huguezbrian
Networker
BRIAN C. HUGUEZ, CPC, CPC-H, MBIC
OBJECTIVE
Seeking a per diem, part time, weekend, evening or remote employment as a Medical Coder/Compliance Auditor where I may utilize my eight plus years of healthcare experience and maximize my potentials for growth in the medical field.
EXPERIENCE
01/12-Present St. Joseph Heritage Healthcare-SJH Fullerton, CA
Coder/Physician Educator
Routine compliance audits
HCC Risk adjustment coding, reviews & provider education
Educate physicians on coding & documentation guidelines
Accurately code inpatient, outpatient, intensive care, trauma/general surgeries, transitional care and family practice cases using ICD-9-CM, CPT-4, HCPCS code sets and properly sequence diagnosis/procedures per patient EMR
Ensure coded data accurately reflects service provided, based on documentation, guarding against fraud and abuse
Review, audit, and submit charges from Touchworks to IDX system Resolve billing & coding discrepancies
09/09–12/11 Vantage Oncology, Inc. Manhattan Beach, CA
Patient Account Services Representative-Collector
Accurately code office visits, radiation therapy & medical oncology treatment cases using ICD-9-CM, CPT-4, HCPCS code sets and properly sequence diagnosis/procedures per patient EMR
Review aging reports for all Government, HMO, PPO, CCS, Worker's Compensation and other Commercial insurances carriers
Audit claims prior to submission to insurance carriers
Research & Analysis of delinquent third party payers
Follow up on insurance denials, requests, and notifications
Determine reimbursement problems and resolve billing & collection discrepancies Redeterminations, appeals, peer to peer reviews, refunds, claim inquiries, TAR, CIF, and Administrative Law Judge hearing requests
Adjusting and resubmitting claims: adding modifiers, units, and procedure codes
Manage up to (4) facilities with a an average year to date collected amount of: $5,728,042.00
06/08-09/09 California Hospital Medical Center-CHW Los Angeles, CA 05/05-05/06
Health Information Management Clerk
Charge capture & diagnosis coding for OB/GYN triage patients
Analysis and assembly of in & out patient medical records
MedWrite & EmergiSoft dictation review
Data entry (AS400) system
Assist physicians & other healthcare professionals on accessing medical records
Collect and create patient charts as they are discharged from the hospital PHI release forms, answering phones, and filing
05/06-06/08 California Hospital Medical Center-CHW Los Angeles, CA
Surgery Attendant-Level II Trauma Center
Charge capture & diagnosis coding for Post Anesthesia Care Unit patients
12 Lead EKG's and Blood withdrawals
Set up anesthesia/surgical equipment before and after each procedure
Assist surgical team on positioning patient prior to procedure
Check patients glucose and temperature after surgery
Pick up and transfer specimen, PRBC, Platelets, and Thawed FFP's for surgical patients Inform patient's relatives on status, length of stay and bed assignment
Respond to patient's needs from neonatal to convalescent
EDUCATION
2009 United Education Institute-College Huntington Park, CA Medical Billing & Insurance Coding Certified
2003 Youth Opportunities High School Los Angeles, CA High School Diploma
SKILLS • Excellent ICD-9-CM, CPT-4, and HCPCS Level II Coding skills • Excellent Coding, Billing, Collection, and Reimbursement skills • MS-DRG, OPPS, DOFR & HIPAA Compliant • Knowledge of Medicare billing, coding & documentation guidelines • Strong knowledge of Medical Terminology, Physiology and advanced human Anatomy • Knowledge of Third Party Payer: PPO, HMO, Medicare, Medi-Cal, Global Period/Case Rates, Technical and Professional Components • Knowledge of the following softwares: IDX, Touchworks, Allscripts, Meditech, MediSoft, AS400, EmergiSoft, MedWrite, Enterprise Intergy, Microsoft Excel, Word, and PowerPoint • CMS-1500, UB04, TAR, RTD, MCR Redetermination, MCAL CIF, and Explanation of Benefit (EOB) forms expert
CREDENTIALS/CERTIFICATES
CPC, CPC-H, Medical Billing/Insurance Coding Certificate
2510 PALM PLACE • HUNTINGTON PARK, CA 90255
HUGUEZBRIAN@YAHOO.COM – (323) 271-2397
OBJECTIVE
Seeking a per diem, part time, weekend, evening or remote employment as a Medical Coder/Compliance Auditor where I may utilize my eight plus years of healthcare experience and maximize my potentials for growth in the medical field.
