Susan L. Cutler, CPC                                                          susancutler711@hotmail.com

1213 W. Holt Farm Lane                             (818) 239-2145

South Jordan, Utah  84095

 

 

Professional Summary:   

Over 9 years of experience in the healthcare industry as an Auditor, Coder and Biller with over 5 year’s onsite with KAISER PERMANENTE (SCPMG).  Interpret patient record per encounter to assign and/or audit correct CPT, E/M, HCC, and or ICD-9 Diagnostic, procedural codes, and modifiers. Extremely knowledgeable with regards to medical coding guidelines and coding techniques (ICD-9, CPT-4 and HCPCS) for outpatient surgery coding for physicians. Sound knowledge of Anatomy; Physiology and Advanced Medical Terminology. Possess excellent communication and group interaction skills.

Technical Summary:

Med Assets, Epic Hyperspace, 3M Encoder, Health Connect, Microsoft Windows, MS Word, MS Excel, MS Outlook, MS Power point, Lotus Notes, Zymed and P-Care Medical Billing Software. 

Education:

Brigham Young University Idaho (Online Learning) 9-4-2013 to present: Field of Study: Bachelors in Health Science

 

Diploma, American Academy of Professional Coders, CPC.  October 28, 2006.  Diploma, At-Home Professions November 24, 1997 Medical Language and Transcription Studies.

Certificate:  West Valley Occupational Center, September 1985- June- 1987 Medical Office Procedures, Medical Terminology and Insurance Billing. Capital Recovery Service, Medical Collections.  December 1988 Outstanding Achievement in Collecting Past Due Accounts.

AHIMA Distant Education Learning, October 6, 2011.  E&M Coding for Professional Services- Including:  In-patient and Out-patient Consultations; Emergency Dept Services, Initial Hospital Care; Subsequent Hospital Care; Observation; Prolonged Services; Critical Care; Home Health; Domiciliary; Preventive Medicine; Neonatal Intensive care and Physician Standby Services. 

Detailed Experience: Kaiser Permanente Revenue Cycle, Fee Schedule Unit. (Contract –Agency- Med Partners HIM Two Harbor Place, 302 Knights Run Avenue, Suite 150, Tampa, FL 33602.  HIMS Hospital Coder I)
December 12, 2011 – December 31, 2012.  (Contract Expiration)

As a SCAL Professional HIMS Hospital Coder I – Under direct supervision I was responsible for accurate coding of professional services of Medical procedures and Surgeries from the 10000-90000 code series and CPT category III. Primary responsibility is to oversee the Penny Work Queue of the Unlisted CPT Codes in Kaiser Permanente Health Connect (KPHC).  Evaluate the medical record to determine if all CPT codes are coded properly and when appropriate determine a fee for the Unlisted code and enter it into KPHC. Utilization of Med Assets software program for verification of CCI Edits.  Interface with Local and Regional Supervisors to bring code designation into compliance to optimize revenue.  Prepare working spread sheets for Unlisted CPT data to be used as a tracking guide for regional areas.  Identify weak coding areas and report to supervisors on a regular basis for remedial action.  Participate in management policy meetings; participate in the preparation of power point presentations for educational purposes, in addition.  Able to work independently and when appropriate, work from home remotely.  Consistently support the precepts of Corporate Compliance and the Principles of Responsibility by maintaining confidentiality, protecting the assets of the organization, acting with integrity, reporting observed fraud and abuse and complying with applicable state, federal and local laws and program policies and procedures.  Instrumental in developing appropriate meeting protocol and presentation methodology.  Participation in implementing ways to close KP Inpatient charge gap issues.  Successful in establishing & maintaining relationships with PSC Supervisors and Coding Managers in the SCAL Region.  Work with Revenue Integrity Dept in providing case examples for training purposes at the local and regional level.  Instrumental in developing Issue log where documentation for pricing of repeated Unlisted Procedures and where research material is tracked for educational purposes on surgery and medicine code(s). 

 

Environment:  Hyperspace, 3M Encoder, Health Connect, Microsoft Office Products, Lotus Notes. Med Assets. WebEx

Kaiser Permanente NCO Department.  (Contract –Agency- MedPartners HIM Two Harbor Place, 302 Knights Run Avenue, Suite 150, Tampa, FL 33602.)  Auditor I September 12, 2011- September 21, 2011 (Contract Expiration)

Using Kaiser Permanente auditing tools, conducted a RIM Guarantor Statement audit of documentation supporting E/M, CPT and ICD9 codes assigned by clinical staff.  Researched correct coding practices in relationship to applicable rules;   regulations and coding conventions for billing to determine compliance with Federal, State and Kaiser Permanente regulations.  Ensured complete and accurate data capture in compliance with Federal and State requirements.  

