Bryan Cruz Email and Phone Number

OUTPATIENT QUALITY AUDITOR - AMBULATORY SURGERY/SDS, ED/TRAUMA, AND OBSERVATION• Extensive background in Outpatient Ambulatory Surgeries/Same Day Surgeries including but not limited to Orthopedic, Breast, Maxillofacial, Integumentary, Cranial/Skull/Spine, Digestive surgeries. • Extensive background in Trauma Encounters with emergency procedures coding including but not limited to CPR, arterial line placement, intraosseous line placement, central venous line placement, chest thoracostomy/thoracotomy procedures, cardiac massage, IP CPT procedures with CA modifier.• Knowledgeable on IP only CPTs appropriate reporting.• Ensure and Validate CPT charges entered in 3M/OPTUM CAC are correct.• Identify missing ICD-10 for medical necessity edits.• Identify/correct any edits ICD or CPT triggered by the system.• Identify missing CPT charges that are rendered during the visit and were supported by the documentation.• Document any missing or incorrect charges/codes reported by the coder.• Ensure all audits are entered/uploaded in the auditor’s spreadsheet clearly and in a timely manner.• Provide feedback/education to coders from audit results that are based on guidelines and coding references.• Provide training to newly hired consultant/auditor in facility specific process, workflow, and systems.• Ensure to provide client excellent customer service.• Assists in backlog, training and other areas needing support.

OUTPATIENT SENIOR QUALITY AUDITOR - AMBULATORY SURGERY/SDS, INTERVENTIONAL RADIOLOGY, OBSERVATION, BEHAVIORAL HEALTH, ANCILLARY• Extensive background in Outpatient Ambulatory Surgeries/Same Day Surgeries and Interventional Radiology including but not limited to Orthopedic, Breast, Maxillofacial, Integumentary, Cranial/Skull/Spine, Digestive surgeries, Selective/non-selective catheterization (e.g cardiac), Pacemaker/AICD placement, Arrythmia Ablation procedures.• Ensure and Validate CPT charges entered in 3M/OPTUM CAC are correct.• Identify missing ICD-10 for medical necessity edits.• Identify/correct any edits ICD or CPT triggered by the system.• Identify missing CPT charges that are rendered during the visit and were supported by the documentation.• Document any missing or incorrect charges/codes reported by the coder.• Ensure all audits are entered/uploaded in the auditor’s spreadsheet clearly and in a timely manner.• Provide feedback/education to coders from audit results that are based on guidelines and coding references.• Provide training to newly hired consultant/auditor in facility specific process, workflow, and systems.• Ensure to provide client excellent customer service.• Assists in backlog, training and other areas needing support.

INPATIENT MEDICAL CODER•Assigns ICD-10 CM and PCS in inpatient Hospital visits based on guidelines and coding references.•Ensures correct DRG is reported.

•Assigns/reports ICD based on Hierarchical Condition Categories (HCC) - Risk Adjustment.•Assigns/reports ICD, CPT, HCPCS and modifiers in Hospital visits including but not limited to ED, Same Day Surgery.

MEDICAL BILLER/INSURANCE RECEIVABLES REPRESENTATIVE•Responsible for filling out Medical Claim forms (HCFA FORM AND UB04) •Responsible for analyzing denied medical claim forms and applying appropriate and necessary corrections•Verify Patient’s Eligibility for Health Care.•Follow up with Healthcare Insurance for medical bills/claims payment.