Florisa Sim

E/M Code Assignment: Selects appropriate Evaluation and Management (E/M) codes for outpatient encounters based on complexity of medical decision-making, history, examination, and time.

CPT Code Abstracting: Assigns CPT, HCPCS, and modifier codes for procedures, surgeries, and treatments performed by healthcare providers.

Medical Chart Auditing: Reviews patient medical records to verify that all documented services are accurate, complete, and support the codes chosen.

Medical Coder - Global Healthcare Resource - Alabang, Philippines

(2024-11 - 2026-04)

• E/M Code Assignment: Selects appropriate Evaluation and Management (E/M) codes for outpatient encounters based on complexity of medical decision-making, history, examination, and time.
• CPT Code Abstracting: Assigns CPT, HCPCS, and modifier codes for procedures, surgeries, and treatments performed by healthcare providers.
• Medical Chart Auditing: Reviews patient medical records to verify that all documented services are accurate, complete, and support the codes chosen.
• Provider Collaboration: Consults directly with physicians and clinical staff to clarify documentation gaps and improve future charting.
• Compliance Maintenance: Adheres to federal, state, and payer-specific regulations to prevent billing fraud, overpayment, or claim denials.
• Applies NCCI (National Correct Coding Initiative) edits and Medically Unlikely Edits (MUEs) to ensure correct code pairing and prevent unbundling errors.
• Follows current CMS guidelines and payer-specific coding policies to ensure claims meet reimbursement and compliance standards.
• Monitors annual ICD-10-CM, CPT, and CMS coding guideline updates and revisions, applying changes promptly to maintain accurate, compliant coding.
• Performs detail-oriented quality audits of coded charts, identifying discrepancies and recommending corrective action to reduce recurring coding errors.
• Serves as coding consultant to care providers; researches and resolves complex coding queries.
• Maintains strict compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Medical Coder - Optum Health - Makati, Philippines

(2023-06 - 2024-07)

• Analyzed medical records and assigned codes for Evaluation and Management (E/M), ICD-10-CM, CPT, HCPCS, and modifiers.
• Coded and abstracted patient encounters, including diagnostic and procedural information, reportable elements, and complications.
• Audited clinical documentation and coded data, applying a detail-oriented approach to validate that documentation supported services rendered for reimbursement and reporting.
• Applied NCCI edits and CMS guidelines, along with payer-specific coding and billing requirements, to ensure accurate and compliant code assignment.
• Conducted routine coding audits to identify trends in errors and support continuous quality improvement.
• Researched, analyzed, and recommended corrective action plans to resolve discrepancies and prevent future coding errors.
• Served as coding consultant to care providers, following established coding conventions.
• Identified documentation gaps in provider notes and gave constructive feedback to physicians to improve coding accuracy and compliance.
• Maintained compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Medical Coder - Shearwater Health - Makati, Philippines

(2022-02 - 2023-06)

• Analyzed medical records and assigned codes for Evaluation and Management (E/M), ICD-10-CM, CPT, HCPCS, and modifiers.
• Ensured codes were assigned correctly and sequenced appropriately per CMS guidelines and payer-specific insurance regulations.
• Applied NCCI edits to identify and prevent improper code pairing and unbundling prior to claim submission.
• Reviewed and verified documentation supporting diagnoses, procedures, and treatment outcomes with strong attention to detail.
• Performed internal auditing of coded charts to ensure accuracy and completeness before final submission.
• Maintained a tracking system for coded charts and ensured timely work completion.
• Implemented strategic procedures and evaluation methods to ensure accurate, compliant coding outcomes.
• Flagged documentation gaps and offered constructive feedback to providers to support accurate, complete charting.
• Maintained compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Covid Response Nurse / Vaccination Nurse - Uniteam Medical Assistance LLC / Seha - Dubai / Abu Dhabi, UAE

(2020-04 - 2021-06)

• Promoted and enforced universal hygiene standards, infection control protocols, and safety procedures on medical premises.
• Verified proper identification of every individual prior to vaccination, swabbing, and blood collection.
• Monitored clients' medical status, signs, and symptoms, reporting findings to the supervisor or medical director.
• Provided direct client care including medical examinations, treatment of communicable infectious diseases, and implementation of medical orders.
• Documented medical consultations, assessments, and treatment plans in accordance with agency policy and applicable regulations.

