Medical Coding Specialist Resume Sample
Alberto Lehner
60668 Helga Lodge,
Houston,
TX
+1 (555) 888 1435
Work Experience
Medical Coding Specialist
11/2017
-
PRESENT
New York, NY
- Codes, abstracts and analyzes inpatient and/or outpatient medical records using International Classification of Diseases, Tenth Revision (ICD-10). Always coding to the highest level of specificity
- Identifies coding error (e.g., incorrect primary diagnosis, MCC’s, CC’s, and procedure codes) and recommends correct coding of medical claims
- Receives and reviews patient assessments for assigned care centers
- Reviews Diagnosis Coding patient status items compared to other related patient documentation to verify completeness and accuracy
- Identifies needs for additional supportive documentation/information and communicates needs to care center leadership and Supervisor
- Communicates any delays in processing assessments to Supervisor and care center
- Interprets and completes: Medical center patient records for evaluation and management codes, procedures, ancillary services and nursing home services from documentation to include: assignment of CPT, ICD-CM and HCPCS codes and modifiers, and ensure AMA/CMS/OIG coding compliance
- Interprets and completes medical patient records for evaluation and management codes, procedures, ancillary services and nursing home services from documentation to include: assignment of CPT, ICD-CM and HCPCS codes and modifiers, and ensure compliance with policies/regulations
- Analyzes audit requests specific to coding issues by abstracting the patient chart information and following appropriate AMA, CMS, and coding guidelines. Compile and summarize the results. Forward the results to the Coding Supervisor
Senior Medical Coding Specialist
08/2010
-
07/2017
Philadelphia, PA
- Determines the appropriateness of the coding, contact the physician/ NPP when necessary for clarification or educational purposes
- Audits or reviews medical records as part of a random or focused audit, at the request of the administrator or manager, and as part of the shadowing program offered by the Coding Department. Reviews medical records to determine the appropriateness of coding and potential patterns of abuse. Includes working with appropriate parties to resolve the issue(s)
- Reviews physician compensation reports for proper coding when requested
- Supports staff through daily interactions to problem solve and trouble shoot coding issues with the authority to advise and recommend coding solutions and change codes according to documentation and coding guidelines
- Assists providers / NPP through coding orientation sessions. Assists other departments with review of physician/ NPP services and documentation, coding education and other needed assistance
- Supports staff by acting as a coding resource to answer questions and educate on coding matters
- Responds to requests in a timely, efficient and friendly manner
- Four years coding experience
Certified Inpatient Medical Coding Specialist
06/2006
-
07/2010
New York, NY
- Registered Health Information Technician graduate, or 4-year Registered Health Information Administrator graduate, or completion of a Coding Specialist Certificate program
- CCS certificate and/or CPC Certificate and/or RHIT/RHIA
- Registered Health Information Technician graduate, or 4-year Registered Health Information Administrator graduate, or completion of a Coding Specialist Certificate program and/or CCA certificate pass the CCS exam or CPC exam/Accreditation within 2-3 years of course completion
- Demonstrate commitment to the Company’s core values
- Customer/ Client focus
- 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’ Billing Office as necessary
- Recommends new approaches, policies, and procedures to influence continuous improvements in department’s efficiency and services performed
- Performs ongoing prospective coding and documentation chart reviews for physician services to ensure that the coding supports the services billed\. Identifies issues and patterns related to coding\
Education
Grand Valley State University
2000 - 2005
School's Degree in Health Information Management
Professional Skills
- + Strong critical thinking and problem solving skills with proven ability to apply creative approaches to complicated questions\
- Experience in general computer skills and knowledge
- Leadership skills to develop team concepts and consensus-building management styles
- Prior training experience with clinicians
- Apply analytic skills to develop and prepare reports as requested
- Data analysis and quality assurance skills
- Professional Coding experience either in a Hospital or Physician setting
How to write Medical Coding Specialist Resume
Medical Coding Specialist role is responsible for training, basic, database, auditing, compensation, coding, oncology, analysis, reporting, research.
