Mary Vicedo RN,CCSP, CCS,CPC,CIRCC,CPMA

Experience

• 

  Magallanes Rural Health Unit

  Jan 2009 - Jan 2010

  Registered Nurse
• 

  Mediclinic Middle East

  May 2010 - Jun 2015

  Medical Coder / Medical Claims Processor

   Obtain appropriate reimbursement levels for professional services by reviewing and coding clinical diagnoses (ICD-9 CM) and procedures (CPT) and other services including Evaluation and Management level (E&M) . Ensures all services documented in Health Record are coded appropriately. And when lack of documentation was encountered, seeks to attain proper documentation in timely manner using the physician query form. Performs coding quality reviews before submission to ensure 95% or greater accuracy and completeness of ICD-9CM and CPT codes appropriateness. Trained in Claims Resubmission. Use in-depth knowledge in medical field and coding to analyzes rejections and find appropriate solutions to resubmit claims. Maintains a working knowledge of CPT and ICD-9-CM coding principles, government regulations (HAAD), protocols and third-party requirements pertaining to billing and documentation such as price limitation, exclusion list, etc. Serves as a resource person for the Health Information Management Department, Physicians and Practitioners to obtain information on accurate and ethical coding documentation standards guidelines and regulatory requirements. Use available systems to process and maintain the quality of claims. Process and validate claims using ERP and Microsoft Excel. Check claims information for accuracy such as reference numbers, name, insurance card and member ID number; validate the price of every procedures and drugs considering the discounts, co- payments, limitation and coverage policy of insurance company. Show less

• 

  Cleveland Clinic Abu Dhabi

  Jul 2015 - now

  • Applies the appropriate guidelines for assignment of the principal diagnosis, complications, and co-morbidities for inpatient accounts utilizing the Health Authority Abu Dhabi (HAAD) code sets. • Assigns the correct ICD-10-CM principal diagnosis code in 95% of the accounts audited. • Assigns the appropriate CPT 4 codes for the principal procedures on 95% of accounts audited. • Assigns the correct ICD-10-CM codes for complications and co-morbidities in 95% of accounts audited. • Assigns the correct CPT 4 codes for secondary procedure codes in 95% of the accounts audited. • Assigns the correct E&M codes for inpatient, observation, and day surgery accounts in 95% of the accounts audited. • Correctly groups the IR-DRG in 95% of the accounts audited. • Abstracts required demographic, statistical, and medical information from each patient record in 95% of the accounts audited. • Demonstrates knowledge of the content of the electronic medical record for both inpatient and outpatient accounts. • Demonstrates knowledge of the physician query process and appropriately queries when documentation is incomplete or ambiguous. • Demonstrates appropriate analysis of electronic medical record documentation for completeness, accuracy, and timeliness. • Coordinates with the Clinical Coding Support Specialist on issues related to documentation. • Maintains confidentiality of the patient’s protected health information (PHI) in both electronic and paper formats. • Participates in the development of internal education programs by identifying key areas for improvement in documentation for appropriate code assignment. • Participates in continuing education programs and maintains a record of continuing education programs attended. • Performs other duties and participates in special projects as assigned by the HIMS Management team Show less

  • Auditor -Audit and Compliance, Revenue Cycle Management

    Jan 2017 - now

  • Coding Technician II / Coding Denial Analyst

    Jul 2015 - Dec 2016