maintains project work list and meets deadlines
Seeks appropriate physician input if required information is missing or unclear
Monitors claims rejections/denials related to coding and documentation issues. Consults with physicians for clarification and additional documentation to resolve coding issues
Works with IT, billing, and financial operations to ensure proper coding and accurate billing/reimbursement of claims
Maintains current knowledge of outpatient coding. Follows coding compliance guidelines, official coding guidelines, regulatory requirements and internal policies and procedures affecting the coding process

214

Coding Coordinator Resume Examples & Samples

Reviews Dashboards and reports to identify and report needs to coding leadership. (30%)
Continually assesses work queues to identify fluctuating needs of staff. (30%)
Processes, records, and trends data of medical necessity requests. (10%)
Assists with entering charges for coder. (10%)
Maintains coder schedule, including PTO requests and vendor scheduling. (5%)
Records coding productivity. (5%)
Performs other duties as assigned or required. (10%)

215

Clinical Coding & Documentation Specialist Resume Examples & Samples

Performs detailed review of historical participant records at time of enrollment to ensure that all appropriate clinical conditions are captured and documented on the LifePlan by the Provider for review by the Interdisciplinary Team as part of the care planning process
In collaboration with Certified Coding Manager, Coding Specialists, and PACE Clinicians, identifies areas of educational need. Researches and develops educational materials related to clinical coding and documentation
Assures that accurate, complete client care documentation is completed timely, in preparation for billing (RAPS, charge tickets, etc). Validate RAPS submission files
Keeps current in area of expertise and assures that standards and practices within the site reflect best practice in coding and LifePlan accuracy. Attends educational opportunities to enhance knowledge in coding and reimbursement systems and obtains/maintains certification from AHIMA or AAPC to validate coding skills
Must be a graduate of an accredited Nursing Degree Program and possess a current, unencumbered, active license to practice as a Registered Nurse
Must possess strong analytical and organizational skills. Must have the ability to meet strict deadlines with a high level of accuracy, ability to prioritize multiple tasks in a highly automated setting and possess strong interpersonal skills. Must be able to concentrate in depth, continuously and manipulate detail to arrive at summary data with application to TH PACE necessary
Candidates should also possess the ability to work as part of a team

216

Manager, Coding Resume Examples & Samples

Upholds the values and mission of the Tandem Hospital Partners family
Responsible for ensuring accuracy and efficiency in the medical records department
Reviews processes and identified area for improvement taking into account user needs
May act as a liaison between Information Services and Technology Department, ensuring that systems are accessible and in accordance with the needs of the organization
Insures that all record keeping and information disbursement complies with local policies, federal and state laws and statutes and HIPAA regulations
Will perform a variety of complex tasks related to the leadership and managing work of others
Will plan, direct and organize the activities of the Coding Department
Supervises and plans the process improvement activities while overseeing the daily operations consistent with the facility policies and procedures
Develops departmental strategic operational planning including staffing and fiscal management
Department planning including operational goals and objectives
Supervises and coordinates activities of personnel engaged in analyzing, compiling, indexing and filing of health information records of patients with total regards to confidentiality
Maintains department statistics on work volume, productivity and accuracy for use in long range planning and budgeting
Arranges for training of departmental personnel in indexing, filing, medical terminology, transcription, coding, outlining procedures, instructing in policies and practices of the hospital, suggesting methods for performing tasks and instructing personnel in medical ethics
Encourages continuing education through workshops, webinars and correspondence courses
Maintains surveillance of incomplete patient health records and follows up until records are completed and filed. Will be responsible for distributing delinquent notices to physicians and/or clinicians and corporate office in accordance with the hospital accreditation standards
Assigns appropriate ICD-10/PCS, CPT, HCPCS and DRG codes to charts after reviewing discharge abstracts and patient information
Performs medical record audits according to corporate compliance and coding plan and prepares reports as needed
Provides feedback and training on coding and compliance to appropriate physician and clinical support personnel as well as corporate and billing staff
Prepares statistical reports required by applicable legal, accrediting and/or licensing regulations and clinical policy
Responsible for organizing the storage, archiving, retrieval and destruction of medical records in accordance with federal and state laws and statutes
Develops and implements policy and procedures for the coding and charge departments
Evaluates and recommends new technology to assist the departments in performance of their duties
Provides response to coding and billing inquiries from the billing department and third party payors
Oversees the development of and adherence to budgets for the coding department
Provides staff development through performance management, training and mentoring
Assists the billing department in the adjunction of claims
Assists the compliance and auditing department as needed
RHIT (Registered Health Information Technician) or RHIA (Registered Health Information Administrator)
CMC (Practice Management Institute), CCS (AHIMA) or CPC (American Academy of Professional Coders) certified with a minimum of three years coding experience. Certification must be current and verifiable
Must be ICD-10 certified
Bachelor’s degree or Associates degree preferred
Prefer at least three years’ experience in a HIM management position
Minimum of three years’ experience with ICD-9/10, CPT and HCPCS coding
Strong training background in coding and reimbursement
Auditing and/or compliance background preferred
Excellent written, oral and interpersonal communication skills
Ability to work with all levels of staff to define business requirements and goals, and to identify and resolve issues
Able to keep a positive attitude and problem solving stance in difficult circumstances
Demonstrated proactive approaches to problem-solving with strong decision-making capability
Knowledge of documentation regulations of JCAHO and CMS
Knowledge of ICD-10-CM, CPT, HCPCS and DRG coding systems and HIPAA requirements
Basic understanding of medical terminology and physiology
High degree of proficiency in computer and analytical skills
Ability to multi task as needed

