Jernie Arquizar

• Fully responsible of the Whole Revenue Cycle Management Process (Registration, Insurance Assignment, Coding, Billing, Claim Generation, Submission and Reconciliation)
•Work in all Hospital facet (Inpatient, Outpatient and Diagnostic Ancillary) both for Facility and Physician based Medical Coding and Billing.
•Denial Management and ERA EOB monitoring and posting.
•Conducting Prospective and Retrospective Audit with Reporting to RCM Manager
•Answering queries regarding Coding from all department of the Hospital.
•Prepares All Office Reports such as Payroll, Petty Cash, Purchase Orders, Visa Application and Cancellation, Licensing and Renewals and all other Administrative documentation and Processes.

• Provide overall Medical Coding Training for Aspirant Coder Professional on ICD 10-CM, HCPCS, CPT, Medical Terminology, Anatomy and Business of Medicine.
• Prepares all Educational Tool and Exams (Quiz, Long Quiz and Mock Exams)
• Closely monitoring each student’s progress on the course.
• Provide Extensive Final Coaching at the end of the course complete with Rationalization and Test taking Strategies.

• Fully responsible of ICD, CPT and E and M assignment with the highest specificity.
• CPT Code Mapping for the facilities services.
• Answer all the coding and billing related question from Physician and other Medical Staff.
• Generation of Claims, Submission and Re-conciliations.
• Answering queries regarding Coding from all department of the Hospital.

● Worked as an Inpatient, Outpatient and Diagnostic Ancillary Medical Coder.
● Abstract relevant information from patient records and Assign ICD-10 to physician’s diagnosis and insure correct level of service and various other CPT codes.
● Evaluated patient records for suitability, completeness, and correctness of health data.
● Process a minimum of minimum of 50 claims per day with at least 95% accuracy.
● Queried Nurses and physicians in case of any ambiguity in patient's chart.
● Generation of Claims and Reconciliations
● Works closely with Cerner Team for the Gaps of Data, CPT Code Mapping and other Coding related issue.
● Provide general assistance to Insurance Department in Pre-approvals
● Submission and Re submissions of Claims.
● Denial Management
● Provide detailed Coding and Billing detail with the Admission and Discharge Department for Outgoing Inpatients.
● Preparing Cost Estimates for Funded patients
● Answering queries regarding Coding from all department of the Hospital.
● Assist my Managers for any Clerical and Administrative works from time to time.

the provider or physician’s diagnosis and the treatment of a patient from a medical record file into codes using a classification system.
•Paying attention to many details to translate records precisely and accurately.
•Prepare and review patient statements
•Maintain strict confidentiality
•Know several different coding systems, including Level 1 HCPCS and Level 2 HCPCS, CPT, ICD 9 and 10.
•Reviewing patient medical records completeness and suitability.
•Strictly adhere to AHA Coding Clinic and Official Guidelines for Coding and Reporting CMS approved guidelines for ICD-10-CM Coding.

● Translates the provider or physician’s diagnosis and the treatment of a patient from a medical record file into codes using a classification system.
● Paying attention to many details to translate records precisely and accurately.
● Prepare and review patient statements
● Maintain strict confidentiality
● Know several different coding systems, including Level 1 HCPCS and Level 2 HCPCS, CPT, ICD 9 and 10.
● Reviewing patient medical records completeness and suitability.
● Strictly adhere to AHA Coding Clinic and Official Guidelines for Coding and Reporting CMS approved guidelines for ICD-10-CM Coding.

for accurately coding patient records for reimbursement.
•Code medical records with ICD-10 and CPT coding
•Reviewed charts for correct details and Information and Completeness of data required.
•Complied with regulations and requirements for coding guidelines and CMS policies.

● Responsible for accurately coding patient records for reimbursement.
● Code medical records with ICD-10 and CPT coding
● Reviewed charts for correct details and Information and Completeness of data required.
● Complied with regulations and requirements for coding guidelines and CMS policies.

Insurance Companies for approval via verbal or E-claim portals as required.
•Responsible in Coding CPT and ICD 9 when applying for Pre-approval thru E-Claim Links and Insurance Portals.
•Provide expert advice on various insurance policies and coverage to external and internal clients.
•Communicate effectively between doctors and Insurance Companies when further information is required.
•Review pending cases and follows up on these to ensure swift resolution.
•Update the Insurance Coordinator about any unusual denials/issues from Insurance Companies and provide recommendations for resolution.
•Assist the insurance Coordinator to manage reconciliation related issues.
•Establish and maintain the approval files for easy access for the Dispatch and Re-submission team.

● Contact Insurance Companies for approval via verbal or E-claim portals as required.
● Responsible in Coding CPT and ICD 9 when applying for Pre-approval thru E-Claim Links and Insurance Portals.
● Provide expert advice on various insurance policies and coverage to external and internal clients.
● Communicate effectively between doctors and Insurance Companies when further information is required.
● Review pending cases and follows up on these to ensure swift resolution.
● Update the Insurance Coordinator about any unusual denials/issues from Insurance Companies and provide recommendations for resolution.
● Assist the insurance Coordinator to manage reconciliation related issues.
● Establish and maintain the approval files for easy access for the Dispatch and Re-submission team.