Alicia Warr
Fort Worth,TX
Summary
Performance-focused Compliance Analyst talented at managing external and internal audits for businesses. Expertise in mitigating risks and interpreting policies. Committed to monitoring compliance with laws, regulations, and policies.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Coding Compliance Auditor
GW Medical Faculty Associates
07.2023 - 05.2024
- Audit documentation and coding to include E/M, Surgical, inpatient and outpatient progress notes, operative reports, encounter forms, and other documentation of procedures and ancillary services performed
- Prepare written reports of audit findings, and recommend corrective action plans as needed
- Meet with physicians and non-physician providers to provide findings and education
- Participate in educational and training programs to ensure correct documentation and coding
- Maintain working knowledge of CMS (Medicare and Medicaid) regulations and Novitas Local Medical Review Decisions (LCD), and National Review Decisions (NCD)
- Familiarity with AMA Coding Guidelines and AHA guidelines
- Review insurance carrier bulletins and healthcare industry periodicals
- Demonstrate diligence, independence and initiative; acted as a resource to other compliance department auditors
Senior Recovery Resolutions Analyst
Optum/UHG
06.2019 - 05.2023
- Perform coding quality audits of inpatient/outpatient facility records to ensure appropriateness and accurate code assignments by Center of Medicare and Medicaid (CMS) guidelines and provide ongoing feedback and analysis of the education needs of the providers, facilities, and staff
- Integrate medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audits
- Coordinate, schedule, and perform documentation and coding audits of outpatient & pro-fee records
- Evaluate the quality of clinical documentation, and identify incomplete or inconsistent documentation that could impact the quality of data being reported
- Responsible for maintaining up-to-date knowledge of coding guidelines as they relate to professional/facility
- Review claims & appeals for compliance with plan guidelines and submit rationale for approval or denial of payment using established guidelines, policy and procedures, and plan directives
- Access appropriate reference materials to verify proper coding
- Develop and coordinate educational and training programs regarding coding elements such as appropriate documentation, accurate coding, coding trends found during chart reviews, third-party audit findings, and annual coding updates
- Perform pre- and post-billing chart reviews to ensure the clinical documentation provides evidence of compliance with coverage requirements, Company policy, and regulatory requirements, including evaluation and management, surgery, radiology, pathology, and medicine
- Maintained an in-depth knowledge of clinical coding processing and documentation standards, guidelines, policies, and procedures
- Prepare accurate, concise, and timely written executive summary of findings and coordinate all provider education sessions
- Perform FWA audits to confirm that coding and medical record documentation is complete, compliant, and accurate, Services are medically necessary and provided within clinical guidelines, and Reimbursement is appropriate
Coding Auditor (Charge Capture- Team Lead)
JPS Health Network
12.2018 - 06.2019
- Company Overview: (Level I Trauma/Teaching Facility)
- Manage the coding, charge entry, and charge review processes for the physician network to ensure accurate charge capture
- Perform periodic compliance audits, and risk assessments and conduct related ongoing compliance monitoring
- Assist health plans in managing relationships with regulatory agencies
- Serve as a companywide resource and liaison on policies, contract issues and provisions, communications, workflow, and quality improvement initiatives
- (Level I Trauma/Teaching Facility)
Revenue Cycle Manager
Sharif Surgical Oncology
09.2017 - 12.2018
- Organize and implement strategies to bill customers, process payments, minimize bad debt, improve cash flow, and manage the overall condition of the company’s receivables
- Manage the operations & revenue cycle functions successfully & achieve financial and productivity goals
- Oversee the daily operations of the billing and follow-up collections team & transmission of claims
- Train, hire, and evaluate front office and billing department staff
- Create appeals processes to dispute denied insurance claims and implement revenue retention processes
- Perform monthly audits to identify billing errors, short payments, overpayments, unpaid claims, & productivity
- Negotiate provider contracts with payors, maintained/updated credentialing
Senior Recovery Auditor
Health Tec Resources
10.2015 - 10.2017
- Perform quality coding audits of multiple specialties
- Knowledge of facility ACEP and Outpatient Coding Guidelines
- Knowledge of AMA, CMS, and OIG regulatory requirements
- Audit and recode multispecialty claims
- Perform CDI Audit of medical record documentation to identify under-coded and up-coded services
- Collaborate with business and technology departments to define deliverables and develop reusable solutions across the organization
- Produce job aids, training material, and instruction manuals for end-users
- Prepare written audit analysis and summary reports, including corrective action necessary to mitigate risk
- Conduct ad hoc coding and billing audits as requested
Coding Specialist
Cergis Billing
12.2012 - 10.2015
- Assign most appropriate diagnosis and procedures to reflect the utilization of resources during patient encounters
- Code claims utilizing ICD-10, ICD-9-CM, CPT, HCPCS codes
- Responsible for auditing coding inputs for Radiology and Pain Management
- Proficient in classifying medical and surgical procedures for billing purposes
- Proficient in applying appropriate modifiers according to CCI/NCCI guidelines and current Medicare LCD
Coding Specialist
Concentra
12.2009 - 12.2012
- Analyzed medical records to accurately code diagnostic and procedural codes in accordance with national coding guidelines and reimbursement requirements
- Consulted with medical providers to clarify missing or inadequate record information and to determine the appropriate codes
Education
Bachelor of Science - Health Information Management
Western Governor’s University
07.2024
Skills
- ICD-10CM-PCS/CPT/HCPCS
- Inpatient Coding
- Outpatient Coding
- Auditing
- Pro Fee Coding
- Provider Education
- Coder Education
- Revenue Cycle Management
- Govt Payers
- Commercial Payers
- MS-DRG
- OPPS
- IPPS
- Risk Assessments
- Evaluation/Management 95
- Evaluation/Management 97
- Epic
- Web Strat
- MD Audit
- 3M/CAC
- Athena Health
- Encoder Pro
- MS Office Suite
- FACETS
- Cerner
- Family Medicine
- OB/GYN
- Gastroenterology
- Pain Management
- Anesthesia
- Radiology
- Emergency Medicine
- Surgical Oncology
- Orthopedics
- Urology
- Finance researching reimbursement knowledge
- Data Analytics
- Regulatory knowledge
- Audit Planning
- Outstanding risk assessment skills
- Understanding of contracts
- Fraud identification
- Financial Data Analysis
Certification
- Certified Professional Coder (CPC), 01239694, 11/2012, AAPC, current
- Certified Outpatient Coder (COC), 10/2016, AAPC, current
- Certified Professional Medical Auditor (CPMA), 11/2016, AAPC, current
Timeline
Coding Compliance Auditor
GW Medical Faculty Associates
07.2023 - 05.2024
Senior Recovery Resolutions Analyst
Optum/UHG
06.2019 - 05.2023
Coding Auditor (Charge Capture- Team Lead)
JPS Health Network
12.2018 - 06.2019
Revenue Cycle Manager
Sharif Surgical Oncology
09.2017 - 12.2018
Senior Recovery Auditor
Health Tec Resources
10.2015 - 10.2017
Coding Specialist
Cergis Billing
12.2012 - 10.2015
Coding Specialist
Concentra
12.2009 - 12.2012
Bachelor of Science - Health Information Management
Western Governor’s University