Coding Analyst Resume Samples

Description :

1. Identified data elements reflecting insurance industry practices and governmental rules and regulations.
2. Analyzed and identified any physician business office updates to the service codes through a review of insurance correspondence and changes to the guidelines.
3. Coordinated with the physician billing office coding and compliance Manager, business departments, and clinical departments on coding and billing updates.
4. Supported and participated in the review of charging and coding issues with the business office departments and clinics.
5. Synchronized coding standards and was responsible for such functions that span all physicians billing in Oregon.
6. Added ICD and CPT codes based on provider documentation.
7. Verified treatment performed and the correct code used for the procedure.
8. Verified the ICD entered met medical necessity for the CPT code.

Experience

7-10 Years

Level

Management

Education

Bachelor's in CS

Description :

1. Practiced Multi-Specialty Network Claim scrubber rejections pertaining to coding worked to its entirety.
2. Provided training to new coding staff that comes on board to the Physician Coding and Compliance Dept.
3. Responsible for E/M coding for Palliative Care and Infectious Disease.
4. Researched specific coding guidelines for specific specialties and insurance carriers.
5. Provided Education coding to charge entry staff at quarterly A/R meetings held at physician offices.
6. Responsible for physician audits E/M documentation audits utilizing the 95 auditing tool.
7. Documented audits on surgical procedures.

Experience

0-2 Years

Level

Entry Level

Education

ICD

Description :

1. Performed audit review on charges during the practices go live with new EMR system.
2. Reviewed office notes templates to ensure compliance and give the office and physicians suggestions and feedback on the notes reviewed.
3. Provided coding education usually by group meetings and results are presented to the practice.
4. Pulled 10 random charts and performed audit regarding the charges matching the documentation.
5. Maintained constant communication with practices and providers during the transition into the new software and provide feedback on the documentation.
6. Provided tools to the offices to ensure compliance is met by their documentation.
7. Kept on up to date on new rules/guidelines regarding the surgical practices that are assigned.

Experience

0-2 Years

Level

Entry Level

Education

Bachelor's in CSE

Description :

1. Selected, assigned and audited diagnostic and procedures codes to patient records for a 166-bed acute-care hospital.
2. Worked collaboratively with patient financial services to ensure accurate billing and resolve claim denials and medical necessity issues.
3. Reviewed medical documentation and consult with healthcare providers when documentation is inadequate or unclear for coding purposes.
4. Maximized reimbursement by ensuring accurate ICD-9-CM and CPT coding.
5. Increased hospital reimbursement by $500,000 through an intense physician query process.
6. Worked closely with Administrative Consultant Service, LLC during inpatient and outpatient Medicare coding audits.
7. Rapidly mastered Meditech and 3M clinical encoder software for fast, accurate coding and abstracting.
8. Provided ongoing training to new coding staff on intricacies of inpatient and outpatient coding.
9. Provided coding training to case management staff for the implementation of the clinical documentation improvement program.

Experience

2-5 Years

Level

Junior

Education

Bachelor's in CSE

Description :

1. Responsible for reconciling DataRAP payment reports, processing payments and reports for participating providers, report deficiencies and recommend solutions, team with IT to resolve deficiencies.
2. Responsible for producing various monthly reports and may provide documentation feedback to physicians under the direction of the Coding Operations Manager or Quality Management personnel.
3. Processed attestation sheets and progress notes out of the RightFax work queue according to DataRAP department guidelines.
4. Analyzed progress notes and documentation sent by providers for validation following CMS guidelines and ICD-9 Coding Manual guidelines and enter final results into the appropriate tab of the DataRAP database.
5. Provided clear communication, with the use of DataRAP application, through query to PCP on documentation not meeting standard of basic administrative components to a progress note.
6. Ensured accuracy of entry by comparing the outcome of diagnoses on attestation post validation entry.
7. Identified and reported quality concerns and errors to DataRAP Clinical Process Quality Analyst for review and education.
8. Responsible for providing coding support to the DataRAP Clinical Coding Nurses and to the providers participating in the DataRAP process.

