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@markzaguirre
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markzaguirre

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• Certified medical coder and auditor • Six year experience in the medical field. A licensed physician. • Has worked in Northern Mariana Islands (USA) and remotely with a Joint Commission accredited facility in California • Started medical coding and billing career at the Fortune 6 company • Proficient in different Microsoft Office programs (Word, Excel, Powerpoint, Publisher) and EHRs (Kareo, AdvancedMD, Epic) • Excellent communication skills both oral and written • Ability to learn and understand new things very quickly • Willing to face new and challenging tasks • Strong organizational and time management skills Specialties: Outpatient Coding Evaluation and Management (E/M) HIPAA compliance Physician Compliance Acute Care Medicine Risk Adjustment – HCC Coding ICD-10-CM ICD-10-AM CPT HCPCS Healthcare Effectiveness Data and Information Set (HEDIS)
$8 USD/hr
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Experiência

Clinical Auditor

Jul 2017 - Jan 2019 (1 year)

• Monitored the quality of work of outpatient medical coders, audits new coders’ work and serves as a clinical and coding support to the team. • Helped reestablish and shape the new Optum360 University. Trained new medical coders on ICD-10-CM and CPT and prepare them for onboarding to production. • Assisted in developing & maintaining technical training content, exercises, presentations, and accompanying materials.

Medical Coding Specialist

Jun 2017 - Aug 2018 (1 year)

• Remotely reviewed telehealth charts of physicians and psychotherapists, assigns appropriate codes and prepare its superbills. • Worked as a clinical documentation improvement specialist, working with providers to maintain compliance in CMS and payers’ policies. • Provided education when it comes to medical coding and documentation, as needed.

Medical Coder and Biller

Oct 2016 - Jun 2017 (8 months)

• Responsible for reviewing patient records and codifying results for reimbursement or payment purposes. Assigned the right evaluation and management (E/M), diagnostic, procedural and supply codes for every visit. • Conducted education for physicians and nonphysician providers to increase awareness and importance of accurate coding. • Adjusted copayments and deductibles as needed.

Process Associate

Feb 2016 - Sep 2016 (7 months)

• Analyzed medical data from McKesson Corporation’s clients and entering it in the form of precise medical codes in the programmed patient record software. • Helped new coders as they undergo facility certification. • Ensured that the productivity objectives determined by the company are met all times during the performance of the assigned duties.

Medical Coding Specialist

Jul 2013 - Feb 2016 (2 years)

• Recipient of Optum Star Award in 2014 and Optum Venus Award in 2015 for exceptionally good and sustained performance yielding significant business impact and customer recognition. • Captured all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives. • Performed provider medical record reviews and abstraction for HEDIS.

Educação

Doctor of Medicine

2003 - 2007 (4 years)

Bachelor of Science in Sociology

2000 - 2003 (3 years)

Bachelor in Business Administration (30 credit hrs)

1999 - 2000 (1 year)

Qualificações

Certified Professional Medical Auditor (CPMA) (2015)

American Academy of Professional Coders

CPMA holders demonstrate expertise in: * Medical documentation, fraud, abuse, and penalties for documentation and coding violations based on governmental guidelines * Medical coding concepts * Medical record auditing skills and abstraction ability * Quality assurance and coding risk analysis * Communication of results and findings * The medical record

Certified Coding Specialist (CCS) (2018)

American Health Information Management Association (AHIMA)

CCS holders are skilled in classifying medical data from patient records. We: * Review patients’ records and assign numeric codes for each diagnosis and procedure * Possess expertise in the ICD-10-CM and CPT coding systems * Are knowledgeable about medical terminology, disease processes, and pharmacology.

Certified Professional Coder (CPC) (2013)

American Academy of Professional Coders (AAPC)

CPC holders demonstrate: * Expertise in reviewing and assigning accurate medical codes for diagnoses, procedures, and services performed by physicians and other qualified healthcare providers in the office or facility setting * A sound knowledge of medical coding guidelines and regulations including compliance and reimbursement * Understanding of how to integrate medical coding and payment policy changes into a practice's reimbursement processes

Physician License (2008)

Philippine Professional Regulations Commission

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