ANNETTE HICKS
Madison
Summary
Proactive and results-driven professional with extensive experience in multi-specialty medical coding, clinical auditing, charge entry, billing and payment posting, and refund procedures. Skilled in leading large teams to perform complex coding tasks, driving metric-based results while focusing on interdepartmental collaboration and process optimization. Committed to confidentiality, compliance, and accuracy, with a proven track record of handling complex clients, facility needs, and meeting targeted goals. Known for innovative leadership, keen attention to detail, and a dedication to contributing expertise to dynamic healthcare organizations.
Overview
15
15
years of professional experience
Work History
Regional Corporate Inpatient Coding Manager
Tenet Healthcare
02.2024 - Current
- Led training and development programs for Inpatient Coding Coordinators, Site Supervisors, Assistant Global Managers, and DNFC Specialists, ensuring team proficiency in meeting company standards and improving coding accuracy
- Optimized workflows using Lean Six Sigma methodologies, driving improvements in operational efficiency, productivity, and coding accuracy across teams
- Fostered cross-departmental collaboration with HIM and Auditing teams to maintain accurate DRGs, MS DRGs, and SOIs, ultimately supporting maximized facility reimbursements
- Managed and monitored coding operation budgets (FTE) for 10 Trauma Level II/III Facilities, consistently aligning financial resources with organizational priorities
- Tracked and analyzed AR performance to reduce KPIs, improving coding turnaround time and contributing to the efficiency of the revenue cycle
- Proficient with the implementing CAC technologies and protocols improving charts per hour and quality standards
- Attending DNFC/B meetings accountable for DNFC performance, reporting, and follow-up to leadership
- Maintaining Coding status of .5 Days to meet weekly targets
Coding Operations Manager
St Peter’s Health Partners
03.2023 - 02.2024
- Managed SPHPMA coding staff to ensuring optimal coding of medical records utilizing ICD-10-CM, CPT-4 Procedure Codes, the use of Correct Coding Initiative (CCI) edits and the 3M software tool as well as payer and industry standards
- Developed all internal coding training throughout SPHPMA, including coders imbedded in practice offices
- Develops and implements systems/methodologies to monitor the quality and effectiveness of coding practices in support of the SPHPMA Compliance Plan
- Managing coder work queues ensuring balanced coder responsibilities and monitoring Epic coding dashboards
- Is responsible for periodic assessment, monitoring and auditing of quality and accuracy of all coder’s work
- Collaborates with Revenue Integrity to recommend and implement changes to ensure documentation integrity and optimal reimbursement for services
- Collaborates with relevant committees and EPFS on denial prevention
- Participates in Trinity-wide work groups, training, and other efforts to address appropriate coding and documentation
- Maintains an awareness of laws and regulations, keeping abreast of current changes that may affect health care systems through personal initiative, seminars, training programs and peer contact to stay current
- Participates in and/or provides guidance in developing analytics for tracking and trending ensuring a proactive approach to identifying and correcting coding deficiencies
Regional Coding Manager
R1RCM
Indianapolis
06.2018 - 02.2023
- Company Overview: Indianapolis, IN
- Develop and Train Site Coding Managers and Assistant Global Managers as well as Coder III’/IIs to ensure Coders meet all company standards, including 30/60/90 ramp up
- Supervises daily workflow and assignments ensuring daily productivity and compliance is maintained
- Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes
- Maintains knowledge of and complies with coding guidelines and reimbursement reporting requirements
- Solves and assists with complex coding problems
- Obtains acceptable productivity/quality rates as defined per coding policy
- Audit Coding Teams to design and identify strategic initiatives, such as performance measures validation of coded claims prevalence of diseases, and treatments and adherence to policies and procedures to ensure compliance
- Presents audit findings to Clients and Providers
- Maintains daily and weekly AR Reporting regarding Coding table space, as well as reduce KPI
- Indianapolis, IN
Coder I
Episource
04.2018 - 06.2018
- Company Overview: Remote
- Review and analyze provider documentation, while focusing on compliance with CMS Rules and Regulations to capture Risk Adjusting (HCC) diagnoses
- Abstract and review Inpatient/Outpatient medical records for ICD-10 CM diagnosis while ensuring code assignment is supported by provider documentation
- Conduct clinical quality audits and support NCQA requirements and HEDIS Measurements
- Proficient at writing AHIMA complaint physician queries and adept at comparing documentation and code assignment
- Also query physician when documentation is inadequate, ambiguous, or conflicting
- Average coding quality standard of greater than 95% accuracy per monitoring period
- Remote
Medical Management I
Anthem BCBS/BCForward
Indianapolis
03.2018 - 06.2018
- Company Overview: Indianapolis, IN
- Contract position with Indiana Anthem Medicaid Utilization Management Prior Authorization Government Programs
- Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
- Conducts clinical screening process by verifying correct coding per CCI
- Refers cases requiring clinical review to a nurse reviewer, and handles referrals for specialty care