217

Manager Itd-rcm HIM & Coding Resume Examples & Samples

Leads all activities related to the department's technology services and defines and enforces Corporate IT Standards
Coordinates department activities with other ITD departments and interfaces with CCF user departments
Directly influence the success of new programs and strategic plans at CCF as they relate to information processing, access and utilization
Acts as consultants to CCF divisions to determine information needs and strategies
Experience with Epic Resolute (HIM HB Coding and Abstracting)
Epic Certifications in any of these areas a plus
Experience with 3M Abstracting and 360 Encompass a plus

218

Supervisory Medical Record Technician Coding Oca Resume Examples & Samples

Determines and evaluates compliance with standards of regulatory and accrediting bodies
Interprets and adapts health information management guidelines that are not applicable to the work or have gaps in specificity
Ability to coordinate work in order to complete duties in an accurate and timely fashion; and
Ability to perform a full range of supervisory duties, to include assigning, planning and evaluating work, recommending awards, approving leave and resolving staff issues

219

Medical Billing & Coding Positions Resume Examples & Samples

Previous Claims experience
Experience processing Denials and Appeals
Experience reconciling patient accounts
Must be proficient with MS Office
Excellent Customer Service Skills
Written and Verbal Communication Skills a must
Must have up to date Certification in regards to Coding positions

220

Coding Quality Monitoring Analyst Resume Examples & Samples

A Bachelor's Degree in Health Information Technology or Management; or a combination of education and experience
Four (4) years professional experience in acute care and ambulatory coding
Experience with health information systems and software database applications
Analytical and operational health information management experience
Working knowledge of ICD-9-CM, CPT-4 coding and APC and DRG payment methodologies, and knowledge of Revenue Cycle/Revenue Management
Knowledge of national quality standards, state and federal laws relating to review for health information management
Versed in foundations of CQI/ TQM including process flow; process oriented
Proficiency in Microsoft Office Suite, Electronic Health Records
Must be self-directed and able to work autonomously in a professional and productive manner
Excellent interpersonal, communication & presentation skills and follow through
Customer focused and attention to detail
Current Credentials as RHIT or RHIA, or CCS, or combination
Revenue Cycle reporting and metrics experience
Epic

221

Director of Hospital Coding Assurance Resume Examples & Samples

The development and maintenance of an annual audit plan to review and standardize coding accuracy and consistency
Oversight of the routine coding reporting and analysis for the System
System-wide identification and mitigation of coding-related risk to the organization and for continually updating Senior Leadership in this regard
Maintaining a consistent management reporting process that provides WellStar with timely and relevant information on all aspects of coding compliance
Monitoring federal, state, local and other rules and regulations, as well as updating policies and communicating changes to appropriate medical staff and clinicians
Development and delivery of orientation and in-service education programs for new and existing providers/staff regarding the requirements of federal, state, local or other laws, rules and regulations related to medical practice, including documentation, coding and billing

222

Coding Resume Examples & Samples

HIM operations, under a centralized model, for WellStar Health System
Health information management operations for the WellStar Medical Group
Ensuring that the data stewardship team is performing corrections to the electronic medical record and master patient index
Leading data governance initiatives for the Health System’s release of information, emergency department charge capture, the MyChart (patient portal) service desk and patient/customer service
The operation and quality of coding services for the Health System
Maintaining subject matter expertise in the areas of responsibility such as State laws & Federal regulations regarding access and release of patient information, Joint Commission Standards, CMS requirements and emerging payment systems
Knowledge of contemporary models for managing HIM and coding services in a health system
Knowledge of, and skill in, managing complex operating department roles
Extensive knowledge of successful HIM & Coding practices
Knowledge of CMS, Medicare and Medicaid regulations, state laws and federal regulations as well as non-regulatory standards such as Joint Commission standards related to HIM and coding
Knowledge and experience in building and supporting teams / collaborative workgroups
Knowledge of the principles of information management in order to effectively analyze data and make decisions

