Accomplished Healthcare Auditor and Coding Specialist eager to contribute extensive leadership and analytical talents toward supporting a dynamic employer in optimizing bottom-line performance.
Significant background in medical billing/coding and collections industry, complimented by numerous certifications and credentials. Adept in steering quality assurance efforts with demonstrated proficiency in conducting internal audits, HEDIS quality audits and Medicare/Medicaid audits. Reputation for exceptional team-building, leadership, training and motivational capabilities. Substantial problem solving skills and expertise in managing billing and coding of health care, auto, and workers compensation claims. Excel in strategic planning, driving process improvements, personnel development and management, and client education. Proactively served on several committees such as Managed Care, Compliance, Finance, Health Information Management, and Continuous Quality Improvement.
Applied dynamic organizational skills toward supporting over 900 physicians and staff members, and consistently achieving favorable Medicare and Medicaid probe reviews.
Introduced innovative software to effectively track patients between same specialty groups at two different sites, dramatically fortifying communication between offices for patient insurance information and authorization and out-of-pocket percentage.
Increased accuracy of office/surgical charges by implementing new charge capture technique and screen capabilities to view patient by expected due date.
Built, motivated and led talented and highly qualified team in driving research and retrieval of revenue 60+ days outstanding, pioneering effort from 4 personnel to 25+, and supporting over 100 physicians.
Captured collection rate of more than 90% for entire group.
Introduced collections by specialty as opposed to insurance company, considerably expediting collection results and success level.
Member of AAPC Orthopedic Steering Committee for 2009 national exam.
Administrator, Pediatric Orthopedic Surgical Practice, Orthopedic Specialist of Brevard, P.A., Melbourne, FL, 2006 to Present
Owner, Physician Auditing & Coding Consultant, Physician Professional Services, Melbourne, FL,
2006 to Present
Auditing and Coding Supervisor, Melbourne Internal Medical Associates, Melbourne, FL, 1999 to 2006
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Professional Experience continued
Established and aligned policies and procedures with Officers of the Inspector General Small Group Practice compliance guidelines.
Presented broad-based educational seminars to physicians and staff.
Met with each physician to review and explain individual audit findings, and resourcefully compiled data on each physician s bell curve with comparative numbers to peers.
Educated physicians in methods of improving collection procedures.
Scrutinized code charged by 100+ physicians consisting of 23 different sub-specialties during 1-year period, and created method to uncover charges not collected and/or with higher adjustment.
Conducted in-depth consultations with physicians to review each code and patient account and ensure proper documentation and correct use of modifiers.
Prior background includes role as Durable Medical Equipment and Pharmacy Billing Supervisor for Brownings Pharmacy, Melbourne, FL and Office Billing Associate with Dr. Mujeeb DDS, Melbourne, FL.
American Academy of Professional Coders, Salt Lake City, UT:
Certified Professional Coder: Orthopedic Surgical Coder 2009
Certified Professional Coder: Obstetrics and Gynecology Specialist 2006
Certified Professional Coder: Evaluation Management Services 2006
Certified Professional Coder 2002
American Academy of Professional Coders
American Health Information Manager Association
Association of Certified Fraud Examiners
Hiring Agent Name
I am currently seeking a challenging career opportunity as Healthcare Auditor and am submitting my resume for your review. In advance, thank you for your time and consideration.
I bring to you significant industry experience and credentials, proven talents in conducting healthcare-specific audits, and the flexibility to skillfully handle simultaneous priorities and projects with an unwavering commitment to accuracy, quality assurance, and efficiency. To complement these qualifications, I offer polished analytical, troubleshooting, and critical thinking skills which are paramount in healthcare auditing.
As a proactive contributor to your organization, you will find me to be a self-motivated professional and stellar leader committed to supporting you in achieving your objectives through ingenuity, integrity, and dedication. I am confident that I could be a valuable asset to your company, and look forward to interviewing with you in the near future.
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