Christina Fraley, Rhit,Cpc Email and Phone Number

Edit Resolution Team memberOutpatient coding (ER & ANC)ICD/CPT & Modifier coding reviewMedical documentation reviewNCCI edit reviewPost billing denial review Software: 3m360 encoder, SSC, Cerner Power Chart, MPF, As400/HMS, Fluency

Reviewed and processed claimant medical chargesProcessed medical claim request timely and efficiently Reviewed and edited Microsoft Excel reportsMedical documentation reviewSet and managed medical reserves (dollar amounts)Handled claim status enquires and appeals

Processed Request for Proposals (RFP) timelyReviewed and edited medical census for accuracy (MS Excel) Set up RFP accounts for Underwriter and Underwriter Assistants

Submitted SNF documentation for Medicare Part A/B and Medicare Advantage MAC audit review Managed high volume audit request/inventory.Queried assigned inventory to maintain deadline standards Reviewed Clinical Documentation (Nursing notes, MDS assessments, ADL's) to validate RUG levels billedTracked & Trended insurance denials issuesReviewed Patient DocumentationSubmitted Appeals (Technical: reconsideration & re-determination)Performed RUG calculations on accepted down coded claims Software/applications: Esolutions (Maven/Quantum), Rehab Optima, PointClickCare, SSI Claim Suite, & Availity.

Billed multi-state medical claims (claim inquiry & re submission)Handled Patient Accounts (adjustments & write-offs) Reviewed Patient Medical Records (review & release) Handled Patient Disputes (working closely with site manager to resolve matters quickly) Software/Applications: FACS, IBM AS/400, ZirMed, Availity, & One HealthPort.

• Supervised a patient unit with assigned unit team• Prepared patient clinical data• Applied patient crisis intervention techniques• Ensured patient and staff safety

• Audited patient charts to ensure compliance• Prepared and submitted audit findings to department supervisor• Maintained, filed, & purged patient charts to ensure information was current/up-to-date• Processed patient information requests in accordance with HIPAA • Assisted HIM Department Supervisor in preparing the facility for Joint Commission and CARF surveys