223

Supervisor Coding / Reimb Resume Examples & Samples

Processes automated or manually enters charges in the applicable billing system
Researches and analyzes coding and payer specific issues
Communicates with providers, either verbally or in writing, related to coding issues that are of high complexity. Including face to face interaction and education with providers
Applies appropriate modifiers and basic knowledge of Relative Value Units as well as appropriate ranking of CPT codes
Coaches providers on documentation improvement
Develops and mentors teammates and serves as a resource
Maintains relationships with physicians, residents and medical staff

224

Coding Investigator Resume Examples & Samples

3+ years of inpatient DRG coding experience or physician coding experience or risk adjustment coding
8+ years coding experience
3+ years auditing experience

225

Coding Process Consultant Resume Examples & Samples

Consult with and coordinate between Cerner and client project leaders to identify capability gaps impacting current and future business strategies
Develop appropriate learning curriculum to meet business needs including process design and solution adoption best practices to address gaps in motivation and ability
Conduct training and classroom-based coaching onsite and in virtual environments that build motivation and ability
Prepare lesson plans including methods, materials, and documentation to be presented
Revise, modify, and develop course content to address current solution features, functions and workflow to address client needs
Evaluate learning solution effectiveness using best practice methodologies aligned with performance and business outcomes
Conduct charging audits as needed
Conduct sales and/or compliance presentations as needed
Excellent verbal, presentation, and written communication skills
Ability to work overtime and irregular hours as needed
CPC, CCS, COC, or RHIT certification
Minimum of 5 years' coding experience
Residing in or able to relocate to the greater Kansas City area
Knowledge and experience with OPPS
Knowledge of and experience in health care billing and coding and I&I charging
Understanding of Finance and Accounting aspects within an organization

226

Developer Coding Wizard Resume Examples & Samples

Setting up a new trading database and further extending and developing the trading platform
Upgrading our current trading infrastructure to PostgreSQL and managing it after implementation
Gathering user requirements and designing, developing and maintaining back-end solutions for one or multiple departments within the company
Closely collaborating with our multidisciplinary team of developers, traders, researchers and analysts
Independently work on related projects to enhance business performance and support Priogen’s rapid growth

227

Clinical Coding Nurse Consultant Resume Examples & Samples

4 - 5 years of General Clinical experience
Knowledge of CMS - HCC model and guidelines along with ICD - 9 10 and guidelines
Ability and willingness to travel (locally and non - locally) as determined by business need

228

Outpatient Coding Team Lead WFH Resume Examples & Samples

Coding Technical skills- extensive regulatory coding (CPT-4, MS-DRGs) and associated reimbursement knowledge
Case Mix Index Analytical skills - ability to analyze trends in CMI and determine root cause and address as appropriate
Effective Decision Making - relating and comparing; securing relevant information and identifying key issues; committing to an action after developing alternative courses of action that take into consideration resources, constraints, and organizational values
Initiative - independently takes prompt proactive steps toward problem resolution
Leadership - leads individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services
Quality Orientation - accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time
Work Independently - is self-supporting; not needing to rely on others to complete a job
Building and Maintaining Strategic Working Relationships - develops collaborative relationships to facilitate the accomplishment of work goals. Possesses good interpersonal skills in building, negotiating, and maintaining crucial relationships
Managing conflict - dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people
Mentor and Educate - provides timely guidance and feedback to help strengthen the knowledge/skill set of others to accomplish a task or solve a problem
Minimum of 5 years' acute care inpatient/outpatient coding experience required
Minimum of 3 years' coding auditing/monitoring experience strongly preferred

229

Professional Coding & Reimbursement Supervisor Resume Examples & Samples

0 Excellence in Service and Clinical Quality: Achieving seamless delivery of quality patient care and safety, excellence in patient experience and customer service. - Achieving seamless delivery of quality patient care and safety, excellence in patient experience and customer service
0 Organizational Leadership: Providing leadership and accomplishing objectives by supporting the integration of processes and initiatives while modeling collaboration. - Providing leadership and accomplishing objectives by supporting the integration of processes and initiatives while modeling collaboration
3-4 years of experience in a healthcare or associated field with supervisory experience or demonstration of increasing responsibilities involving leadership, project management, training or audit experience
5-7 years of varied experience in professional or hospital-based coding with demonstrated competency in ICD and CPT coding systems and AHA Coding Clinic Guidelines

