HIM Officer/ Medical Coder/ Insurance and Claims Officer
AMERICARE
Total years of experience :17 years, 10 Months
Department Officer - May 2013 to present
• Directs and manages the functions of the Health Information Management Department.
• Implements the Joint Commission International Standards in documentation and data reporting.
• Utilizes different electronic software for data analysis, documentation storage and technical reports
• Responsible for coding assignments for both outpatient and homecare departments
• Performs pre-authorization requests, billing, claims submissions and resubmissions.
• Supervises coding quality audits and prepares performance improvement plans based on the internal and external audit results.
• Collaborates with clinicians and medical staff on coding and documentation guidelines and addresses clinical coding related issues and questions.
• Monitors electronic coding systems to ensure optimal performance and suggests improvements or
changes for a more effective system.
• Reviews, analyzes and abstracts clinical information from patient medical records and documents for diagnostic and procedure codes assignment.
• Ensures accurate coding and sequencing as specified by established coding principles and guidelines, following the clinical coding system.
• Coordinates with case managers, clinicians and patients for referrals and service approvals
• Reviews and confirms assigned codes for resubmissions & denials for re-imbursement needs.
• Queries physicians for clarifications in medical documentation to ensure adequate and clear coding assignment.
Supervisor Assistant - November 2012 to May 2013
• Prepared medical records for the quality assurance and medical audit purposes.
• Developed programs for human resources recruitment and established systems for labor contracting and professional licensing.
• Handled staff scheduling, department finance report and facility equipment procurement.
• Conducts detailed analysis of medical and scientific journals.
• Performs accurate and precise indexing of technical and medical terms from various publication forms
using specified software to enhance search capabilities of the publications in the internet.
• Ensures the online processing of technical and medical terms according to client specifications within a week turnover time.
• Assists senior editors in determining and clarifying issues on article content and analysis.
• Supervises and monitors team performance to increase productivity output and to improve quality score.
• Documents daily records of articles and journals processed with the aid of software applications.
• Gathers information and content research by utilizing electronic media and various internet search
engines.
• Reviews indexing manual content to check for revisions, corrections and modifications of client
guidelines.
• Participates in monthly discussions and provide feedback to further enhance the efficiency of the indexing process
• Responsible for bringing together bodies of information on a specific subject area in a form of text
abstracts.
• Identifies key terms and phrases in scientific and medical journals to provide accurate and permanent
electronic copy.
• Utilizes Microsoft Office applications to organize and store monthly records of articles and journals
indexed.
• Ensures both quantity and quality of output product following client specifications and guidelines.
• Coordinated with the team to achieve and exceed monthly quota.