Description :

1. Conducted routine audits of posted charges for all Florida Hospital campuses on a monthly basis.
2. Determined whether services ordered by physicians and rendered to patients were accurately billed and supported by documentation according to ICD9, CPT codes, and HIPPA regulations.
3. Prepared reports with findings and facilitated recommendations to improve procedures and enhance revenue.
4. Determined that accounting, operating policies and procedures, and regulatory requirements were being followed.
5. Provided acute care for psychiatric patients with a broad range of psychiatric and medical disorders.
6. Oversaw up to 7 staff and coordinated duties.
7. Pre-certified patients with insurance companies.

Experience

10+ Years

Level

Senior

Education

Associate In Nursing

Description :

1. Reviewed medical charts to check for correct documentation, charges.
2. Worked with staff to correct errors.
3. Found missing procedure charges.
4. Worked closely with the Revenue and Reimbursement Department to find charges.
5. Helped teach staff to be more careful with correct documentation.
6. Worked in the health care field to determine that information coding systems and organization techniques are accurate.
7. Conferred with company officials about financial and regulatory matters.

Experience

2-5 Years

Level

Junior

Education

Medical Coding And Insurance Billing

Description :

1. Audited medical record documentation to identify undercoated and upcoded services.
2. Researched, analyzed, and responded to inquiries regarding compliance, inappropriate coding, denials, and billable services.
3. Interacted with providers and management to review and/or implement codes and to update charge documents.
4. Ensured strict confidentiality of financial records.
5. Attended coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
6. Performed miscellaneous job-related duties as assigned.
7. Reviewed files and charts in hospitals, clinics, and doctor's offices to make certain the health care facility is complying with standards established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Collect and analyze data to detect deficient controls, duplicated effort, extravagance, fraud, or non-compliance with laws, regulations, and management policies.

Experience

2-5 Years

Level

Junior

Education

BA In International Trade And Finance

Description :

1. Documented resident information obtained from interviews.
2. Responsible for supervising DCSII and DCSII staff, train staff, and audit medication.
3. Authorized drug refills and provided detailed prescription information to pharmacies.
4. Provided behavioral/emotional support and supervision for adolescent girls that have been sexually exploited, physically and mentally abused.
5. Ensured safety and well-being of residents.
6. Researched reimbursement regulations for claim payment compliance reviews and Documentation to support current audit findings.
7. Utilized healthcare experience to perform audit recovery procedures.
8. Identified and validating incorrect claim payments.

Experience

7-10 Years

Level

Management

Education

HS Diploma In Speech And Communication

Description :

1. Took weekly inventory and place a medication order at each of the district's eleven offices.
2. Assisted doctors, physician assistants, and staff members fill prescriptions via PDRx dispensing software.
3. Audited 60+ prescription logs, transaction reports, patient charts, and patient billings on a daily basis.
4. Resolved medication dispensed errors, billing errors, and wrong diagnoses codes for each patient.
5. Trained managers and staff members on the new dispensing software and current hospital protocols.
6. Retrieved patient information in DocStar and ensuring accurate payments have been posted in MicroMD.
7. Reviewed clinical documentation in medical records for charge audits.
8. Audited medical charts against itemized hospital bills.
9. Audited patient accounts to ensure regulatory compliance.

Experience

10+ Years

Level

Senior

Education

BS In Psychology

Description :

1. Reviewed documentation to support billing/charges, make corrections to ensure compliant billing.
2. Utilized coding resources for accurate CPT & HCPC coding associated with charges.
3. Conducted focused audits to monitor billing inconsistencies.
4. Educated nursing staff on audit findings.
5. Collaborated with Billing Office team members regarding Insurance Company and patient complaints.
6. Identified the root cause of Medical Necessity denials of Medicare insurer.
7. Educated department/understands the application of Medicare Coverage determinations to avoid future medical necessity denials.
8. Provided initial and ongoing claims payment training.
9. Audited payment of provider claims for compliance with NRS, NAC, and company policy and prepare audit results.
10. Tracked errors for trends and make necessary adjustments to staff training.

Experience

5-7 Years

Level

Executive

Education

BS In Nursing

Description :

1. Responsible for planning and conducting medical functions and financial chart audits, presenting audit results to employed practices, creating, and overseeing the creation of appropriate audit spreadsheets.
2. Performed internal medical chart audits to assure that billing codes are appropriate and supported by documentation in the patient record, and that all coding/documentation combinations are compliant with Federal and State regulations.
3. Consulted with physicians and physician staff, as needed, on documentation issues, requirements for supervision of resident services, and other regulatory issues as they arise.
4. Reported concludes with recommendations to correct areas of deficiencies including but not limited to departmental educational training sessions.
5. Communicated results and findings.
6. Reviewed medical records for competent care and proper health management by the medical team.
7. Liaisoned between physicians and insurance companies.
8. Reported on a weekly basis, the status of all assignments, pertinent information obtained during the report week, and provide projections for the upcoming week to the Compliance Manager.

