ALICIA MCCLENDON
Atlanta,GA
Summary
Certified Professional Coder with over five years of experience in accurately assigning codes and modifiers, achieving a 98% accuracy rate through meticulous medical records documentation. Expertise in reviewing charges and abstracting information from medical records to assign appropriate ICD-10, CPT, and HCPCS codes for efficient internal coding and billing processes in hospital emergency rooms and outpatient acute care settings. Proficient in translating outpatient medical records into CPT and ICD-10 billing formats to ensure timely reimbursement for rendered medical services across hospitals and clinics. Committed to maintaining high standards of accuracy and efficiency in coding practices to support optimal revenue cycle management.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Critical Care Coder II
Advocate Aurora Health System
Remote
01.2025 - Current
- Accurately codes high-acuity cases, including critical care, procedures, and evaluation and management (E/M) services, using ICD-10 and CPT codes.
- Reviews medical records for compliance with federal, state, and insurance regulations, maintaining a 95% or higher accuracy rate.
- Provides ongoing feedback to clinicians regarding documentation improvement (CDI) to ensure all billable services are captured, specifically regarding complex diagnoses
Risk Adjustment Medical Coder- Remote
Judge Group (Ciox)
11.2023 - 01.2025
- Accurately review and interpret coding and analyze medical record documentation for diagnosis accuracy, documentation, and Hierarchical Coding Code abstraction.
- Reviews may include inpatient, outpatient treatment, and professional medical services, according to ICD-10 coding guidelines and risk adjustment model regulations.
Registry Patient Access Rep (PRN)- Atlanta GA
EMORY HEALTHCARE
Atlanta, GA
09.2021 - Current
- Obtains demographic and insurance information for preregistration/registration on all patients.
- Communicates hospital’s financial counseling policies.
- Schedules procedures/follow up appointments.
- Provides patients with exam information.
- Communicates with physicians, nursing units, and departments.
E/M Denials Coder II
PIEDMONT CARDIOLOGY OF ATLANTA
Atlanta, GA
09.2020 - 01.2025
- Apply Coding corrections and adjustments as appropriate to ensure claims are paid.
- Reviews outstanding claims for appeals, adjustments, or re-code based on review of medical records, assigns appropriate ICD-10, CPT, and HCPCS codes.
- Collaborate across Revenue Cycle departments to ensure claims are resolved in a timely manner.
Revenue Cycle Rep II
WELLSTAR HEALTH SYSTEM
Atlanta, GA
03.2019 - 08.2020
- Reviews outstanding claims for appeals, adjustments, or re-code based on review of medical records, assigns appropriate ICD-10, CPT, and HCPCS codes.
- Collaborates with peers and upper management in tracking possible contract issues, preauthorization, denial trends, or credentialing issues.
- Extracts information from Nursing notes, Pathology and lab reports.
- Assists with special projects to meet departmental monthly collections goals.
- Exceeds departmental standards for quality, productivity, and accuracy.
Financial Counselor
SHEPHERD CENTER
Atlanta, GA
11.2015 - 03.2019
- Served as liaison between clinical staff and insurance carriers to ensure medical necessity measures were met.
- Obtained insurance verification, referrals, and pre-certification for outpatient/in-patient services.
- Reviewed claims for missing charges, modifiers and corrected coding edits.
- Collaborated with providers to bridge documentation gaps to support medical necessity for ICD-10, CPT, and HCPCS code assignment.
Insurance Verification Rep
CHILDREN’S HEALTHCARE OF ATLANTA
Atlanta, GA
12.2013 - 01.2016
- Coordinated all aspects of scheduling referrals received via phone, fax, and email.
- Linked referral to appropriate encounter and monitor for procedure for modification.
- Performed insurance verifications of insurance benefits for patients prior to visits to ensure proper collections of patient responsibilities.
- Interviewed patients and families to obtain complete demographic and financial information and accurately enter data into electronic medical record.
- Entered facility and physician charges daily with 100% accuracy.
Patient Service Coordinator
DAVITA DIALYSIS
Atlanta, GA
04.2011 - 11.2013
- Obtained patient demographic and insurance information for pre-registration.
- Scheduled, communicated and collected patients’ financial responsibilities prior to service being rendered.
Education
CPC – Certified Professional Coder -
AAPC
Bachelor of Science - Human Services
WESTERN GOVERNORS UNIVERSITY
01-2024
Skills
- ICD-10 and CPT coding expertise
- Medical record auditing
- Documentation improvement feedback
- Electronic medical record management
- Critical care expertise
Certification
- Certified Professional Coder, AAPC
- Forklift Certified
Personal Information
Title: Certified Professional Coder
Timeline
Critical Care Coder II
Advocate Aurora Health System
01.2025 - Current
Risk Adjustment Medical Coder- Remote
Judge Group (Ciox)
11.2023 - 01.2025
Registry Patient Access Rep (PRN)- Atlanta GA
EMORY HEALTHCARE
09.2021 - Current
E/M Denials Coder II
PIEDMONT CARDIOLOGY OF ATLANTA
09.2020 - 01.2025
Revenue Cycle Rep II
WELLSTAR HEALTH SYSTEM
03.2019 - 08.2020
Financial Counselor
SHEPHERD CENTER
11.2015 - 03.2019
Insurance Verification Rep
CHILDREN’S HEALTHCARE OF ATLANTA
12.2013 - 01.2016
Patient Service Coordinator
DAVITA DIALYSIS
04.2011 - 11.2013
CPC – Certified Professional Coder -
AAPC
Bachelor of Science - Human Services
WESTERN GOVERNORS UNIVERSITY