Provided technical expertise to Regional and local leadership to identify and resolve coding and chart documentation problems impacting the accuracy and consistency of coded data.  Read and interpreted medical data written by providers.  Entered audit results into NCO audit tools to support quality assurance process, analysis and training activities.  Introduced a protocol for productivity standards. Ensured verification of Insurance through Passport.

 

Environment:  Hyperspace, 3M Encoder, Health Connect, Microsoft Office Products, Passport Insurance Verification system.

 

 

 

Susan L. Cutler, CPC                                                                                     susancutler711@hotmail.com

1213 W. Holt Farm Lane                                            (818) 239-2145                        South Jordan, Utah 84095 

 

Kaiser Permanente (SCPMG), (Contract – Agency -ASAP Staffing, Inc. Long Beach, CA),
Medical Compliance Auditor, 3/15/07 – 7-30-10, (Contract Expiration)

Contractual employee assigned to Kaiser Permanente, Pasadena, California. Extensive experience in the following:  HCC Specialist, two years; auditing, specifically for cancer codes and verifying accuracy of the medical record; Long Term Care Specialist, seven months. Designed and created Excel spreadsheet to track Physician coding errors; and presented to supervisor for education of physician improvement for lost and potential revenue.  Three years of experience in Evaluation and Management Auditing using 1997 protocols;  Applied correct use of ICD-9 coding and knowledge of Pharmacology and HCPC codes. 

Served as a QA specialist in Ventura for three months working with supervisor helping to educate and provide support for her staff. Assigned to Woodland Hills for just over 4 months working directly with Carolyn S. White and her staff in training and educating physicians in Pediatrics, Oncology, Neurology, Endocrinology, Cardiology and Internal and Family Medicine Departments.  One week of onsite training of Evaluation and Management, and proper coding requirements to Physicians in local Pasadena pediatrician office.  Worked with Hans Eric Tan in testing data base of which Kaiser now uses for E&M coding.   Heavy use of Microsoft Excel (2003, 2007, 2010);  Areas of specialty experience:  Urgent Care, Internal Medicine, Family Medicine, Bariatric, Geriatrics, Ophthalmology Optometry, Psychiatry, Cardiology, Surgery, Orthopedics, Neurology, Pediatrics, Endocrinology, Physical Medicine, Physical Therapy, Urology, Ob-Gyn,& Otorhinolaryngology.

Environment: Epic Hyperspace, 3M Encoder, Health Connect. Microsoft Office Products.

Quest Diagnostic Laboratories, West Hills, Ca, (FTE), Billing Coordinator II, 10/2005 – 3/14/07 (Better Opportunity)

Substantial correspondence and contact with Medicare, Medical, Champus and other secondary and private Insurance Companies in managing rejections due to coding errors.  Researched, verified and identified appropriate diagnosis codes, and provide report analysis and follow-up on aged accounts. Received Training on UPIN Registry, provided Diagnostic update between physicians’ office and Quest Diagnostics.  Acted as liaison with Physicians and medical offices regarding proper use of ICD 9 Coding.  Initiate mail merge monthly and handle correspondence from patients as well as provide customer service to Patients in updating insurance information; contributed to finding solutions to complex billing issues.

Environment: UB82, CMS1500, Quest Billing System and Microsoft Office Products.
Gary V. Gordon, M.D., Wane PA, Billing Coordinator and Bookkeeper 06/1998-04/1999

Managed all medical and secondary billing, accounts receivable, monthly aging reports, payment posting, and charge entry. 

Environment:  Zymed

Physician Billing Solutions, Inc., Wayne PA, Medical Biller, 06/1998-01/1999 (contract)

Handled medical billing, ICD9 and CPT coding, charge entry and payment positing.

 

Cataract Implant and Laser Center, West Hills CA Billing Assistant 01/1988-08/1991 (relocated to Philadelphia)

Managed all medical billing, and accounts receivables.  Scheduled all surgeries and assisted patients during the pre and post-op surgery period.

 

 

References

Professional Associate:Laura Denke.....................(206-992-6693)

Professional Associate:Kari Karabats...................(818-389-9065)

Clergy:Bishop Clark Everitt........(818-995-7158)