230

Senior Coding Quality Auditor / Educator Resume Examples & Samples

Develop and administer an ongoing Quality Review Program that seeks to ensure all coders are meeting a 95% accuracy rate while adhering to acceptable coding practices as defined by the ICD-9-CM/ICD-10 CM Coding Guidelines
Successfully perform consistent coding quality reviews to validate correct coding of both the Risk Adjustment Coding Team as well as vendors providing coding support to BCBSMA
Develop and conduct ongoing coding training to include but not limited to ICD-9, ICD-10-CM and Medicare Risk Adjustment coding to new associates, as well as training for existing staff as needed
Develop and maintain coding reference tools for the Risk Adjustment Coding Team as well as BCBSMA providers
Prepare, compile, trend and communicate QA results to identify opportunities for performance improvement and further education
Provide feedback to coding staff and Risk Adjustment Management on quality assurance results and provide follow up training on the areas requiring improvement
Attend continuing education classes to maintain coding proficiency and certification requirements
Provide assistance with coding as workload permits
Provide feedback and auditing results to providers upon request
Participate in special projects as needed
Advanced knowledge of ICD-10 official coding guidelines, including the use of AHA Coding Clinic or similar authoritative resources
Demonstrated ability to mentor and train other coders and providers
Ability to work independently in a fast-paced environment
Ability to interact with management personnel and the provider community
Possess strong organizational skills and attention to detail
Ability to multi-task and meet multiple deadlines
Proven ability to prioritize
Adaptive and flexible to new ideas and change
Baccalaureate or Associates degree in health information management or similar preferred
Acceptable coding or HIM certification; RHIT, RHIA and/or CCS/CCS-P or CPC/CPC-H required. CRC strongly preferred, and will be required within first year of employment
A minimum of five (5) years of relevant coding experience, with a high level of coding expertise in the following areas and/or disciplines is required

231

Certified Coding Technician Resume Examples & Samples

Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) who possesses professional standing in the American Health Information Management Association required
Completion of Medical Terminology and Anatomy and Physiology courses required
Two (2) years experience with ICD-9-CM and CPT-4 coding experience in acute care facility preferred

232

Iis-manager, Operations DP & Coding Resume Examples & Samples

Manage a team of Senior Data Analysts, Data Analysts and/or Data Associates
Ensure the work of the entire staff is delivered with the highest level of quality at all times
Together with Senior Management, set clear standards, procedures and policies. Communicate these to your team members and ensure these criteria are followed
Ensure that direct reports recognize the costs associated with their work and to keep them in-line with the Business Unit’s goals
Manage relationships with outside vendors, including scheduling, budgeting project costs, communicating processes and managing client expectations
Assist direct reports in answering client questions and offer alternative solutions to specific project execution
Provide solutions and support to direct reports when conflicts in scheduling, costing or other project-related issues arise
Build a reputation with internal and external clients for excellent service and repeat business
Responsible for training new staff at all levels within Data Processing
5 – 7 years data processing experience
Proven ability to be quick and accurate when assessing situations and in determining next crucial steps and to take appropriate action
Active listener with demonstrated negotiation and problem solving skills
Demonstrate diplomacy and tact when handling difficult situations
A self-starter; ready to champion initiatives beyond the scope of the job
Strong attention to detail, accuracy and superior organizational ability
Proficient with data processing platform such as Quantum, Dimensions, UNIX, NextWorkbench
Bachelor’s degree or equivalent related experience

233

Supervisor / Clinical Coding / Trauma Service Resume Examples & Samples

Hires, supervises, and evaluates personnel productivity and effectiveness according to departmental, hospital and system policies and procedures
Maintains responsibility for physician education
Ensures that performance reviews are completed timely and that disciplinary actions and/or terminations are carried out within established hospital policy
Ensures that all internal and external audit information is provided to the CMC Coding Director in a timely manner
Supports the Senior Clerk function for prioritizing high dollar, accounts over 30 days and accounts in AR status
Supports the analyst function for working failed claims and other account issues
Coordinates flow of information between coding and other departments including Medical Records, Patient Accounts, Medical Audit and Clinical Care Management
Monitors registration issues
Coordinates activities, documentation and responses to outside coding reviews which include Medical Review of North Carolina and other payors

234

Junior Producer, Coding Resume Examples & Samples

Help to manage and coordinate work in teams
Strive for industry-leading development practices, owning and iterating process, schedules and tracking
Ensure the milestones/goals/tasks are always clear to the team and appropriate review forums are established
Monitor the balance of time and resource and make recommendations for adjustment as appropriate
Ensure great communication across the team, internally and externally
Act as the ultimate diplomat, identifying areas of potential conflict and preventing issues from escalating
Establish prioritized daily/weekly/monthly goals for team, in conjunction with producers, leads and directors
Keep studio management up to date on progress, slippage and risk
Thoroughness, initiative approach
Ability to work well in a team
Very good communication skills
Analytic and creative thinking
Ability to accept responsibility for organizing tasks and priorities
Ability to work well even under pressure of tight deadlines
Interest in further self-education and development of own abilities
Interest in computer games and their development

