Medical Coder

  Tomiya O. Gaines, CPC (01174399)

Phone: (209) 470-8264 • Email: tomiyag@sbcglobal.net

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 MEDICAL CODER

Detail Oriented Professional with excellent problem solving skills, with expertise in increasing revenue, with an emphasis on compliance

Published Current Procedure Terminology Manual. Technically sophisticated and knowledgeable in the area of professional medical billing/coder. Strong leadership qualifications coupled with excellent medical billing/coder education.  Maintain focus on achieving bottom-line results while implementing advance medical coding/auditing skills.

 

Professional Experience

 

(2013 AAPC President-Modesto Chapter, Sept 2012-Current; Published CPT Manual, Completed ICD-10 Training Anatomy related training, Consulting Bill Right Medical Billing Company, Conducted ITT Tech Coding/Reimbursement Educational Seminars)

 

Medical Coder, Modesto, CA December 2012-Current

Codes and abstracts all Cardiology specialty outpatient facility medical records in accordance with Medicare coding guidelines using ICD-9-CM, CPT classification systems. . Provide customer service to both internal and external customers, data entry, prepare related reports. Prepare related daily production reports. Other related work as assigned

 

Medical Billing and Coding, (Outpatient Facility) Stockton, CA  04/2011 – Sept 2012

Codes and abstracts all  outpatient surgery, orthopedic medical records in accordance with Medicare, Medi-Cal and coding guidelines using ICD-9-CM, CPT classification systems.  Audit Outpatient Charge Documents, analyze patient medical records, abstract information Audit physicians E/M level of care. Provide feedback, accompanied by supporting documentation to physician when erroneous trends are identified. (Cardiology, Orthopedics, Internal Medicine, & Surgery Clinics) assign appropriate medical procedure and diagnosis codes (ICD9, CPT4, & HCPCS). Using independent judgment & sensitivity, coach's individual physicians, reviewing their audit findings, making suggestions for documentation improvements. Provide customer service to both internal and external customers, data entry, prepare related reports. Prepare related daily production reports. Other related work as assigned. 

 

Medical Claims Processor/Analyst, ATI Claims Stockton, CA          06/98 – 04/2004

(Temporary) Review Third Party Liability, Workman's Compensation, Dual Coverage, Coordination of Benefit, Medicare, HMO, INDEMNITY, DENTAL, & PPO claims per written guidelines. Claims processing of complex claims (processed & paid; stop loss, etc.)  Adjudication and claims research when necessary. Obtained necessary information from third partied to determine medical necessity.  Provides informational resource for employees, assist in training new staff, handle difficult claims. Other related work as assigned.

 

Medical Biller/Coder, Prairie Medical Group, Inglewood, CA    02/01 – 03/2003

Audit Claims for accuracy prior to submitting for payment. Meet claims processing procedures as stated in production manual, and payment accuracy

Assisting in educating both the staff members and the physicians on how to maximize their potential income.  Follow up phones calls with patients and providers. Other related work as assigned.

 

Education

  • AAPC Modesto Chapter President 2013
  • AAPC (CPC)  Exam Proctor
  • CPC Certified (01174399) – Medical Coding – 2011
  • Real Estate Broker’s License (01345602) NMLS Certified (433802)
  • Member of AAPC
  • Approved  AMA Current Procedural Terminology Manual Publisher 
  • ID#: 81008
  • Location: Stockton, CA , 95219

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