Certified Professional Coder/Auditor

PAULA PEARSON

*** *. *** ** ********* Sd, ***** · 605-***-****

advcc0@r.postjobfree.com · ·

OBJECTIVE:

To seek a more challenging career in the field of Health Information Management that will enhance my skills and abilities in an everyday profession.

STRENGTHS:

Diversified background in coding various Outpatient, Emergency Room, E/M physician and specialty clinic charts. As well as having 7 years of risk adjustment coding experience.

EXPERIENCE

AUGUST 2022- CURRENT

AUDITOR & PROVIDER EDUCATOR RISK ADJUSTMENT TEAM LEAD AND PROJECT MANAGER, himagine solutions

I conducted a remote review of charts that have been coded by providers to assess the appropriateness of any code assigned and whether the documentation is sufficient and has enough specificity.

As the provider educator I had to be available via phone call and/or email to answer questions from the providers. I also had to capture the foregoing information from Excel spreadsheets and compile the information in a summative education PowerPoint presentation. I would then educate the providers on any identified trends. I provided case examples illustrating what was reviewed, information on why and how the changes need to be made and made the recommendations on how to improve.

Education sessions were conducted remotely unless otherwise agreed upon by the client and Himagine solutions and would be held every other week with each provider.

I have also been an active project manager and coding team lead for several risk adjustment auditors. While also auditing providers coding.

I worked with a FQHC facility for 1.75 years providing education for providers and my team of coders with me.

I am working pre-visit planning and doing CDI work and prospective hcc coding and finding HCC coding gaps while in EPIC.

SEPTEMBER 2014 – SEPTEMBER 2020

REMOTE RISK ADJUSTMENT MEDICAL CODER/AUDITOR & QUALITY ASSURANCE ANALYST, Cotiviti

Assisted with execution of the daily activities of quality assurance programs. I provided first level quality audits. I was responsible for all coding tasks. I worked with several payors; mainly Aetna. I worked in numerous EMR systems and various other systems within our vendors.

I reviewed and queried and made sure all entries were compliant for submission.

JUNE 2011 – OCTOBER 2013

CLINIC OFFICE MEDICAL CODER Faulkton area medical center

I did physician coding for five providers. I coded their daily visits and submitted them to billing to review and submit to clearing house. I had weekly provider meetings with the providers for clinical documentation improvements. I was available via phone and email to the providers for any questions for documentation improvement. I applied proper E/M levels for office visits, ED visits and swing bed visits. I coded HCPCS and modifiers as well.

SEPTEMBER 2006 – MAY 2011

DATA ENTRY CLERK, MEDICAL BILLING, MEDICAL CODER, AND ACCOUNTS RECEIVABLE, DT-TRAK

I was involved with various roles within this company. I started out as a data entry clerk who entered data from paper charts into the new EMR systems. We were mainly employed for Indian Health Services.

I then went into billing and took over a managing role there to launch a new billing system for several commercial owned offices. Sage was the system I learned and taught to my fellow billers and billed out of for specific clients we had. Exclusively private sectors. I took payments via phone and patient phone calls who had questions with their bills. I worked aged reports and resubmitted claims once denials were corrected.

I was also in a role for A/R and posted payments and took payments via phone and worked aged reports.

I also was a medical coder exclusive for Indian Health Services in ED, OP, an IP encounters.

EDUCATION

CPC CERTIFIED, American academy of professional coders

I have been CPC certified since 2006. I am also certified as a proficient ICD10 coder.

SKILLS

Maintained 95% accuracy

8+ years in HCC coding

12+ years of experience in Physician coding

7+ years in auditing

List one of your strengths

Epic, Sage, Nex Gen, Snowmed, 3M, IHS RPMS

Citrix, Meditech

Proficient Excel Spreadsheets

7 years E/M level experience 95, 97 and now 2021 guidelines

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