1. Fort Worth, TXApr 2013－Mar 2014
Fort Worth, TxJul 2001－Apr 2013
Cynthia Herrera, C.P.C.
Professional Summary
I am a certified professional coder with over 13 years of experience in the healthcare insurance field.
I have strong knowledge in all facets of medical coding including certification in ICD-10-CM. I am
a dedicated member of my profession and look forward to contributing to a compliant healthcare
environment.
Skills
ICD-9-CM Official Coding Guidelines
ICD-10-CM Official Coding Guidelines
CMS Online Manuals
Medicare Parts A,B,C,D
Time Management
Ability to work as a team member or
independently.
Experience
North Texas Specialty Physicians ( Delegated Utilization Management-United Healthcare MCR)
Intake Specialist
Responsible for organizing various specialized data entry tasks and communications for multiple
insurance plans including Unitedhealthcare MCR, Medicare ACO, Humana Gold and Care N
Care PPO plans. Job tasks comprised of:
Utilized ICD-9-CM, CPT and HCPCS codes for professional providers on a daily basis.
Processed prior-authorization Including: Physician referrals, elective inpatient and outpatient
surgeries, home health, inpatient ER admissions and skilled nursing facility admissions.
Processed professional and facility claims. Reviewing up to 100 claims daily for authorization
approvals which entailed payment for claim processing.
Ensured prior-authorizations were a covered benefit and met Medicare guidelines and criteria
prior to approval using Centers for Medicare and Medicaid Services-CMS, NOVITAS solutions
and UnitedHealthcare websites.
Lumbar Surgeries – Gathered clinical information; including imaging within a 6 month period
and sending surgery requests out for physician review.
Urgent precertification requests - Processed urgent requests for medical emergency procedures
and then contacting the physician's office and insurance member when approval is authorize.
Responsibilities also included interacting with providers, office staff, medical directors and
healthplan employees to ensure a seamless interface between managed care activities and
providers.
Gordian Health Management (Delegated Utilization Management-United Healthcare MCR)
Senior Intake Specialist
Responsible for organizing various specialized data entry tasks and communication for multiple
insurance plans including Unitedhealthcare MCR, Medicare ACO, Humana Gold and Care N
Care PPO plans. Job tasks comprised of:
Utilized ICD-9-CM, CPT and HCPCS codes for professional providers on a daily basis.
Including prior authorizations for: Physician referrals, elective inpatient and outpatient
surgeries, home health, inpatient emergency room and skilled nursing admissions.
Processed professional and facility claims. Reviewing up to 100 claims daily for authorization
approvals which entailed payment for claim processing.
105 Noelle Lane, Weatherford, TX 76087
cynthia.herrera28@yahoo.com
Ph: 682.558.6394

2. Fort Worth, TX
Mar 2015
Fort Worth , TX
Dec 2014
Houston, TX
Jul 1999
Fort Worth, TX
Jul 1997
Ensured prior-authorizations were a covered benefit and met Medicare guidelines and criteria
prior to approval using Centers for Medicare and Medicaid Services-CMS, NOVITAS solutions
and UnitedHealthcare website..
Lumbar Surgeries – Gathered clinical information; including imaging within a 6 month period
and sending surgery requests out for physician review.
Urgent precertification requests - Processed urgent requests for medical emergency procedures
and then contacting the physician's office and insurance member when approval is authorize
Ability to work from home as needed.
Responsibilities also included interacting with providers, office staff, medical directors and
healthplan employees to ensure a seamless interface between managed care activities and
providers.
Education
Texas Career Center, Inc.
ICD 10 CM: Advanced ICD 10 coding
Understanding the conventions and general coding guidelines of ICD-10-CM. Differentiating changes
between ICD-9 AND ICD-10-CM coding classifications. Referencing coding guidelines for Chapter-
Specific Diseases (Guideline Section I.C)
30 Hours of advanced coursework.
Online AAPC Proficiency Assessment completed and certification recieved in ICD-10-CM.
Texas Career Center, Inc.
Certified Professional Coder: Medical Coding
AAPC advanced course study includes 312 hours of coursework to include:
CODING
• CPT® Coding Guidelines, CPT® Modifiers
• CPT® Category II and III codes
• ICD-9 Official Coding Guidelines
• HCPCS Supplemental Codes
• Anatomy and Medical Terminology
• Coding applications-surgery, radiology, pathology and evaluation & management.
• ICD-9-CM, CPT and HCPCS codes to over 160 athentic medical records.
COMPLIANCE
• OIG Annual Work Plan, OIG Compliance Plan
• HIPAA & HITECH
• Advance Beneficiary Notice
• National Correct Coding Initiative
• CMS Online Manuals and Transmittals
REIMBURSEMENT
• Novitas NCD & LCD, CMS NCD & LCD Policies.
• CMS Physician Fee Schedule
• CMS 1500 Claim Form Components
• Medicare Part A,B,C & D
• RBRVS and Relative Value Units
Member of American Academy of Proffesional Coder
Certified Professional Coder, License #01355144
General Equivalency Diploma
GED
Tarrant County College
Office Administration Program: Microsoft Office Suite, Microsoft Excel, Microsoft Word