Review of clinical reports for US military veteran patients to ensure proper ICD-10-CM diagnosis, CPT, and/or ICD-10-PCS procedural coding for VERA review and payment. Skilled in outpatient, laboratory, radiological coding. Currently training and working inpatient coding for AAPC-CIC certification.

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Medical Management Processor; Military and Veterans Branch - TRICARE account work. Administrative intake and case building based on incoming referrals and clinical data. Verification of provider/facility selection. Assignment of DRG, ICD-9, and/or CPT codes as case requires. Ensure proper tasking to clinical teams.Clinical Administration Coordinator; Employer and Individual - Primary duties working Affordable Care Act account. Initial triage and administrative intake of members, managing the admission/discharge information, working with hospitals and the clinical team. Data entry and scrub of clinical data for nurse review. Performs data inquiries and qualitative and quantitative review of patient records. Review and report of action required cases, making appropriate adjustments such as verification of in-network/out-of-network status to patient accounts, proper selection of provider. Verify correct ICD-9 and CPT codes. Ensure 48 hour turn-around-time for clinical review. 99% compliance rate. Knowledgeable in state and federal timely filing restrictions. Ensure office practices are in compliance with HIPAA regulations.High-Dollar Claims/Contract Pricing; Cost Containment Unit. - Responsible for evaluation and contract pricing of inpatient facility and surgeon claims in excess of $10,000. Negotiated pricing for non-contracted, rehabilitation and home health care. Scrubbed incoming UB-92/UB-04 facility claims and HCFA-1500 surgeon claims to ensure proper billing. Provided customer service on claim and pricing status.