# Telecommuting coding, billing, auditing



## Sunitajain

SUNITA JAIN
______________________________________________________________________________
216 Valley West Court, West Des Moines, Iowa 50265, sjain11@hotmail.com

PROFILE

Professional team player with exceptional analytical and problem-solving skills.  Highly motivated with a passion for continuously improving aspects of the Health Care industry for both patients and providers.  Proficiencies include research, writing and presenting on a variety of health-related topics.  

PROFESSIONAL EXPERIENCE

Wellmark Blue Cross Blue Shield of Iowa			May 1989 - Present

Medical Policy Research Analyst					February 2008 - Present
•	Researched, developed and implemented medical policies for new and emerging technologies
•	Analyzed data provider utilization of services

Redeployment Program						August 2007 â€“ February 2008

•	Networked with leaders from different areas, resulting in successful placement in a new role
•	Utilized the Wellmark Learning Center's online catalog of courses to develop skills
•	Assisted with the implementation of a project within Whole Health Dimensions, focused on writing and testing cases

Medical Review Clinical Analyst					July 2003 â€“ August 2007

•	Performed medical reviews of provider records to discover â€œFailure to Discloseâ€� conditions
•	Explained medical policy and benefit adjudication to internal and external customers
•	Ensured proper payment of medical benefits according to company policies
•	Provided ICD-9 and CPT coding consultation to various departments within Wellmark

Medical Policy Research Analyst					January 1995 â€“ July 2003

•	Researched, developed and implemented medical policies for new and emerging technologies
•	Created articles for provider newsletters to communicate changes in policies
•	Analyzed data for Provider Profiling and provider utilization of services
•	Provided codes to assist with HEDIS reports
•	Researched and responded to providers' claims inquiries

	Health Research Analyst						October 1992 â€“ January 1995

•	Analyzed data for Provider Profiling and provider utilization of services
•	Collected, maintained, analyzed and disseminated provider data to users
•	Advised the Provider Credentialing Committee to assist in the selection of Blue Cross Blue Shield health products
•	Searched and analyzed literature to establish clinical guidelines and lifestyle studies for employer reports

	Systems Analyst, Medicare Part B					October 1991 â€“ October 1992 

•	Analyzed and implemented Healthcare Financing Administration (HCFA) mandates
•	Updated Medicare fee schedules and established pricing
•	Tested to determine inherent reasonableness for durable medical equipment

	Profile Consultant, Medicare Part B				May 1989 â€“ October 1991

•	Ensured that all technical details involved with the development and maintenance of providers' fee schedules for provider reimbursement were completed accurately and in compliance with HCFA guidelines
•	Prepared training material for the Medicare staff
•	Developed educational newsletters for the providers

	Medical Review Coordinator, Des Moines General Hospital Clinics	January 1988 â€“ May 1989

•	Reviewed all charge tickets for proper CPT and ICD-9-CM coding prior to billing
•	Investigated denied claims for resubmission
•	Educated the professional and clerical staff on billing and coding practices

	Medical Records Technician, Iowa Lutheran Hospital		January 1985 â€“ January 1988 

•	Applied CPT and ICD-9-CM coding and on-line abstracting for hospital billing 
•	Reviewed medical records for appropriate DRG assignment

	Medical Assistant, West Des Moines Internal Medicine Clinic	April 1976 â€“ January 1985

•	Conducted laboratory, radiology, ultrasound treatments, phlebotomy, patient history and physical examinations
•	Performed audits and appeals for denied claims
•	Managed billing, book-keeping and accounting


EDUCATION

•	Master of Science, Health Care Administration
Des Moines University, Des Moines, IA

•	Utilization and Evaluation of Health Care Services					          Des Moines University, Des Moines, IA

•	Comprehensive Medical Review Course
St. Barnabas Medical Center, New Jersey

•	Bachelor of Medicine and Bachelor of Surgery (M.B.B.S.)
Rajendra Medical College, Ranchi, India

•	Pre-Medical Certification 
Hindu College, Delhi University, Delhi, India









ACCOMPLISHMENTS

•	Served as an adjunct teacher at Hamilton College, Des Moines, IA			
o	Anatomy and Physiology
o	Health Insurance and HCPCS & ICD-9 coding
•	Served as Treasurer of AAPC (American Academy of Professional Coders) local chapter
•	Received Certified Professional Coder (CPC) accreditation	
•	Achieved Managed Healthcare Professional (MHP) designation
•	Achieved Health Insurance Associate (HIAA) designation
•	Conducted coding workshop for allergists
•	Consulted physicians privately concerning reimbursement and coding
•	Conducted a two-day workshop for physicians and staff on Medicare, Medicaid, Blue Cross Blue Shield and HMO billing, coding and reimbursement guidelines
•	Developed a comprehensive manual for physicians and clinic staff
•	Served as a guest speaker at Des Moines University on ambulatory care and physician reimbursement


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