Joseph Gantala

JOSEPH S. GANTALA #112 Brgy 24 San Roque Sarrat, Ilocos Norte Contact No.:- Email:-PROFESSIONAL SUMMARY  Registered Nurse  Certified Outpatient Coder 7 years of Medical Coding Experience February 29, 2012 – Present REGISTERED NURSE Nurse Licensure Examination PRC no- Certified Outpatient Coder (COC) AAPC Certified Outpatient Coder Examination Member ID:- ICD-10 Proficient ICD-10 Proficiency Exam July 25, 2015 EMPLOYMENT RECORD HOME HEALTH CODER MY HOME CARE BIZ January 2018 to April 2019 DUTIES AND RESPONSIBILITIES:  Review OASIS H&P and provide detailed ICD 10 CM code.  Input Coding Wizard review and suggestions on accurate documentation to optimize coding and billing..  Ensures compliance with HIPAA and CMS by adhering to established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines  Work with physician and promotes accurate database information, optimizes reimbursement. QUALITY AUDITOR RADIUS GLOBAL SOLUTIONS LLC November 2013 to July 2017 DUTIES AND RESPONSIBILITIES:  Responsible in auditing both Outpatient (Same day surgery, Clinic, ED and EM leveling) and inpatient (MS-DRG, APR-DRG) chart and determine coder’s accuracy. Making sure that coders adhere to the set General and Facility coding guidelines.  Coordinate Quality Audit results to Team Manager and Operations.  Identify training needs. And communicate results to the training team.  Generate a Daily, weekly and monthly Quality report.  Audits medical record documentation to identify undercoded and upcoded services; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues.  Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.  Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentati IMPLEMETATIONS TEAM NCO November 2012 to October 2013 DUTIES AND RESPONSIBILITIES:  Responsible for delivering implementations to new clients, new accounts, additional products/services and re-implementation of previous accounts launched.  Actively increasing knowledge about the Accounts’ products and services as well as knowledge sharing and training of colleagues.  Document all actions taken, all testing and client setups during implementations, and ensure all parties are informed on progress.  Log any Technical Issues/Problems encountered during system navigation for the new client’s system.  Coordinate any feedback or any important client information to Client Services Team and/or Technical Support Team.  Identify any training/knowledge needs for clients and colleagues.  Prepare and perform trainings of colleagues if necessary  Responsible in assisting in launching new facilities acquired by NCO.  Documenting general reports on each new facility’s performance and targets as well as ensuring that the medical coders are exceeding the targets. MEDICAL CODER NCO February 29, 2012 to November 2012 DUTIES AND RESPONSIBILITIES:  Reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments.  Performs ICD-9-CM, ICD -10-CM and PCS, CPT and HCPCS coding for reimbursement. Assigns and sequences ICD-9-CM/CPT/HCPCS codes to diagnoses and procedures for documented information.  Ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.  Promotes accurate database information, optimizes reimbursement  Assures the final diagnoses and operative procedures as stated by the physician are valid and complete.  Abstracts all necessary information from health records to identify secondary complications and co-morbid conditions.  Work on NCCI edits by addressing CCI conflicts and perform claim edit resolution by thoroughly reviewing the charts available documentation and utilized 3M encoder and encoder pro. NURSE January 10, 2011 to December 2011  Establishes a compassionate environment by providing emotional, psychological, and spiritual support to patients, friends, and families.  Assures quality of care by adhering to therapeutic standards; measuring health outcomes against patient care goals and standards; making or recommending necessary adjustments; following hospital and nursing division's philosophies and standards of care set by state board of nursing and other governing agency regulations.  Maintains patient confidence and protects operations by keeping information confidential. title:nurse, registered  Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.  Maintains a cooperative relationship among health care teams by communicating information; responding to requests; building rapport; participating in team problem-solving methods.  Contributes to team effort by accomplishing related results as needed. EDUCATIONAL BACKGROUND Tertiary: Divine Word College of Laoag Batch 2010 Laoag City Qualifications  Bachelors Degree in Nursing  Good academic record; graduated as Cum laude  Passed the Nurse Licensure Examination  Certified Outpatient Coder  Passed the ICD-10 Proficiency Examination Character References: Ms. Mae Angeline Esperida Medical Coding Trainer HIM Training Institute Contact no- Mr. Carlos Ongaco Chief Training Officer HIM Training Institute Contact no- Ms. Myka Alyssa Tumbaga Medical Coding Specialist My Home Care Biz Contact no-