Seasoned Certified Risk Adjustment Coder with strong communication, organizational and time management abilities. Offering fully credentialed LPN, CRC and ICD10 proficient. Motivated and collaborative with exceptional analytical thinking and problem solving abilities.
CRG's, EPass, HCC, HEDIS, Highmark, TSAk and HHS
Computer Knowledge: 60 wpm and have completed college courses in Microsoft word, Excel, Power Point and Access
Critical thinking skills
Work well independently
ICD-9 coding experience
ICD-10 coding experience
Ensured charting accuracy through precise documentation.
Documented patient information obtained from intake interviews.
Monitored patient's respiration activity, blood pressure and blood glucose levels in response to medical administration.
Risk Adjustment Quality Coder/AuditorDec 2017 to Current Pulse8 － Annapolis, MD
Monitor HCC coding performed by outside vendors by performing quality audits to ensure accuracy.
Conducts chart audits to identify incorrect HCC MA/ACA coding and errors.
prepares reports of findings, following the official coding guidelines including AHA Coding Clinic and other similar authoritative resources.
Validates and abstracts diagnosis codes from provider documentation, entering essential information into the coding platform.
Analyzes and researches provider and vendor HCC MA/ACA coding issues and patterns through medical record review.
Identifies and offers education in relation to HCC MA/ACA coding errors and documentation standards.
Identify HCC MA/ACA coding patterns identified with the audit process and compliance.
Performs Peer Quality Reviews and provides feedback on results
Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current CPT-4, HCPCS II, and ICD-9 materials, the Federal Register, and other pertinent materials. Assists in the preparation of training materials.
Maintains confidentiality and complies with company policy regarding the use and disclosure of protected health information.
Performs related work and projects as required.
Quality Analytic Pullback Team MemberMay 2016 to Current Inovalon － Remote, MI
Conduct medical record reviews for purposes of identifying, confirming, and/or documenting appropriate medical coding;.
Perform quality control re-overreads to ensure accuracy, completeness, and overall high quality of Inovalon's record review processes, including:.
Electronically downloading completed, pre-filled record reviews to assigned computer system and DCD;.
Complete and correct the original, pre-filled review as necessary and note any discrepancies found.
Upload completed quality control reviews and over-read reviews to Inovalon's centralized server system via the Internet, intranet, and associated web portal;.
Conduct Quality Improvement studies and audits under the guidance of the Quality Manager and Director to ensure that high quality medical record reviews are completed with 95% accuracy including performing Quality re-overreads;.
Compiling and tracking data using the identified analysis spreadsheet per project;.
Maintaining communication with Lead and QM in regard to variance and inconsistencies found throughout the review process;.
Perform high quality assessment within project deadline requirements;.
Participate in the Client Audit process including quality re-review of the medical records under question through presentation of data to the Medical Director;.
Participate in other Quality Improvement/Analysis studies as assigned;.
Gather and track data to identify opportunities for process improvement within the company;.
Assist in training processes associated with in-field and/or other medical chart code review staff as necessary and assigned.
PreceptorAug 2014 to May 2016 Inovalon － Remote, MI
Perform quality control over-read reviews of previously completed record reviews to ensure accuracy, completeness, and overall high quality of new or transitioning staff in the Quality Department staff;.
Provide mentoring and feedback to assigned preceptors to establish or enhance knowledge of coding concepts and to ensure a thorough understanding of the same;.
Partner with Quality Leads to ensure a successful orientation period for staff;.
Communicate pertinent feedback to the appropriate Quality Lead and/or Quality Preceptor Lead on a regular basis;.
Participate in the weekly reporting of trends in errors found;.
Be a contributor to the knowledge base items, training events, communications and creation of best practices for the Quality Preceptor team; and.
Attend all meetings and trainings as directed.
Remote Data Review ConsultantMar 2013 to Aug 2014 Inovalon － Remote, MI
Responsible for performing quality control overread reviews of preciously completed record reviews to ensure accuracy, completeness, and quality.
Site Review ConsultantSep 2009 to Mar 2013 Inovalon － Remote, MI
Responsible for accurately and efficiently conduct medical record review/abstractions.
Site Data CollectorFeb 2009 to Sep 2009 Inovalon － Remote, MI
Responsible for scanning records and uploading completed assignments.
Education and Training
License in Practical Nursing2009Kirtland Community College － Roscommon, MI
AAPC Certified Risk Adjustment Coder
AAPC ICD-10 Proficient
State of Michigan License Practical Nurse
Computer Knowledge, Client, diagnosis, documentation, ICD 10, Director, medical coding, medical record review, meetings, mentoring, Access, Excel, office, Power Point, Microsoft word, Nursing, processes, process improvement, coding, Quality, Quality Improvement, quality control, read, reporting, scanning, sound, spreadsheet, 60 wpm, web portal
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Companies Worked For:
Kirtland Community College
Job Titles Held:
Risk Adjustment Quality Coder/Auditor
Quality Analytic Pullback Team Member
Remote Data Review Consultant
Site Review Consultant
Site Data Collector
License in Practical Nursing 2009
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