EXPERIENCE
01/12-Present St. Joseph Heritage Healthcare-SJH Fullerton, CA
Coder/Physician Educator
Routine compliance audits
HCC Risk adjustment coding, reviews & provider education
Educate physicians on coding & documentation guidelines
Accurately code inpatient, outpatient, intensive care, trauma/general surgeries, transitional care and family practice cases using ICD-9-CM, CPT-4, HCPCS code sets and properly sequence diagnosis/procedures per patient EMR
Ensure coded data accurately reflects service provided, based on documentation, guarding against fraud and abuse
Review, audit, and submit charges from Touchworks to IDX system Resolve billing & coding discrepancies
09/09–12/11 Vantage Oncology, Inc. Manhattan Beach, CA
Patient Account Services Representative-Collector
Accurately code office visits, radiation therapy & medical oncology treatment cases using ICD-9-CM, CPT-4, HCPCS code sets and properly sequence diagnosis/procedures per patient EMR
Review aging reports for all Government, HMO, PPO, CCS, Worker's Compensation and other Commercial insurances carriers
Audit claims prior to submission to insurance carriers
Research & Analysis of delinquent third party payers
Follow up on insurance denials, requests, and notifications
Determine reimbursement problems and resolve billing & collection discrepancies Redeterminations, appeals, peer to peer reviews, refunds, claim inquiries, TAR, CIF, and Administrative Law Judge hearing requests
Adjusting and resubmitting claims: adding modifiers, units, and procedure codes
Manage up to (4) facilities with a an average year to date collected amount of: $5,728,042.00
06/08-09/09 California Hospital Medical Center-CHW Los Angeles, CA 05/05-05/06
Health Information Management Clerk
Charge capture & diagnosis coding for OB/GYN triage patients
Analysis and assembly of in & out patient medical records
MedWrite & EmergiSoft dictation review
Data entry (AS400) system
Assist physicians & other healthcare professionals on accessing medical records
Collect and create patient charts as they are discharged from the hospital PHI release forms, answering phones, and filing
05/06-06/08 California Hospital Medical Center-CHW Los Angeles, CA
Surgery Attendant-Level II Trauma Center
Charge capture & diagnosis coding for Post Anesthesia Care Unit patients
12 Lead EKG's and Blood withdrawals
Set up anesthesia/surgical equipment before and after each procedure
Assist surgical team on positioning patient prior to procedure
Check patients glucose and temperature after surgery
Pick up and transfer specimen, PRBC, Platelets, and Thawed FFP's for surgical patients Inform patient's relatives on status, length of stay and bed assignment
Respond to patient's needs from neonatal to convalescent
EDUCATION
2009 United Education Institute-College Huntington Park, CA Medical Billing & Insurance Coding Certified
2003 Youth Opportunities High School Los Angeles, CA High School Diploma
SKILLS • Excellent ICD-9-CM, CPT-4, and HCPCS Level II Coding skills • Excellent Coding, Billing, Collection, and Reimbursement skills • MS-DRG, OPPS, DOFR & HIPAA Compliant • Knowledge of Medicare billing, coding & documentation guidelines • Strong knowledge of Medical Terminology, Physiology and advanced human Anatomy • Knowledge of Third Party Payer: PPO, HMO, Medicare, Medi-Cal, Global Period/Case Rates, Technical and Professional Components • Knowledge of the following softwares: IDX, Touchworks, Allscripts, Meditech, MediSoft, AS400, EmergiSoft, MedWrite, Enterprise Intergy, Microsoft Excel, Word, and PowerPoint • CMS-1500, UB04, TAR, RTD, MCR Redetermination, MCAL CIF, and Explanation of Benefit (EOB) forms expert
CREDENTIALS/CERTIFICATES
CPC, CPC-H, Medical Billing/Insurance Coding Certificate
2510 PALM PLACE • HUNTINGTON PARK, CA 90255
HUGUEZBRIAN@YAHOO.COM – (323) 271-2397