Antonia Dietrich
Champaign,IL
Summary
Hardworking professional applies official coding conventions and rules established by American Medical Association and Centers for Medicare and Medicaid Services. Confident Medical Coder adheres to data confidentiality and privacy rules in all workflows and promotes dynamic interpersonal skills.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Coding Specialist
Sheakley UniComp
01.2022 - Current
- Reviews outpatient records and interpreted documentation to identify diagnoses and procedures
- Examines documents for missing information to support correct coding
- Performs patient chart audits and provides coding feedback and education to Physicians and Offices as needed
- Ensures compliance with medical coding policies and guidelines; understands application of each code set
- Maintains current knowledge regarding coding and diagnostic procedures
- Works towards compliance in all aspects of coding, participates in compliance activities as requested, and conducts/participates in provider coding reviews and education, as requested
- Maintains strict confidentiality with adherence to HIPAA guidelines and regulations
- Maintains current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols, and third-party billing requirements.
Payment Integrity Specialist
Cotiviti
10.2022 - 05.2023
- Utilized healthcare experience to perform audit procedures that include identifying and defining issues, developing criteria, reviewing, and analyzing evidence with intent to audit standard medium and complex reports
- Leveraged knowledge of client, contract terms and complex claim types
- Made determinations based on prior knowledge, experience of client contract terms with likelihood of recovery acceptance
- Responded to client disputes for claims written
- Provides verification of claims validation and confirmation, in a concise written manner
- Identified and validated overpayments of claims
- Developed and ran custom queries and validate accuracy of current reports used.
- Evaluated large datasets for quality and accuracy
Special Investigation Unit Analyst
Health Alliance Medical Plans
01.2021 - 12.2021
- Conducted data mining activities, data analysis and reports using available tools and internal data warehouse
- Used appropriate sampling methodology, worked with Team to develop an investigative action plan, which included requesting, tracking, and auditing medical records for coding accuracy and documentation requirements
- Reviewed, investigated, documented, and responded to all Fraud, Waste and Abuse issues identified in Healthcare Fraud Shield
- Reviewed HPMS memos, CMS Fraud, Waste, Abuse Alerts, and industry alerts (including the annual OIG Work Plan and Medicare Part D Plan)
- Created reports to assist in medical criteria development and updates based on current clinical literature, standard healthcare practices, State Mandates, CMS Guidelines or as assigned by internal departments to develop payment integrity initiatives
- Worked not only independently but remotely with high productivity statistics
- Facilitated meetings and prepared presentations to share ideas and findings.
Medical Management Intake Coordinator
Health Alliance Medical Plans
01.2015 - 01.2021
- Performed selected prior authorization functions under the supervision of an RN, following department policy and procedure, and forwards the balance to appropriate department resources
- Input all patient data regarding claims and prior authorizations into system accurately
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization
- Works not only independently but remotely with high productivity statistics.
- Verified eligibility and compliance with authorization requirements for service providers
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues
Case Management Assistant
Carle Foundation Hospital
01.2017 - 09.2017
- Assisted Inpatient Coders, Nurse Case Managers and Clinical Social Workers with anything they needed
- Processed requests for Higher Level of Care Transfers for complex cases with Nurse or Doctors accompanying the patient
- Facilitated Care Conferences between a patients care team and the patient and family
- Delivered Medicare Patient Rights notifications for compliance purposes.
- Completed intakes and assessments on clients to determine needs and eligibility for services and public benefits
- Developed and maintained relationships with community organizations and agencies
- Developed and maintained accurate records of programs and services
Customer Solutions Representative
Health Alliance Medical Plans
12.2013 - 01.2015
- Met standards for documentation, answering and follow-up on all benefit, eligibility, network, and claims inquiries from Health Alliance members and providers generated by telephone, walk-in, or written correspondence
- Took action to resolve customer service, claims, or billing complaints
- Referred unresolved complaints to the Customer Service Complaint Resolution Specialist or advised members/providers of the right to appeal
- Educated members and providers regarding a variety of insurance topics, including, but not limited to Healthcare Reform, Exchanges, coordination of benefits and Medicare coordination
- Followed up on customer interactions to maintain customer communication and successfully close resolved issues
- Learned and followed customer service policies and procedures to meet organizational and industry standards
Education
Medical Billing and Coding Certificate -
Purdue University
West Lafayette, IN05.2019
Associate of Science - undefined
Parkland College
Champaign, IL05.2017
High School Diploma - undefined
Tuscola High School
Tuscola, IL05.2000
Skills
- 3M Encoder
- Optum EncodePro & Revenue CyclePro
- Epic Systems
- Data Visualization and Presentations
- Data Mining
- Advanced Microsoft Excel
- General Surgery Coding
- E/M Coding
- Dermatology Coding
- Orthopedic Coding
- Anesthesia and Pain Management Coding
- Gynecological Procedural Coding
Certification
- CPC - Certified Professional Coder
- CPMA - Certified Professional Medical Auditor
Languages
English
Full Professional
Timeline
Payment Integrity Specialist
Cotiviti
10.2022 - 05.2023
Coding Specialist
Sheakley UniComp
01.2022 - Current
Special Investigation Unit Analyst
Health Alliance Medical Plans
01.2021 - 12.2021
Case Management Assistant
Carle Foundation Hospital
01.2017 - 09.2017
Medical Management Intake Coordinator
Health Alliance Medical Plans
01.2015 - 01.2021
Customer Solutions Representative
Health Alliance Medical Plans
12.2013 - 01.2015
Medical Billing and Coding Certificate -
Purdue University
Associate of Science - undefined
Parkland College
High School Diploma - undefined
Tuscola High School
- CPC - Certified Professional Coder
- CPMA - Certified Professional Medical Auditor
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