235

Mgr, Coding Research Resume Examples & Samples

Function as the corporate authority regarding claim editing policy and procedure
Responsible for direct interaction with market leadership regarding all claims editing rules
Provide leadership and expertise in the development of potential new rules
Lead the coordination, validation and implementation of new rules
Perform routine and ad hoc financial impact analysis and reporting regarding effectiveness of rules
Manage support across the organization to PR, Customer Service, Claims and other areas as appropriate
Develop and manage the maintenance approach relative to coding issues and contractual arrangements
Manage dedicated payment policy team of policy research, implementation and provider resolution
Cross-functional interaction with Health Services regarding payment policy development activities and escalated claim issues
Routinely interface with coding experts and representatives regarding payment policy issues, rule justifications and rule changes
Maintain a library of all the existing and retired rules, the source of the rule, the implementation/retire date of the rule (by Market and by Line of Business) and other configuration-related decisions (e.g. provider exclusions) as necessary
Document supporting authority for payment policy by Market and by Line of Business (Master Grid)
Participate in cross-functional teams to address key claims coding issues facing the organization
Write and administer communication to Markets and collect feedback
Coordinate evaluation of change requests from clinical perspective, financial perspective, and claims operational perspectives; Prepare and present analysis of payment policy changes
Research CMS/State regulations, AMA and other professional organization guidance to support existing policy and implementation of potential new policy
Present change proposals to Claims Payment Policy Committee (CPPC)
Effective Market Communication
Develop and maintain relationship payment policy software vendors
Train organization (Claims, Customer Service, PR reps) on use of research tools
Required A Bachelor's Degree in a related field or relevant managed care industry experience
Required 5+ years of experience in a health care payer/provider (hospital, multi-specialty physician) organization
Required Other Experience working with health insurance claims payment systems and government payment systems
Preferred Other Formal claims coding training and/or certification
Advanced Other Professional knowledge of medical terminology and abbreviations
Advanced Other Knowledge of Medicaid payment systems, including ability to quickly research and absorb new payment systems
Required Advanced Other Billing expertise in UB04, 1500 and other healthcare services
Required Advanced Other Knowledge of Medicare payment systems and use of payment schedules, including: DRG, APC, Physician Fee Schedule, Lab Fee Schedule
Required Advanced Other Advanced user of payment rules engine

236

Mgr, APG Coding Rmbrsmnt Resume Examples & Samples

Oversees, monitors and reports on Key Performance Indicators for APG billing to Hospital, PAANS and clinic leadership
Implements and chairs APG revenue committee meetings
Conducts and monitors initial and subsequent training and education on E/M documentation, coding and billing guidelines for physicians and staff providing services in clinics
Develops and monitors schedule for internal chart reviews and conducts reviews of documentation/coding and billing utilizing advanced, specialized knowledge of medical codes and coding procedures for clinic billing to assign and sequence appropriate diagnostic/procedure billing codes in compliance with governmental payer requirements. Reports results to Hospital, PAANS and clinic leadership
Coordinates internal (Corporate Compliance) and external audits (Government and Private payers) for Medicare Part A and Part B services associated with clinics
Maintains and updates charge documents with new and deleted codes in cooperation with clinic leadership, PAANS and Finance IT systems. Educates staff and physicians based on yearly code changes
Utilizes IDX and Invision billing system to obtain, analyze and interpret coding, denial and other reimbursement data
Collaborates on site with clinical staff to help maximize their financial benefit with comprehensive documentation and accurate completion of encounter forms
Conducts research on coding for proposed new services to ensure accurate coding and billing
Maintains knowledge of coding and billing requirements. Attends periodic coding meetings and training sessions
Selects, develops, manages and evaluates direct reports. Conducts training and education sessions on coding and regulatory updates for Coding/Compliance staff
Bachelor's Degree in Business Administration, Health Care Administration or related field, required
Credentials in one or more of the following

237

Mgr, Training Coding Rmbrsmnt Resume Examples & Samples

Designs, establishes and implements coding and reimbursement education training programs for PAANS providers and staff
Advanced Coding Specialist (ACS)
Certified Coding Specialist - Physician (CCS-P)
Certified Professional Coder (CPC)
Registered Health Information Administrator (RHIA)
Registered Health Information Technician (RHIT)
HCC, risk coding experience, preferred
Evaluation of Coding, preferred