To write great resume for medical coding specialist job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Medical Coding Specialist Resume
The section contact information is important in your medical coding specialist resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Medical Coding Specialist Resume
The section work experience is an essential part of your medical coding specialist resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous medical coding specialist responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular medical coding specialist position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Medical Coding Specialist resume experience can include:
- Develop and maintain effective relationships and provide outstanding customer service internally and externally
- + Demonstrated proficiency in Microsoft Office Suite, including Word, Excel and PowerPoint\
- Demonstrated proficiency in Microsoft Office Suite, including Word, Excel and PowerPoint
- Experience with CPT and ICD-9 coding
- One (1+) year Home Health ICD-10 coding experience
- Experience in ICD-9/10 medical coding
Education on a Medical Coding Specialist Resume
Make sure to make education a priority on your medical coding specialist resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your medical coding specialist experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Medical Coding Specialist Resume
When listing skills on your medical coding specialist resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical medical coding specialist skills:
- Adapt to and work effectively in a fast paced and changing environment with multiple priorities
- Basic keyboarding, word processing and data entry skills
- Interacts and communicates effectively with other departmental personnel (i.e., medical staff)
- Data entry and medical coding experience- Knowledge and understanding of current procedural and diagnostic coding systems
- ICD10 training and/or Dual/Double coding experience
- Coding experience
List of Typical Experience For a Medical Coding Specialist Resume
1
Experience For Senior Medical Coding Specialist Resume
- Prior oncology or Transplant coding
- EPIC HB, 3M encoder ORCA and mindscape experience
- + Participates in annual and on\-going mandatory compliance training\. Fulfills Continuing Education Units necessary to maintain certification status\
- Assign and enter accurate diagnostic codes into the clinical documentation system ensuring consistency when applying policies and procedures of documentation
- Remain current on relevant coding guidelines and maintain coding certification
2
Experience For Medical Coding Specialist Program Resume
- + Participates in internal and external audits of billing operations and activities\
- + Enters charges into the practice management billing system, ensuring to meet productivity and quality\-based departmental benchmarks\. Performs charge entry batch quality assurance\
- Maintains 95% coding accuracy while meeting department's productivity standards (Coding Productivity of 60 HAR accounts per day)
- Works in coordination with other members of the Physicians’ Practice and/or Billing Office as necessary
- Research procedural and diagnostic coding system and ensure that current codes are applied
3
Experience For Certified Inpatient Medical Coding Specialist Resume
- Identify and report conflicting, ambiguous or nonspecific information to manager
- Knowledge and understanding of anatomy, physiology, clinical disease processes, and pharmacology
- E & M, Surgical and Infusion coding
- Participate in staff discussions and provides valuable input to the team
- Serve as first point of contact for intake inquiries for programs
4
Experience For DRG Medical Coding Specialist Resume
- Follow guidelines for follow-up to ensure accurate and timely response to all referrals and to maximize enrollments
- Enter and update referral, case notes, demographic, and financial information into the EHR database
- Evaluate processes and procedures for continuous process improvement
- Knowledge of Medicaid/Medicare/Commercial
- Certified Coding Specialist designation (CCS), Certified Coding Assistant /Apprentice/ Associate (CCA) issued by the American Health Information Management Association; or, Certified Professional Coder (CPC) or Certified Professional Coder Apprentice (CPC-A)
- CPC Certification required
- LI - MW1
List of Typical Skills For a Medical Coding Specialist Resume
1
Skills For Senior Medical Coding Specialist Resume
- Abide by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis
- Efficiently operate computer software for Electronic Health Record and Practice Management Systems
- Experience with Microsoft Office products also required
- Combination of education and experience from which comparable knowledge and abilities can be acquired
- Working knowledge of medical billing and coding utilizing CPT, ICD-10 and HCPCS
- Working knowledge of CMS Official Guidelines for Coding and Reporting
- Working knowledge of MUEs, LCDs, and other coding resources from CMS
2
Skills For Medical Coding Specialist Program Resume
- Working knowledge of CMS risk adjustment model
- Working knowledge of insurance plans, LCD/NCD’s
- Keep abreast of coding guidelines and reimbursement reporting requirements. Bring identified concerns to supervisor or department manager for resolution
- Intermediate Other Working knowledge of CMS Official Guidelines for Coding and Reporting
- Participates in annual and on-going mandatory compliance training. Fulfills Continuing Education Units necessary to maintain certification status
- Firm understanding of basic medical billing process
- Knowledge of professional claim billing requirements including HCFA1500s, CPT codes and ICD-9/ICD-10 diagnoses codes
- Prepare claims for medical director review by completing worksheets and attaching all pertinent medical information
3
Skills For Certified Inpatient Medical Coding Specialist Resume
- Conducts on-going review monitoring and communications to promote and ensure adherence to established protocols and best practices
- Responsible for meeting CareSource and associated department standards for timeliness of review claims while maintaining accuracy of medical decisions