Experience

2-5 Years

Level

Junior

Education

Diploma

Description :

1. Audited patient billing charges selected randomly on a daily basis.
2. Completed an audit of patient billing charges required by insurance companies that implies verification of charges accuracy.
3. Quito, Ecuador Medical audit of medical records of clinics in agreement with the Social Insurance IESS Ecuador as well as with Private Insurances.
4. Audited Medical Records for coding analysis and correct documentation according to Peruvian national guidelines.
5. Conducted concurrent inpatient and outpatient audits, performed patient request audits, and corresponds results in a timely manner.
6. Traveled to different nursing facilities for patient audits and would input their information into our computers.
7. Functioned as the technical expert in documentation requirements for correct coder assignments.
8. Responsible for knowledge of all regulatory changes affecting coding assignments and will maintain continuous monitors of Patient Treatment Files (PTF).

Experience

7-10 Years

Level

Management

Education

Associate Of Science In Early Childhood Education

Description :

1. Held progressively responsible positions in nursing in Intensive Care, Dialysis, and Emergency Room environments.
2. Provided recommendations to improve documentation.
3. Corrected errors in billing to comply with insurance.
4. Evaluated medical claims for commercial clients.
5. Evaluated professional coding and billing of acute care claims.
6. Evaluated ICD and CPT codes.
7. Examined and evaluated financial and information systems, recommending controls to ensure system reliability and data integrity.

Experience

2-5 Years

Level

Junior

Education

Business Administration

Description :

1. Performed audits on all medical records contained in health care facilities.
2. Reviewed data to ensure the accuracy of the record as well as assess the quality of patient care.
3. Performed audits of patient medical history in compliance with state law.
4. Ensured quality assurance of medical and pharmaceutical supplies Verified shipment's arrival at hospitals with the correct prescription.
5. Assisted the FDA (Food & Drug Administration) on quality to verify all control substance is handled appropriately.
6. In charged of handling and receiving control products class A to C.
7. Audited all shipments to ensure quality assurance.

Experience

0-2 Years

Level

Entry Level

Education

BS In Business Management

Description :

1. Managed and coordinated organ/tissue donor cases.
2. Interviewed families regarding medical /social history of loved ones.
3. Coordinated arrival/departure of deceased and notify loved ones of recovery completion.
4. Acted as a liaison with hospitals, funeral homes, and families regarding case setup arrangements of donor gifts.
5. Prepared paperwork through researching medical records, gathering information and sending it to processor for final review before physical examination of approval/acceptance of donor gifts and assisting with saving lives through excellence.
6. Saved lives through excellence in organ/tissue donation.
7. Used Professional, empathetic, paying great attention to detail and accuracy, time management, organization, effective, caring.

Experience

2-5 Years

Level

Executive

Education

GED

Description :

1. Assigned diagnostic and procedural codes to patient records using ICD-9-CM and CPT/HCPCS and any other designated coding classification system in accordance with coding and documentation guidelines.
2. Reviewed and analyzed medical records against billed procedures to ensure accuracy of diagnostic and Evaluation and Management codes.
3. Communicated documentation improvement opportunities and coding issues to physicians and appropriate clinical staff by providing onsite visits and teleconferences.
4. Provided detailed summary reports of audit findings and educational materials for reference to physicians and appropriate clinical staff.
5. Provided administrative assistance to practice managers as well as other duties as assigned.
6. Worked independently with a high degree of attention to detail and reliable decision making abilities.
7. Reviewed and audited patients account.

Experience

5-7 Years

Level

Executive

Education

Diploma In Medical Coder/Biller

Description :

1. Responsible for opening and closing the clinic daily.
2. Answered calls and scheduled appointments for counselors.
3. Prepared charts scheduled for appointments for the following day.
4. Prepared all new charts in alphabetical order with names, labels and any pertinent flags such as allergies.
5. Prepared necessary correspondence related to medical records of patients including requesting copies of medical record from outside physicians and making copies of records.
6. Responsible for filing and other duties related to medical clerk.
7. Assist the Medical Records Department with audits and review of medical records In-service with the license nursing staff regarding correct chart documentation Daily reports to the D.O.N.

Experience

5-7 Years

Level

Executive

Education

MS

Description :

1. Reviewed and audited medical records for completeness and accuracy.
2. Maintained all records and data logs Investigated and resolved billing, coding, and medical necessity.
3. Surpassed client and employer expectations by exceeding the daily standard quota.
4. Worked independently and in a team, environment to achieve goals set by management.
5. Audited medical records for required documentation and clinical support; prepare reports and/or roadmaps/packets of findings for the initial response of ADRs.
6. Assisted with all levels of the appeal process, including but not limited to preparation of claims for Redetermination, Reconsideration, and the ALJ.
7. Researched, analyzed, and responded to audit inquiries, including but not limited to claim review as well as medical record review.

Experience

2-5 Years

Level

Executive

Education

Associates In Sciences