238

Coding & Reimbursement Coordinator Resume Examples & Samples

Reviews inpatient and outpatient medical records prospectively to ensure that the care of the patient is recorded in language that payers can interpret and which accurately and completely depicts acuity of the patient and resources expended
Reviews inpatient medical records pre-billing to determine if there are additional codes that need to be added. This includes queries to the physicians regarding appropriate documentation for any additional codes. Ensures that any changes will be done on excel spreadsheets to show changes in reimbursement
Tracks DRG assignment against national benchmarks to identify documentation variances. Identifies potential solutions where documentation problems occur. Reviews the Federal Register, other Medicare memorandums and BIDMC contracts related to changes in coding and DRG assignment. Conducts analysis and training for clinicians and coders on changes
Reviews DRG potential changes made by auditors (RAC, BC, HP) and appeals cases when appropriate
Identifies selected DRG target benchmarks and tracks performance including documentation problems, both individual and systemic. Interacts with physician for individual documentation problems. Develops solutions for systemic documentation problems
High School diploma or GED required. Bachelor's degree in Healthcare preferred
Knowledge of ICD-9-CM, ICD-10-CM/PCS and CPT-4 coding
Knowledge of Medicare, Medicaid, and third party coding requirements
Experience as a coding specialist
CCS, RHIT or other coding certification
Problem Solving:Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues
Team Work:Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments
Customer Service:Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner

239

Coding & Acuity Documentation Analyst Resume Examples & Samples

Performs ongoing analyses of coding and acuity patterns throughout the BIDCO provider network, using claims data and reports from multiple payers
Designs training tools and online resources for the BIDCO provider community with regard to coding and acuity documentation, including Webinar presentations and quarterly email updates/newsletters
Acts as a key contact and liaison between BIDCO and multiple payers related to documentation and coding efforts; facilitates data exchange between BIDCO and payers
Disseminates coding analyses and data such as suspect condition reports to key provider contacts, and receives and aggregates findings and outcomes from practices related to these reports
Establishes criteria by which to monitor trends in coding and acuity by practice and provider, and determines when trends indicate a need for specific practice outreach and focused training
Certificate 1 Certified Professional Coder preferred., and Certificate 2 Certified Risk Adjustment Coder preferred
1-3 years related work experience required
Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases
Prior experience with provider training and education preferred
Knowledge of the process for developing audit samples and analyzing coding trends
Problem Solving:Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents
Independence of Action:Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager
Written Communications:Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers
Oral Communications:Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers
Knowledge:Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations
Team Work:Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments
Customer Service:Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner

240

Coding Education Specialist Resume Examples & Samples

Graduate of an approved Health Information Technology/Management program with credentials of CPC, CPC-P, CCS, CCS-P, or ability to obtain within three months of hire
A health information management professional with at least 5 years of coding experience required. Physician practice coding experience is preferred
Strong knowledge base in complete and accurate clinical documentation in all healthcare settings and for all healthcare disciplines
Strong knowledge base and experience in interpreting and applying federal/government regulations to ensure coding and documentation compliance
Strong knowledge base of the conventions, rules and guidelines for multiple classification and reimbursement systems (i.e. ICD -10, DRGs, APR-DRGs, etc)
Ability to establish rapport with physicians and other healthcare practitioners
Demonstrated knowledge of medical terminology, anatomy and physiology, pharmacology, computers, and encoding software
Demonstrated interpersonal, critical thinking, and time management skills
Demonstrated strengths in communication, teaching and presentation skills; must be detail oriented, possess good problem solving skills, and have legible handwriting
Must be able to successfully pass the Basic Windows Skill Assessment at 80% or higher rating within 30 days of date of hire
Provides appropriately messaged and continuous education and updates to physicians, advanced practice providers (APPs), and practice leadership regarding coding and billing practices to meet regulatory requirements and to capture appropriate revenue. Educates physicians and key healthcare providers regarding clinical documentation improvement and the need for accurate and complete documentation in the health record
As part of the on boarding process, will educate assigned new physicians and APPs on coding needs specific to their specialty
Performs shadowing services for billing providers and administrative staff to gather information and provide constructive input to operations and the billing provider to become more efficient in daily workflow and accuracy in charge selection supported by their clinical documentation. Summarizes and reports findings to manager and other CPG leadership
Partners with Coding, Compliance, and other applicable departments on coding issues while coordinating review of open issues and monitoring until resolved
Communicates compliance and review concerns to manager; helps to develop action plans to address
Attends and prepares content for other department leadership meetings as assigned that will help progress any revenue related issues
Monitors coding resources and payer updates for issues that impact professional billing; report to manager
Develops tools as assigned that will assist providers, practice management, and office staff to meet regulatory requirements and in capturing all appropriate revenue
Analyzes billing and denial information, claim error and other data for potential coding and billing opportunities. Summarizes and reports findings to manager and uses findings in educational trainings
Understands post billing review findings and have the ability to assist in relaying any constructive education for the purpose of improving deficiencies identified in the review
Reviews and analyzes E/M coding and other billing trend profiles to identify patterns that may provide clues requiring focus for further analysis, support and/or education
Reviews encounter forms, coding forms, or billing tool information, at least annually, and recommend changes to codes and encounter form layout as necessary
Supports and participates in the continuous assessment and improvement of the quality of services provided