- Work with Clinicians/Physicians if code assignments are not straightforward or documentation in the record is inadequate or unclear for coding purposes
- Knowledge of CMS documentation and billing regulations
- Analyze system edits to evaluate appropriateness of coding and apply appropriate third party payer rules
4
Skills For DRG Medical Coding Specialist Resume
- Extensive knowledge of CPT, ICD-10 trained, HCPCS coding,
- NCCI edits and modifier application (National Coding
- Knowledge of medical records coding procedures
- One of the following licenses: RHIA, RHIT, CCS, CPC, COC, CCS-P
- Current certified coder (CCS, CCS-P or CPC) and/or current nursing certification and/or Registered Health Information Technician (RHIA/RHIT)
- Knowledge of diagnosis codes, and CPT coding guidelines; medical terminology; anatomy and physiology; and Medicare/Medicaid/Commercial reimbursement guidelines
- Generate reports & identify trends in coding
5
Skills For HIM, Medical Coding Specialist Resume
- Broad understanding of business considerations and functionality
- Complete appropriate paperwork and documentation regarding claim/encounter diagnosis information
- Perform analysis from the chart reviews for provider education training
- Work with other members of the organization to ensure the smooth processing of the chart review functions
- Assist in the development of educational materials. Provide articles for the quarterly coding newsletter
- CCS, RHIT, RHIA, IDC-10
- Certified Inpatient Coder - Hospital (CIC)
- Certified Medical Coder (CPC, RHIT or RHIA) is required
- Abstract important information from patient records and assign/review medical codes for accuracy
6
Skills For Senior Certified Inpatient Medical Coding Specialist Resume
- + Conducts job related activities in a highly confidential manner and in accordance with the Health Insurance Portability and Accountability Act \(HIPAA\)\
- + Certified coder \(CPC, CCS\-P\)
- Follow office practices and procedures
- Conducts job related activities in a highly confidential manner and in accordance with the Health Insurance Portability and Accountability Act (HIPAA)
- Certified coder (CPC, CCS-P)
- Certified Professional Coder is required
- Some travel as required, about 10%, not overnight
7
Skills For Medical Coding Specialist Resume
- Completion of a course in medical record technology
- Work with clinical professionals
- Medical records and EMR/EHR knowledge
- Intermediate level of Facets, Microsoft Word, Excel, PowerPoint and Access
- Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association; or, Certified Professional Coder (CPC) issued by the American Association of Professional Coders
- + Submits queries to physicians, as appropriate, for documentation clarification\
8
Skills For Senior Medical Coding Specialist Resume
- + Reviews and resolves charge router and charge review edits, as needed\
- + Keeps informed of changes in policy within the field\
- + Stays abreast with compliance on federal, state health care laws, regulations and rules\. Reports any differentiation from institutional or departmental procedures\
- + Selects and assigns the appropriate ICD\-10, CPT and HCPCS codes, based on chart review documentation\. Identifies issues and patterns related to coding\
- Assist with, create or enhance internal claim and review recommendations.. Communicate with co-workers and management regarding clinical and reimbursement findings
- Review high volume of medical records to determine if specific disease conditions were overlooked in billing
- Adhere to all official coding rules and CMS guidelines for risk adjustment reporting and ensure accuracy, completeness, specificity and appropriateness of diagnosis information
- Performs ongoing prospective coding and documentation chart reviews for physician services to ensure that the coding supports the services billed. Identifies issues and patterns related to coding
- Participates in internal and external audits of billing operations and activities
9
Skills For Medical Coding Specialist Program Resume
- Enters charges into the practice management billing system, ensuring to meet productivity and quality-based departmental benchmarks. Performs charge entry batch quality assurance
- Selects and assigns the appropriate ICD-10, CPT and HCPCS codes, based on chart review documentation. Identifies issues and patterns related to coding
- Submits queries to physicians, as appropriate, for documentation clarification
- Reviews and resolves charge router and charge review edits, as needed
- Keeps informed of changes in policy within the field
- Stays abreast with compliance on federal, state health care laws, regulations and rules. Reports any differentiation from institutional or departmental procedures
- Responsible for reviewing and evaluating as a secondary-level review and decision maker on medical record documentation for claims and/or appeals to ensure diagnostic and procedural codes accurately reflect and support the visit as it relates to correct coding guidelines and medical necessity
- Maintain incoming pended claims, electronic inquiries and medical records work queue as a secondary-level review and decision maker
- Read and interpret medical procedures and terminology by reviewing medical notes
10
Skills For Certified Inpatient Medical Coding Specialist Resume
- Collaborate with leadership to communicate opportunities based on industry standard coding practices
- Assist in the analysis and development of claims test case scenarios and test plans to ensure industry standard coding practices are implemented
- Maintain an understanding of Federal and State Regulatory requirements, i.e. CMS, ODJFS & MDCH
- Analyze and make a determination of appropriate reimbursement for unlisted and by report codes submitted on claims
- Leverage an automated workflow system to track/monitor/report on progress and issues/blockers
- Abstracts relevant clinical and demographic information from the medical record to assign ICD-10 and CPT-4 codes in accordance with coding and reimbursement guidelines
- Understand and apply correct coding, regulatory and compliance guidelines, APCs, ICD10, CPT, E&M, procedure codes and modifiers, and applies documentation guidelines
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