Experience

0-2 Years

Level

Entry Level

Education

Diploma in CS

Description :

1. Applied ICD.9 diagnostic codes to patient encounters in compliance with applicable state and federal statutes/guidelines and Care Level Management policies and procedures.
2. Provided queries for additional information that may be needed to code encounters correctly according to applicable state and federal statutes/guidelines and CLM policies and procedures.
3. Responsible for Risk Adjustment Coding Know and adhere to HIPAA regulations.
4. Recognized, interpreted and evaluated inconsistencies, discrepancies and inaccuracies in the medical data received and appropriately alert and/or query the responsible party and supervisor.
5. Recognized data that is inadequate for coding purposes or in violation of coding guidelines and flag these encounters requiring additional clarification to the attention of the supervisor or physician.
6. Utilized reference material such as ICD.9 Official Guideline, medical dictionary, Coder's Desk Reference, Coding Clinic, and NCCI edits.
7. Maintained up to date knowledge of current coding guidelines and annual updates and changes.
8. Met quality and productivity standards and deadlines/turnaround times established by CLM.

Experience

7-10 Years

Level

Management

Education

Medical Coding Specialist

Description :

1. Abstracted data from the electronic medical records to assign appropriate ICD-9CM and CPT codes.
2. Coded all major and minor surgical cases performed both in the office and hospital setting.
3. Coded all E/M visits, performed in both the office and hospital setting.
4. Ensured all procedures are coded correctly for timely and accurate reimbursement from all payers.
5. Edited software tools used by various insurance companies.CCI Edits, WebDenis, Mckesson Contract.
6. Reviewed medical records and appended the correct ICD-9-CM codes.
7. Reviewed co-workers ICD-9-CM codes to ensure documentation supports assigned code.
8. Managed workload for each clinic and assigned to specific coders.

Experience

5-7 Years

Level

Executive

Education

Associate Coding Specialist

Description :

1. Received assigned medical charts to code both electronically and paper form Review medical charts electronically using a computer.
2. Abstracted and coded diagnosis and documentation information Research and resolution of coding projects as assigned.
3. Documented requested information from the medical record via Meditech.
4. Determined valid encounters including legibility and valid signature requirements query physicians are missing/illegible.
5. Identified valid face to face encounters. Performed ongoing analysis of medical record charts for the appropriate coding compliance.
6. Requested medical charts from clinics to review.
7. Coded and reviewed charts from multiple specialties.

Experience

5-7 Years

Level

Executive

Education

Medical Coding

Description :

1. Experienced with FP clinic coding as well as SDS coding of Gen Surg, Ortho, ENT and a variety of other Specialties.
2. Assigned to Pro-fee OB/GYN coding of Clinic, SDS and deliveries.
3. Worked denials and patient complaints.
4. Provided on going education and feedback to providers and other clinic staff as needed.
5. Responsible for all coding for over 30 different physicians.
6. Specialized in five different areas of specialty.
7. Delivered and utilized CPT, ICD-9, HCSPCS, 3m encoder and all channels thru the AAPC.

Experience

10+ Years

Level

Senior

Education

Coding

Description :

1. Read and interpreted health information documentation to identify all diagnoses and procedures that affect the encounter.
2. Possessed formal training in Anatomy and physiology, medical terminology, pathology and disease processes, health record formats and content, reimbursement methodologies and conventions, rules and guidelines for current classification systems (ICD-9-CM and CPT).
3. Applied knowledge of CPT format, guidelines and notes to locate the correct codes and to sequence properly for services rendered.
4. Applied knowledge of procedural terminology to recognize when an unlisted procedure code is indicated.
5. Coded in accordance with CCI Bundling Guidelines.
6. Used the CMS Common Procedural Coding Systems (HCPCS) where appropriate.
7. Utilized the CMS Medical Policy Center website to make sure medical necessity and comprehensive coding edits are meeting Medical guidelines .

Experience

5-7 Years

Level

Executive

Education

Certified Professional Coder