241

Coding Education Specialist Resume Examples & Samples

Acts as documentation and coding liaison to clinicians to include review, education and necessary follow-up to help ensure that clinical documentation and coding services meet government and organizational policies and procedures
Analyzes and provides education on revenue capture, clinical documentation including Electronic Health Record (EHR) requirements, coding accuracy and denial management to clinicians and clinic staff
Reviews documentation and coding for new providers for accuracy and charge capture as per standard
Responsible for sending coding reports to providers received from coding vendor resources
Communicates directly with providers on coding feedback and chart review findings
Reports areas of risk directly to the Manager – Physician Coding Education
Monitors Medicare and other Payer rules for updates and changes
Uses spreadsheets to log physician performance results and to re-educate on those outstanding issues and trends
Maintains familiarity with such issues as HCFA E/M Documentation Guidelines, HCFA Teaching Physician Documentation Guidelines and the OIG model compliance plans
Attends seminars and workshops, as applicable, for updates on new coding rules and regulations
Participates in decision making concerning departmental policies and procedures
Meets organizations objectives set by leadership
Understands coding trends by billing area, location, and provider for all groups and physicians
Handles in a professional and confidential manner all correspondence, documentation, and files
Supports CSMN’s core values, policies, and procedures
Follows policies and procedures pertinent to the coding and compliance departments

242

Inpatient Coding Health Info Supervisor Resume Examples & Samples

Responsible for the successful day to day management and system-wide coordination of the Coding Unit of the Health Information Department
Functions in accordance with CSHS and HID guidelines and budgets with oversight of the Director
As a member of the management team, works with supervisors and staff to develop each unit’s objectives to be consistent with the mission, plans and objectives of the Department and CSHS
Achieves goals related to total quality, productivity, team development, customer service and financial performance

243

Specialist, Coding Rmbrsmnt Resume Examples & Samples

Collaborates with coding and compliance staff in the performance of periodic physician medical record reviews
Reconciles medial record documentation, coding, claims and reimbursement data. Ensures appropriate billing and reimbursement
Collaborates with practice revenue managers to ensure correlation of information on superbills with rendered clinical services
Reviews codes diagnoses and surgical procedures in accordance with established coding and abstracting guidelines (ICD-9-CM or ICD-0-CM) as a part of physician medical records review. Makes recommendations for changes and improvements
Utilizes IDX and related modules to obtain, analyze and interpret coding, denial and other reimbursement data to support compliance and practice management activities
High School Diploma or equivalent, required. Knowledge of Health Information Administration or related field, as normally acquired through the completion of a Bachelor's Degree
Credentials in one or more of the following, required

244

Manager ERA Coding Resume Examples & Samples

Optimize Blue Cross’ receipt of earned risk adjusted revenue for all risk adjusted segments (i.e., Medicaid, Medicare, and the Affordable Care Act Commercial segments)
Enable improved accuracy in understanding the illness burden of our membership to better manage their risk, care, and health
This position leads a team to review patient records to capture and code for accurate risk adjustment revenue, conducts audits of provider and vendor records to ensure accuracy and completeness, and ensure operational readiness for government audits of our risk adjustment practices. The incumbent will manage employees, including skill and career development, policy administration, discipline, employee relations, goal setting, and performance reviews
Lead a team responsible for all quality assurance, provider, vendor, and government audit functions to support enterprise risk adjustment optimization across Medicare, Medicaid, and Exchange populations in the following areas
Perform all administrative duties related to the planning, scheduling, and conducting audits and maintaining records associated with audits of medical records for risk adjustment reporting
Review patient records in accordance to published standards to analyze provider documentation to ensure that it meets standards and supports the diagnosis and procedure codes selected,
Conduct audits on abstracted files to ensure accuracy and completeness of coding by identifying accurate coding opportunities and rechecking all diagnoses and procedures using ICD-CM (ICD-9 and ICD-10) and CPT-4 codes, and mapping to relevant HCC and/or CDPS categories
Prepare and implement necessary internal controls for related entities consistent with CMS and State requirements to support RADV or other regulatory audits
Manage vendor and provider audits with regard to risk adjustment and prepare a summary of findings to leadership
Prepare reports for the Regional Provider Coach team to address provider specific opportunities for improvement based on audit findings
Perform quality assurance reviews of audit findings and provide guidance on medical record review issues
Conduct periodic risk adjustment workgroups, especially when changes have been made to the risk adjustment models(s), CMS and other regulatory guidance, coding guidelines, etc
Develop implement, and/or maintain documentation and chart reviews consistent with CMS and other governmental regulations, company goals and policies
Oversee chart abstraction projects and other chart audit activities as appropriate
Manages the ERA Audit team, including building a successful team, developing strategic partnerships
Working with the Director, develop the audit policies and procedures to accomplish the measurement objectives established by BCBSA, FEP Directors Office, contractual arrangements and BCBSM leadership. Manages audit work in accordance with accepted industry practices, and contractual and licensure agreements
Prepares and reviews audit reports; reaches concurrence with respect to facts and needed actions; advise management of findings; collaborates with business areas to prepare responses and define solutions for items needing action
Directs the team, including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations, and cost control

