Auditor- Clinical Coding & KPI Jawda Data Certification

• Jun 2019 - Present

Case Manager (DRG management) Inpatient UHDDS guidelines

• May 2017 - May 2019

Senior coding Auditor

• Apr 2015 - Apr 2017

Team Lead/Coach

• May 2013 - Apr 2015

Worked for a client Duke University Health system one of the largest and Biggest hospital in the US, over 2500 physicians and mid-level as a potential, Team Leader & Lead Auditor Handling Coding Denials for (E/M, Radiology, Cardiology, Hospital Coding Denials) Roles and Responsibilities, • Client interaction for resolving issues related to coding denials and Billing related information also for various coding updates through Clinical In Service • Team leadership, motivating and supporting the team in proper training & updates for solving coding&Billing related Denials, AR Issues,Providing the knowledge about various insurance and billing guidelines for solving the denials. • Lead the teams in the monthly achievement of deadline targets in completeness, timeliness & accuracy. Managing all personnel actions and staff, generating Key Performance Indicator inventory and Overall Effective Rating for each employee, formulating personnel improvement plan for individuals to achieve goals and develop improvement strategy. Plan and schedule work for coding, abstracting and medical data research to all employees to ensure proper distribution of assignments and adequate manning. Coordinate day to day work process activities for staff in assigned unit. Ensure an effective data collection and processing system by reviewing and analyzing data input, processing and data output activities for denial trends and data reporting. Perform audits to evaluate the quality and timeliness of coding and abstraction charges. Read and interpret LCD, NCD and other payer regulations and guidelines as related to coverage of services. Participate in the Internal Audit Process. Provides the billing knowledge about HCFA1500, UB04, EOB, claim forms. Provides feedback to other areas for education and recommends actions to avoid further denials and coordinate processes for a streamlined, effective and efficient revenue cycle. Show less

Certified Professional Medical coder

• Aug 2011 - Apr 2013

I am audting the Outpatient Medical records(ER,Officevisits,Consultations,Dental records with more accuracy of Quality in ICD& CPT) In patient Medical records, DRG coding, Reviewing the documentation and educate the Doctors to correct the documentation in necessary of coding. I am audting the Outpatient Medical records(ER,Officevisits,Consultations,Dental records with more accuracy of Quality in ICD& CPT) In patient Medical records, DRG coding, Reviewing the documentation and educate the Doctors to correct the documentation in necessary of coding.

Sr Medical coder

• Jan 2011 - Aug 2011

Sr Medical coder, Worked as a auditor for a interesting client in the Evaluation and management,(Office visits, consultations, preventive medicine, using 1997 E/M guidelines, Had a exposure in the HCC coding for a Medicare patients, amazing experience... Sr Medical coder, Worked as a auditor for a interesting client in the Evaluation and management,(Office visits, consultations, preventive medicine, using 1997 E/M guidelines, Had a exposure in the HCC coding for a Medicare patients, amazing experience...

Medical coder

• Jul 2009 - Dec 2010

My playing roles& responsiblities from Ajuba solutions Allogation(allotment) for Team members, Tracking the team hourly towards production,Coding the most Challengeble sites in Evaluation&Management Well expertise in following (Emergency room coding, office visits, consultations, Observation records), Meeting the hourly production of 17 records with 98-100% Accuracy.Radiology coding have an little exposure, Partially act as a Quality auditor Meeting daily production of 270 records per day,Denials management,Additional responsiblities are Clarify the junior coders douts, Assisting a Teamleader whenever the needs action in their absence. Show less