Diane Rhodes Barnes, CPC
17713 Innsbruck Point, CT. Canyon Country, CA 91387 (818) 916-2661
A self-starter, highly motivated and energetic with vast and in-depth knowledge of HCC, CPT, ICD-9, ICD-10, HCPC’S, E&M Auditing, and CCI Edits, HIPAA, Privacy Act and documentation resulting in optimum reimbursement. Twenty years of experience includes expertise in Multi-Specialty Auditing, Compliance, Coding, Surgical Auditing, Corporate Auditing, and HIM functions of electronic patient records. Articulate and persuasive in written and verbal communications with providers, medical staff, and peers.
Proven ability as a problem-solver, negotiator, and has expert follow-through skills to meet deadlines. Very creative and has excellent interpersonal skills and communicates well with fellow employees and staff. Multi-Specialty includes the appropriate diagnostic and bundling procedures in the following categories:
Oncology & Hematology
Family & Internal Medicine
Extensive knowledge of Medical Insurance, Medicare, Medi-Cal, PPO, and HMO. Organized project meetings and used software to compose letters/reports and training materials. I have provided training to Physicians and Nurses on proper coding guidelines. Reviewed, analyzed, and evaluated the productivity reports of staff coders. Performed HCC coding, researched Reimbursement Appeals, in addition to Surgical Outpatient Coding, Multi-Specialty Coding, Claims Manager and Edited CCI Reports, Perform annual OIG audits.
Technical Skills include:
IDX / EPIC /Cerner/Web ABA
All Scripts ECC
Ingenix (Encoder Pro)
Cyber Lab MD-Audit
Intel Code Pro (Audit Tool)
Flash Code Athena
360 Behavioral Health
Van Nuys, Ca
Coding Auditor/Revenue Integrity Specialist 1/14/2019-8/2/2019
Reviewing medical charts for errors to ensure the proper HCPCS, CPT and modifiers are entered accurately, reviewing claims, EOB’s, authorizations, medical notes, clinical and reimbursements for Medicare, Medi-Cal/Medicaid, and 3rd party payers also perform compliance audits for Beacon, Magellan and Cal Optima. Responsible for monitoring, identify, correcting with analysis of account errors. Establish audit trails for investigation of adjustments, refunds, write-offs, and collection efforts by internal and external audit firms, Assist in preparation of reports to share with payers when discrepancies for reimbursement are noted. Perform other duties as assigned.
Children’s Hospital Los Angeles Medical Group (CHLMG) 7/2014 – 10/2018
Los Angeles, CA
Perform compliance audits, for Infectious decease for nine providers, Gastroenterology for ten providers, pediatric surgery for 15 providers, Anesthesia for 22 providers, Transgender clinic for seven providers, NICU clinic for 12 providers, Emergency for 30 providers. Making sure documentation meet’s the E&M level of service billed. Prepared and distributed audits report to the Division chief. Meeting one-on-one with the physicians whose documentation fail to meet compliance rules. Setting up new provider orientation for documentation guidelines, once the physician has met with me, I sign them off to start billing and documenting. Responsible for privacy breach’s also analyzed rules and regulations for HIPAA, implemented powerpoint presentation, issue citations, and warnings. Interim-Supervisory experience for one year.
Kaiser Permanente, Pasadena, CA 6/2014 – 7/2014
Compliance Auditor (Contract)
Evaluation and Management Auditing, Multi-Specialty within each category of E/M service, audit components used to describe and define the various levels of care within E/M. Taught the proper use of Modifiers with E/M service. Audit the levels of each component within the chief complaint: Including HPI Elements, Review of Systems, PFSH, Number of Diagnoses, data that was reviewed, and the Risk Score. Expert experience in 97 and 95 Coding Guidelines.
Diagnostic Laboratories & Radiology, Burbank, CA 9/2013 – 6/2014
Revenue Auditor (Contract)
Auditing Laboratory Reacquisitions, Instructing the Directors of Nursing Home facilities and their staffs on proper coding guidelines and compliance. Teaching the Different types of medical Record Documentation techniques and Training on preparedness on ICD-10.
Heritage Provider Network, Northridge, CA 10/2012 – 8/2013
Corporate Auditor, Educator (Contract)
Blue Shield Audits, ACO Audits, Corporate Audits, Senior Quality visit Audits, and HCC Sweep Audits. I have assigned user logins and passwords to I Code and provided Physician training and feedback on audits reports.
Facey Medical Foundation, Mission Hills, CA 11/2000 – 10/2012
Medical/ Surgical Auditor
Provided Correct CPT, ICD-9, Bundling Edits, and HCPCS coding as needed for Multi-Specialty Coding. Responsible for Auditing Operative Reports, which includes ENT operations for Endoscopic frontal Sinusotomy, with exploration, with Ethmoidectomy, with Sphenoid Sinusotomy, and Maxillary Antrostomy. I have audited Orthopedic services for Malunion of proximal phalanx of the little finger with Corrective Osteotomy of proximal phalanx of the left little finger. I have inspected OBGYN Hysteroscopy with D&C sampling and endometrial ablation. Audited General Surgery Incarcerated umbilical hernia, Laparoscopic Cholecystectomy and Chondroplasty of Femoral medial condyle. E/M Auditing.
Coding of Physician E/M encounters with a focus on the principles of coding and documentation. Ensured accuracy and correct coding of CPT and ICD-9, making sure our physicians document to the highest level. Responsible for the education of all newly hired Physician and Nurses maintained work files daily and answered nurse and physician’s hotlines in regards to coding issues.
American Academy of Procedural Coders; Salt Lake City, Utah
Renewal Date: 6/2020
Other courses taken:
CPMA-CPCO Course-Completion only
Professional References Available Upon Request.
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