245

Medical Billing & Coding Team Lead Resume Examples & Samples

Supervises medical bill review workflow process and ensures compliance with internal policy and procedures
Supervises a team of MBR Analyst
Assigns daily tasks and provides direction to MBR Analyst
Ensures accurate and timely adjudication of medical bills in accordance with jurisdictional and internal policy requirements
Reviews daily production, quality, and status reports and sets daily priorities
Ensure that production quotas within the quality guidelines of the division
Response to provider and customer inquiries in a timely manner
Communicate to management any workflow problems, issues or backlog immediately
Consistently achieve or exceed established performance and results standards for the essential functions and responsibilities of the position
Perform all aspects of the job in an accurate and highly motivated fashion
Prioritize and organize assigned work
Continually foster a teamwork spirit
Maintain a neat working environment
Pursue personal and professional development
Assist with special projects and assignments as necessary
Maintain a professional image of the company, including professional appearance and attitude
Maintain a good rapport with internal and external customers
Possess excellent organizational skills
Possess good customer service skills
Desire for growth
Must have good medical terminology knowledge
Must be able to type a minimum of 50 WPM
Familiar with windows based programs
Minimum 2 years MBR experience in the workers compensation industry
Post-secondary education in medical billing and/or AMA Certified Coder designation preferred

246

CPB Client Support Services Tax Coding Team Lead Resume Examples & Samples

Responsible for the set-up, maintenance, review and reporting on approximately 30,000 cusips on the Private Bank platforms
Compile and process manual daily pricing files of non-automated vendor supplied pricing into Citi’s platform
Conduct regular quality checks, review data discrepancies and resolve issues for pricing rejects, price changes, etc
Compile and track issues with third party data service providers and participate in regularly schedules calls
Ensure all maker checker processes are followed and properly evidenced
Responsible for all Metrics and MCA reporting as required

247

Manager Risk Adjustment Coding & Quality Assurance Resume Examples & Samples

Developing and overseeing the timely completion of annual physical, and ad-hoc chart reviews
Tracking and effectively summarizing chart review findings
Completing annual HEDIS chart review and maintain policies and procedures related to HEDIS chart review
Developing training programs/materials to educate and update physicians and business owners on coding guidelines, CMS regulations, chart review findings and coding improvements

248

Hcs Manager Outpatient Coding Health Information Management Resume Examples & Samples

Previous coding/coding operations experience required
Extensive coding, documentation, and billing compliance (MS-DRGs/IPPS, APC/OPPS) experience preferred
Ability to effectively manage projects, plan and implement programs, and evaluate outcomes
Ability to effectively manage and direct various levels of staff (including on-site and remote) as well as manage vendor relationships and expectations
Ability to interpret federal and state regulations as they relate to coding and compliance

249

Adjunct Faculty Medical Billing & Coding Resume Examples & Samples

Possesses an earned associate degree from a regionally accredited institution, and
Has a minimum of one year of related work experience, and
Holds a professional certification in at least one of the following
Certified Professional Coder (CPC), or
Certified Coding Specialist (CCS), or
Certified Medical Assistant (CMA (AAMA)), or
Registered Medical Assistant (RMA) or
Registered Health Information Technologist (RHIT), or
Registered Health Information Administrator (RHIA), or
Certified Billing and Coding Specialist (CBCS)

250

Manager, HIM Coding Resume Examples & Samples

Manages the daily operations of the HIM Coding Program
Hires personnel, conducts performance evaluations, counsels employees in performance improvement, conflict resolution, disciplinary action, and coordination of resources for adequate coverage
Develops and deploys functional coding polcies and procedures to ensure standardization, compliance, customer service and other metrics are achieved
Establishes and achieves functional outcomes for Key Performance Indicators (KPIs), including unbilled accounts receivables and case mix index
Develops and deploys coding training and education programs for staff. Ensures development plans are in place for each employee and updated on a regular basis
Administers software systems and tools utilized by the team and serves as functional project manager for all system upgrades
Plays a key role in denials management involving HIM related issues
Skills: Acute care inpatient and outpatient coding; Knowledge of revenue cycle, reimbursement systems and regulatory/legal/compliance; Effective communication and presentation skills
Years of Experience: 3-5 years of management experience
Education: Bachelor’s degree in health information management or related field (or completion within six (6) months)
Skills: Proficiency with spreadsheets, databases, coding/CDI, reimbursement and EHR Systems
Years of Experience: 5-8 years of management experience
Certification: RHIA or RHIT strongly preferred. CCS

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