Medical Coder - Magrabi Eye Day Care Center - Al Ain, UAE

(2017-06 - 2019-06)

• Accurately coded patient medical records to the highest level of specificity for diagnoses, injuries, and operations using ICD-10-CM (2015), CPT (2012), and HCPCS code sets for billing and compliance purposes.
• Coded same day surgery (ambulatory/outpatient surgical) encounters at this day care surgery center, including pre-operative, operative, and post-operative documentation for ophthalmic procedures such as cataract extraction, phacoemulsification, and other same-day eye surgeries.
• Applied CMS guidelines and payer-specific requirements (HAAD, Thiqa, Daman, NAS, ADNIC, Nextcare) when assigning and validating codes.
• Applied NCCI edits to check code pairing and prevent billing errors or claim rejections.
• Ensured complete medical record documentation — chief complaints, history, examination, diagnosis, and plan — to support accurate medical decision-making and E/M level assignment.
• Queried providers and clinical staff on insufficient or unclear documentation, following a proper escalation standard, and delivered constructive feedback to close recurring documentation gaps.
• Conducted detail-oriented internal audits of coded claims to ensure adherence to company policy and regulatory/accrediting body standards.
• Followed up on insurance claim denials, exceptions, and exclusions in a timely manner; resubmitted rejected or partially rejected claims with proper justification.
• Maintained working knowledge of anatomy, physiology, medical terminology, disease processes, and surgical techniques through continuing education, AAPC monthly tests, webinars, and UAE conferences.
• Experienced in Tasneef JAWDA Data Certification, DAMAN, and JCI audits.
• Maintained strict confidentiality of patient, employee, and administrative information.

Trainee Medical Coder - Al Noor Hospital / Mediclinic - Al Ain, UAE

(2016-03 - 2016-06)

• Accurately assigned ICD-10-CM and CPT-4 codes and sequenced diagnoses, procedures, and supplies per patient medical records, applying CMS coding guidelines under supervision.
• Provided supportive diagnosis coding for laboratory and radiology procedures.
• Practiced detail-oriented chart review to build foundational auditing and NCCI-edit awareness ahead of full coder responsibilities.

Nursing Assistant (Ward Clerk) - Al Noor Hospital / Mediclinic - UAE

(2012-03 - 2017-01)

• Assisted the assigned doctor daily in the OPD clinics department.
• Oriented patients on admission, surroundings, and how to call for help.
• Ensured patient safety in the unit and reported incidents or unsafe practices to the Staff Nurse/Head Nurse.
• Assisted in moving, positioning, ambulating, transferring, and lifting patients; escorted patients between units and upon discharge.
• Coordinated scheduling of patient appointments at the OPD Clinics.
• Followed infection control and facility safety policies (EHSMS) in accordance with hospital guidance.

Auxiliary Nurse - Downsvale Nursing Home - Dorking, Surrey, UK

(2008-12 - 2011-04)

• Ensured patients were kept as comfortable as possible; performed activities of daily living such as washing, dressing, and feeding.
• Performed minor medical procedures such as colostomy care.
• Administered oral medication safely, monitored patient responses, and reported related incidents promptly.
• Positioned patients to promote comfort, reduce risk of skin breakdown, and support healing.
• Demonstrated safe handling and proper use of equipment, including hoists.
• Maintained a safe environment by following infection control policies and applying patient safety measures.

Bachelor of Science in Nursing - Nursing - St. Jude College and Baguio Central University (2003 - 2008)

Bachelor of Science in Commerce - Management - Saint Louis University (1997 - 2001)

The Sisters of Mary School (1993 - 1997)