VisualCV

Deliver educational career based training to individuals seeking to become Certified Professional Coders. Founded company from ground up; establishing curriculum, course syllabus requirements and student performance measurement protocols. Provide ongoing coding training on a national basis, including documentation requirements, chart auditing, operative note coding, CMS regulations, and claim denial management. Design, implement and manage online learning modules used by distance education students.  Developed metrics for accurate measurement of student progress against course objectives.  Responsible for all maintenance of online course content hosted using Blackboard/Angel Learning Suite; including: content, grading scale, and user access. Organize and administer weekly tutoring and Q&A conference calls and online chat sessions for both classroom and online students.

Identify changes needed to client policies to maintain up-to-date and accurate medical payment policies. Coordinate and partcipate in monthly/quarterly client policy meetings. Review client payment policies for accuracy and make important decisions to ensure the integrity of the client is maintained. Present medical policies for review and acceptance by the client, as well as provide direction to the client to aid in understanding of medical policies. Create value for the clients with ad hoc data analysis, including claims analysis, provider trends and identify aberrant coding. Identify necessary changes to existing library claim edits and identify potential new edits through researching, reviewing and interpreting coding and billing professional journals/industry publications, periodicals, and governmental regulations. Develop client specific edits through reviewing of claims data, targeting problem areas of monetary loss. Perform follow-up with Medical Directors to ensure reviews are completed on a timely basis. Responsible for initiating data analyses and claims analyses for new issue development. Review claims analysis results for identification of potential new issues, areas for provider education, or areas for recoupment of incorrectly paid claims. Provide training material for customer service reps on iHT administered edits. Monitors edit trends for potential logic modification. Coordinate all issues and activities within iHT and between iHT and the client. Address inquiries relating to edits administered by iHT. Considered the 'subject matter expert', within the company internally, as well as externally (client). Attend and involved in Steering Committee meetings and Operational Meetings on a monthly basis. Assist with the Implementation Department to ensure that all edits for new clients are compliant with the state laws, mandates and the client's internal policies (i.e. prior authorization, non-covered procedures, etc.

Responsible for all functions of billing and collections, including EDI claims and reports. Review all operative reports and code procedures accordingly. Provide physician and staff training on compliance and reimbursement issues. Post all surgeries and track procedures on Excel Spreadsheet. Post insurance payments and run fee schedule comparisons. Appeal all denials; up to fair hearing level. Work with other specialties for accurate and profitable coding of co-surgeries/team surgeries. Responsible for credentialing new physicians and offices. Developed all office policies and procedures, as well as maintained the accuracy of the policies. Responsible for building relationships between the physicians and affiliated facilities. Contracted with sleep labs and free-standing radiology departments to increase practice revenue by securing the interpretation of the studies for the physicians. Audited charts and records, as well as financial records to guarantee compliance throughout the practice for all physicians.; Responsible for identifying and tracking denials; organize and gather information necessary to appeal denials; actively appeal all denials; keep current with compliance issues in light of recent HIPAA requirements; assist practices with coding questions/issues; identify trends in denials due to coding and/or non-compliance and assist practice with correcting trend to eliminate such denials; general reports; accounts receivable; customer service duties as needed.

Home-Healthcare (DME supplier) agency serving metro Atlanta; responsible for coordinating
DME orders and delivery between patients and home healthcare nurses; complete all CMN's
(Certificate of Medical Necessity) as required by Medicare; work closely with dietians to
ensure enteral fed patients received equate amount of supplies; bill all claims to
Medicare; handle all follow-up, collections and appeals.