Carl Benavides
Lake Charles,LA
Summary
Detail-oriented and experienced Certified Medical Coder with over 8 years of experience in professional fee and physician based coding. Demonstrated ability to accurately assign ICD-10, CPT, HCPCS codes and ensure compliance with regulations. Currently advancing my education by enrollment of AAPC CPMA training course and exam prep with the goal of transitioning into auditing. Seeking a long-term, permanent position where I can contribute my skills and continue to grow within the organization.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Coding Specialist | Medical Review Analyst
BCBS NC
07.2024 - Current
- Special Investigations Unit, Fraud, Waste and Abuse detection and prevention. Documentation review and analysis, ethical coding and compliance. External audits and hard denials.
PRN Profee Coder
CSI Companies
07.2024 - Current
- E&M Clinic/ED/Obs/IP Rounds. Denial Team Lead, weekly soft audits, monthly hard audits, coding compliance and education. Productivity tracking. Special projects focusing on researching claim denials to identify and analyze patterns and resolving identified issues.
Pro-Fee Senior Surgical Coder
Children’s Hospital of Wisconsin
05.2024 - 07.2024
- General Surgery, ED/IP E&M, Denials. ICD-10, CPT, HCPCS code extraction from clinical documentation. Denial tracking and resolutions.
Pro-Fee Denial Coder
HCA Healthcare
12.2023 - 04.2024
- Denial Team, rejected claims and appeals, denials research and resolution. ICD-10, CPT, HCPCS code extraction from clinical documentation. E&M Clinic/ED/Obs/IP.
Pro-Fee Coder II
Jupiter Medical Center
02.2023 - 06.2023
- Family Medicine, Urgent Care, Cardiology, Denials. ICD-10, CPT, HCPCS code extraction from clinical documentation. Denial research and resolution. Physician documentation education and compliance.
Pro-Fee Coder II
Phoenix Children’s Hospital
10.2021 - 02.2023
- Endocrinology OP/IP, Pulmonology, Urgent Care, Family Medicine, Behavioral Health, Denials. ICD-10, CPT, HCPCS code extraction from clinical documentation. Denial research and resolution. Physician documentation education and compliance.
Pro-Fee Denial Coder II
Lake Charles Memorial Hospital
02.2021 - 10.2021
- Denials, Internal Audits, Coding Education, Productivity Tracking, Rejections, General Surgery, Orthopaedics, Family Medicine, ENT, Urgent Care, Urology. ICD-10, CPT, HCPCS code extraction from clinical documentation. Denial tracking, research and resolution, staff education.
Revenue Cycle Specialist
AMD Global Healthcare
01.2020 - 05.2020
- Cost Analysis, Coding Audits & Education, Denials, Rejections, Appeals, Physician Documentation Education, Credentialing, AR/AP, Productivity Tracking. ICD-10, CPT, HCPCS coding and compliance. Physician documentation education.
Branch Manager, Branch HR, OASIS Medical Coder
STAT Home Health
02.2019 - 11.2019
- Administrative & Operational Management, Compliance & Regulation, Financial Management, Staff Management, Recruitment, Performance Evaluation, Patient Relations, Community Outreach, Policy Implementation, Precertification, Prior Authorization, Clinician Documentation Education, Internal Audits, Code Edits, Claim Denial Management. ICD-10, CPT, HCPCS coding with strong focus on diagnostic hierarchy.
Team Lead Medical Coder
Imperial Health Medical Center
05.2016 - 02.2019
- Endocrinology, Family Medicine, Urgent Care, Hospitalist, Cardiology, Orthopaedics, Rheumatology, Denials. ICD-10, CPT, HCPCS code extraction from clinical documentation.
- Lead Assignment: Weekly Soft Audits, Weekly Team Meetings, Productivity Tracking, New Hire Training, Internal Education, Team Building, Physician Documentation Education
Education
Medical Coding & Billing, Medical Office Assistant -
Academy of Acadiana
Lake Charles, LA05.2012
High School Diploma -
Hamilton Christian Academy
Lake Charles, LA05.2009
Skills
- ICD-10-CM
- CPT
- HCPCS
- Professional fee E&M inpatient & outpatient
- Surgery coding
- Medical records/documentation review & analysis
- Claim audits
- Modifiers
- CMS guidelines
- CDI
- Anatomy & physiology
- Global timelines
- Physician education
- Documentation quality & compliance
- Team leadership
- Production based coding
- Medical coding research & data analysis
- MDM guidelines
- Denial review & management
- Multi-specialty coding
- Appeals
- Fraud
- Abuse
- Discrepancy management
- Collaboration
- Training & mentoring
- Coding conventions
- Clinical content standards
- DRG validation
- DME
- Precertification
- Prior authorization
- Medical billing
- EOB/benefits evaluation
- Commercial insurance
- Private insurance
- CPT code bundling
- Technical: Epic
- Cerner
- Allscripts
- 3M
- Encoder Pro
- Codify
- Athena
- EClinical Works
- Open EMR
- McKesson
- Medflow
- Centricity
- TruCode
- ReviewMate
- Microsoft Office
- Microsoft Word
- Microsoft Excel
- Microsoft Powerpoint
- 80 WPM
Certification
- AAPC: Certified Professional Coder
- AACE: Certified Endocrine Coder
- NCCT: National Certified Insurance & Coding Specialist
- NCCT: Medical Office Specialist
Timeline
Coding Specialist | Medical Review Analyst
BCBS NC
07.2024 - Current
PRN Profee Coder
CSI Companies
07.2024 - Current
Pro-Fee Senior Surgical Coder
Children’s Hospital of Wisconsin
05.2024 - 07.2024
Pro-Fee Denial Coder
HCA Healthcare
12.2023 - 04.2024
Pro-Fee Coder II
Jupiter Medical Center
02.2023 - 06.2023
Pro-Fee Coder II
Phoenix Children’s Hospital
10.2021 - 02.2023
Pro-Fee Denial Coder II
Lake Charles Memorial Hospital
02.2021 - 10.2021
Revenue Cycle Specialist
AMD Global Healthcare
01.2020 - 05.2020
Branch Manager, Branch HR, OASIS Medical Coder
STAT Home Health
02.2019 - 11.2019
Team Lead Medical Coder
Imperial Health Medical Center
05.2016 - 02.2019
Medical Coding & Billing, Medical Office Assistant -
Academy of Acadiana
High School Diploma -
Hamilton Christian Academy
- AAPC: Certified Professional Coder
- AACE: Certified Endocrine Coder
- NCCT: National Certified Insurance & Coding Specialist
- NCCT: Medical Office Specialist
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