Karen Hart, CPC,

PCS75 Loggerhead DriveColumbia, SC 29229

(803) 466-1599 cell (803) 865-9220 Home

karenhart2468@yahoo.com

ObjectiveDedicated Medical Coder Specialist / Medical Billing and Coding Program Coordinator/ Instructor with a total nine years’ experience in the field . Four years in the Medical Office as a Coding Specialist and five years as an Medical billing and Coding Program Coordinator and Instructor.. Qualifications include:

Certified Coding Specialist (CPC) certification Professional Coding Specialist (PCS) certification Medical Billing and Coding Administration certification Expertise in ICD-9-CM, ICD-10 and CPT coding Knowledge of licensing, reimbursement and accreditation standards

Work Experience

HCC Remote Coder10/2015 – present; Columbia, SC

Coding Outpatient High Risk Coding

Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries. Review for clinical indictors and query providers to capture the severity of illness of the patient. Review all Medicare record documentation using the Healthcare Effectiveness Data and Information Set (HEDIS). Measure Providers’ performance on important aspects of care and services Provide feedback that will assist Health Plan with reporting valid HEDIS measures with the goal of ensuring accurate, reliable, and publicly reportable data.

MBC Program Coordinator (Department Chair)/ Instructor3/2009 – Present, October 23, 2015; Columbia, SCTeaching Hospital Billing, Anatomy & Physiology, Medical Terminology, Health Insurance, Coding (ICD-9,ICD-10, HCPCS, CPT), Electronic Health/Medical Records, Basic Computers Skills/Writing/Math, Medical Office Procedure etc.

Selected Contributions:

Head of the Advisory Board for MBC Program Seek Internship for MBC Program/ Assist in Job Placement Interview/Supervisor New MBC Instructors Order Books for MBC Instructors Schedule/Proctor Certification Exam Retention Plan

Coder/Patient Representative6 /2007 – 3/2009 The Dental Team; Columbia, SCCoding and Billing Dental/ Medical (Implants, Bone graft etc) Claims.Insurance Dental Claims Follow-up on Denied Claims for Metlife, Delta Dental, Medicaid, Bluecross Blueshield etc. Reimbursement/Accounts Receivables; Aging Reports, Unscheduled patients Reports, Assist in Scheduling appointments, Working up Dental treatment plans that Dentist has prepared (getting patient to comment to completing treatment plan). Prepare/ make Deposits. Train new employees, fee schedule, appeals/estimate/predetermine procedure/working billing error reports.

Coder/Billing Specialist 6/2007 - 1/2007 Midtown Family Medicine; Columbia, SC

Select, assign and audit diagnostic and procedure codes to patient records for 5 Service Centers and 16 Physicians. Manage chart completion (ICD-9-CM and CPT coding/abstracting). Work collaboratively with patient account department to ensure accurate billing and resolve claim denials and medical-necessity issues. Review medical documentation and consult with healthcare providers when documentation is inadequate/unclear for coding purposes.Selected Contributions:

Insurance Follow- up on Denied claims for Cigna, BCBS, Cigna and Assist with Medicare, Tricare, Medicaid and other Commercial Insurance.

Aging Reports, Credit Balances and Warning Error Reports Fee Schedule/Appeals Posting Surgical Charges, InMed Claim Charges, Zeros, Patients

Deductibles,. Billing claims on the Website and Electronic. Maximized reimbursement by ensuring accurate ICD-9-CM and CPT

coding and conducting regular quality audits of providers’ selected codes compared to chart documentation.

Ensured records met quality and risk-management requirements by participating in physician chart review .

Provided ongoing training to staff on intricacies of insurance submissions, codes and intake procedures to minimize rejections for referral- or registration-related reasons.

Medical Billing and Coder/Insurance Instructor11/2006 – 1/2007, Beta Technical College; Columbia, SCTeaching Medical Assistant to Code ICD-9-CM, CPT-4, HCPCS, Billing and Insurance. How to fill out CMS-1500 forms for All Payers, collections, Refunds, Read Pre/Post- op Reports, Reimbursement, Appeals forms etc.

Front Checkout/Coder10/2005 - 10/2006; Women Physician Associate; Columbia, SCCheck-out patient, key BCBS claims to box and internet, schedule appointments, collections, refunds and billing, verifying insurance coverage/eligibility, completing disability forms.Selected Contributions:

Collected/post in bad debt from patient. Post all payers incoming Checks. Coding and posting billable procedures Research claims for payments, rejected/denied/voided claims Credential physician for their NPI numbers Prepare Daily reports and Appeals Built mutually respectful relationships with third-party payers, HMOs,

PPOs, Medicare, Medicaid, workers’ compensation (WC) carriers and independent commercial carriers.

Education2000 –2000, State College; Orangeburg, SC

Method of Teaching 2004 – 2005 Midland Technical College; Columbia, SC

Medical Business Education; CertificateRelated Courses: Health Data Classification Systems I (ICD-9-CM, HCPCS and CPT), Medical Terminology, Health Insurance

Certification CPC Issued by American Academy for Professional Coders (AAPC) Certification ICD-10-CM, ICD-10-PCS

Affiliations2005 – present: American Academy for Professional Coders (AAPC)2008 – present: American College of Medical Coding Specialist (ACMCS)2005 – present: Capital CodersSkillsSkill Name Skill Level Last Used/Experience ICD-10-CM and ICD-10-PCSICD-9-CM and CPT Coding

ExpertExpert

Currently used/2 yearsCurrently used/8 years

DRG & APG Assignments Expert Currently used/4 years

HIPAA Regulations Expert Currently used/8 years

Insurance Reimbursement/ Collections

Expert Currently used/8 years

Medicare/Medicaid Reimbursement

Expert Currently used/8 years

Hospital Information Systems Expert Currently used/8 years

Medical, Pharmacology and Anatomy Terminology

Expert Currently used/4 years

Chart Control, Access and Storage

Expert Currently used/8 years

Chart Status Tracking and Assembly

Expert Currently used/8 years

Clinical Data Analysis and Extraction

Expert Currently used/8 years

Managed Care Regulations/JCAHO Guidelines

Expert Currently used/4 years