- Act as liaison between Medical Management and internal departments including responding to telephone and written/faxed inquiries from clients, providers and in-house departments as well as verifying Provider Credentialing status
- Indianapolis, IN
Clinical Support Analyst
Availity LLC
Indianapolis
06.2016 - 10.2017
- Company Overview: Indianapolis, IN
- Interviewed customers, gathered appropriate details to thoroughly understand their needs and their workflow and created individual processes
- Reviewed and analyzed business rules, edits, and bridged routines to meet payer guidelines
- Identified patterns of issues occurring within data
- Coding and auditing inpatient and outpatient records for various facilities
- Performed ongoing analysis of medical record charts for the appropriate coding compliance
- Answer coding and abstracting questions from clients as well as internal staff
- Update and maintain existing rules, regulations, and edits, Built and maintained a 'world class' rules engine to drive all Availity products with a Prior Authorization concentration
- Utilized best practices and proven data techniques to proactively develop editing rules and requirements
- Participate in initiatives to improve the quality and content of rule data
- Performed comprehensive, on-going review of all providers 835, 837, & HL7 Feed results to further assist with the development of the requirements for the comprehensive Availity rules
- Indianapolis, IN
RCS Analyst
IU Health
Indianapolis
09.2015 - 06.2016
- Company Overview: Indianapolis, IN
- Primary responsibilities included Posting insurance payments as well as balancing payments/batches
- Worked closely with the insurance specialist, patient account collector, and/or other team members to resolve patient issues
- Experienced working with multiple insurance carriers including working with daily deposits as well as month end balances
- Indianapolis, IN
Patient Accounts Billing Coordinator
University of Illinois Medical Center
Chicago
07.2014 - 09.2015
- Company Overview: Chicago, IL
- Managed Inpatient & Outpatient accounts receivable balances, inclusive of billing and collections procedures
- Ensured proper controls adhered to for accuracy and timeliness of billing
- As well as maintaining accurate patient billing files
- Closed out all month-end deposits and account receivable requirements within 5 business days of each fiscal month ending date
- Handled and maintained Medicaid Billing and multiple Work Queues to ensure timely Medicaid Filing
- Chicago, IL
Prior Authorization Denial Coordinator
Edgewater System for Balanced Living
Gary
03.2010 - 07.2014
- Company Overview: Gary, IN
- Developed data tracking system for analysis and reporting Prior Authorization approvals, denials, and suspensions
- Assured timely and effective Prior Authorization submission which maximized managed care and other payer reimbursements
- Served as the primary liaison for managed care, improving submission processes and maximizing reimbursement
- Served as lead knowledge base expert for the managed care process and provided information to Clinicians as well as give in-services to new Clinical staff
- Ensured compliance with federal and state rules and regulations
- Posted Payments, Billing duties, as well as any Special Projects
- Monitor billing and medical policy notices from all payers
- Assigned and sequenced codes accurately based on clinical documentation
- Assigned appropriate discharge disposition
- Gary, IN
Education
AHIMA CERTIFIED CODING SPECIALIST - ICD-10 Professional Medical Coding & Billing
Ivy Tech
Indianapolis, IN01.2018
MEDICAL CODING AND BILLING with Honors -
Illinois Health And Human Services Technical Training
Chicago, IL07.2006
MEDICAL BILLING INSURANCE with Honors -
South Suburban College
Chicago, IL12.2005
Bachelor of Science - LIBERAL STUDIES, SOCIAL AND BEHAVIORAL SCIENCES
Knoxville College
Knoxville, TN12.2002
Skills
- Athena
- Pluto
- Facets
- Macess
- Salesforce
- CAC
- 3M Encoder
- EPIC
- CENER
- IDX Billing Application HPF
- Inpatient coding
- Outpatient coding
- Physician coding
- Charge entry
- Clinical auditing
- Investigation
- Provider Queries
- DRG/MS-DRG
- HCC Coding
- Risk Adjustment Hierarchical Condition Category Coding
- Medicare Ambulatory Payment Classification (APC) code abstracting
- CMS Guidelines
- HEDIS Measurements
- ICD-10 Coding
- Billing
- Agile
- Scrum
- JIRA
- Confluence
- Professional billing
- Hospital billing
- Physician billing
- Collection procedures
- Financial reimbursement
- Insurance claim adjudication
- Business correspondence
- Letters
- Reports
- Appeals
Timeline
Regional Corporate Inpatient Coding Manager
Tenet Healthcare
02.2024 - Current
Coding Operations Manager
St Peter’s Health Partners
03.2023 - 02.2024
Regional Coding Manager
R1RCM
06.2018 - 02.2023
Coder I
Episource
04.2018 - 06.2018
Medical Management I
Anthem BCBS/BCForward
03.2018 - 06.2018
Clinical Support Analyst
Availity LLC
06.2016 - 10.2017
RCS Analyst
IU Health
09.2015 - 06.2016
Patient Accounts Billing Coordinator
University of Illinois Medical Center
07.2014 - 09.2015
Prior Authorization Denial Coordinator
Edgewater System for Balanced Living
03.2010 - 07.2014
AHIMA CERTIFIED CODING SPECIALIST - ICD-10 Professional Medical Coding & Billing
Ivy Tech
MEDICAL CODING AND BILLING with Honors -
Illinois Health And Human Services Technical Training
MEDICAL BILLING INSURANCE with Honors -
South Suburban College
Bachelor of Science - LIBERAL STUDIES, SOCIAL AND BEHAVIORAL SCIENCES
Knoxville College
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