1. Karen Hart,
CPC, PCS
75 Loggerhead Drive
Columbia, SC 29229
(803) 466-1599 cell
(803) 865-9220 Home
karenhart2468@yahoo.com
Objective
Dedicated Medical Coder Specialist / Medical Billing and Coding Program
Coordinator/ Instructor with a total nine years’ experience in the field . Four years in
the Medical Office as a Coding Specialist and five years as an Medical billing and
Coding Program Coordinator and Instructor.. Qualifications include:
 Certified Coding Specialist (CPC) certification
 Professional Coding Specialist (PCS) certification
 Medical Billing and Coding Administration certification
 Expertise in ICD-9-CM, ICD-10 and CPT coding
 Knowledge of licensing, reimbursement and accreditation standards
Work Experience
HCC Remote Coder
10/2015 – present; Columbia, SC
Coding Outpatient High Risk Coding
Review medical records, patient medical history and physical exams,
physician orders, progress notes, consultation reports, diagnostic reports,
operative and pathology reports, and discharge summaries. Review for clinical
indictors and query providers to capture the severity of illness of the patient.
Review all Medicare record documentation using the Healthcare Effectiveness
Data and Information Set (HEDIS). Measure Providers’ performance on
important aspects of care and services Provide feedback that will assist Health
Plan with reporting valid HEDIS measures with the goal of ensuring accurate,
reliable, and publicly reportable data.
MBC Program Coordinator (Department Chair)/ Instructor
3/2009 – Present, October 23, 2015; Columbia, SC
Teaching Hospital Billing, Anatomy & Physiology, Medical Terminology, Health
Insurance, Coding (ICD-9,ICD-10, HCPCS, CPT), Electronic Health/Medical
Records, Basic Computers Skills/Writing/Math, Medical Office Procedure etc.
Selected Contributions:
 Head of the Advisory Board for MBC Program
 Seek Internship for MBC Program/ Assist in Job Placement
 Interview/Supervisor New MBC Instructors
 Order Books for MBC Instructors
 Schedule/Proctor Certification Exam
 Retention Plan
Coder/Patient Representative
6 /2007 – 3/2009 The Dental Team; Columbia, SC
Coding and Billing Dental/ Medical (Implants, Bone graft etc) Claims.
Insurance Dental Claims Follow-up on Denied Claims for Metlife, Delta Dental,
Medicaid, Bluecross Blueshield etc. Reimbursement/Accounts Receivables; Aging
Reports, Unscheduled patients Reports, Assist in Scheduling appointments,
Working up Dental treatment plans that Dentist has prepared (getting patient to
comment to completing treatment plan). Prepare/ make Deposits. Train new
employees, fee schedule, appeals/estimate/predetermine procedure/working billing
error reports.

2. Coder/Billing Specialist
6/2007 - 1/2007 Midtown Family Medicine; Columbia, SC
Select, assign and audit diagnostic and procedure codes to patient records for
5 Service Centers and 16 Physicians. Manage chart completion (ICD-9-CM and
CPT coding/abstracting). Work collaboratively with patient account department to
ensure accurate billing and resolve claim denials and medical-necessity issues.
Review medical documentation and consult with healthcare providers when
documentation is inadequate/unclear for coding purposes.
Selected Contributions:
 Insurance Follow- up on Denied claims for Cigna, BCBS, Cigna and Assist
with Medicare, Tricare, Medicaid and other Commercial Insurance.
 Aging Reports, Credit Balances and Warning Error Reports
 Fee Schedule/Appeals
 Posting Surgical Charges, InMed Claim Charges, Zeros, Patients
Deductibles,.
 Billing claims on the Website and Electronic.
 Maximized reimbursement by ensuring accurate ICD-9-CM and CPT
coding and conducting regular quality audits of providers’ selected codes
compared to chart documentation.
 Ensured records met quality and risk-management requirements by
participating in physician chart review .
 Provided ongoing training to staff on intricacies of insurance submissions,
codes and intake procedures to minimize rejections for referral- or
registration-related reasons.
Medical Billing and Coder/Insurance Instructor
11/2006 – 1/2007, Beta Technical College; Columbia, SC
Teaching Medical Assistant to Code ICD-9-CM, CPT-4, HCPCS, Billing and
Insurance. How to fill out CMS-1500 forms for All Payers, collections, Refunds,
Read Pre/Post- op Reports, Reimbursement, Appeals forms etc.
Front Checkout/Coder
10/2005 - 10/2006; Women Physician Associate; Columbia, SC
Check-out patient, key BCBS claims to box and internet, schedule appointments,
collections, refunds and billing, verifying insurance coverage/eligibility, completing
disability forms.
Selected Contributions:
 Collected/post in bad debt from patient. Post all payers incoming Checks.
 Coding and posting billable procedures
 Research claims for payments, rejected/denied/voided claims
 Credential physician for their NPI numbers
 Prepare Daily reports and Appeals
 Built mutually respectful relationships with third-party payers, HMOs,
PPOs, Medicare, Medicaid, workers’ compensation (WC) carriers and
independent commercial carriers.
Education
2000 –2000, State College; Orangeburg, SC
 Method of Teaching
2004 – 2005 Midland Technical College; Columbia, SC

3.  Medical Business Education; Certificate
Related Courses: Health Data Classification Systems I (ICD-9-CM, HCPCS and
CPT), Medical Terminology, Health Insurance
 Certification CPC
 Issued by American Academy for Professional Coders (AAPC)
 Certification ICD-10-CM, ICD-10-PCS
Affiliations
2005 – present: American Academy for Professional Coders (AAPC)
2008 – present: American College of Medical Coding Specialist (ACMCS)
2005 – present: Capital Coders
Skills
Skill Name Skill Level Last Used/Experience
ICD-10-CM and ICD-10-PCS
ICD-9-CM and CPT Coding
Expert
Expert
Currently used/2 years
Currently used/8 years
DRG & APG Assignments Expert Currently used/4 years
HIPAA Regulations Expert Currently used/8 years
Insurance Reimbursement/
Collections
Expert Currently used/8 years
Medicare/Medicaid
Reimbursement
Expert Currently used/8 years
Hospital Information Systems Expert Currently used/8 years
Medical, Pharmacology and
Anatomy Terminology
Expert Currently used/4 years
Chart Control, Access and
Storage
Expert Currently used/8 years
Chart Status Tracking and
Assembly
Expert Currently used/8 years
Clinical Data Analysis and
Extraction
Expert Currently used/8 years
Managed Care
Regulations/JCAHO Guidelines
Expert Currently used/4 years