Ayanna Opoku
The Bronx,NY
Summary
Accomplished Medical Coder Specialist at D&S Medical Auditing and Compliance Services, adept at ensuring coding accuracy and compliance with ICD-9 guidelines. Demonstrated strong communication and time management skills while educating providers and reducing claim discrepancies, contributing to improved documentation and coding practices.
Overview
2
2
years of professional experience
1
1
Certification
Work History
HCC Medical Coder Specialist
D&S Medical Auditing and Compliance Services
Brooklyn, NY
05.2024 - Current
- Interpreted provider’s progress notes and assign the appropriate diagnostic and procedural codes for accuracy
- Assigned and make sure diagnosis codes are supported by the documentation and ensure adherence with ICD-10 Guidelines for Coding and Reporting.
- Assigned the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted time frame (HCC).
- Reviewed for clinical indicators and query providers to capture the severity of illness of the patient.
- Kept track of provider’s coding pattern to reduce any insurance fraud claims, clarifying information or diagnosis by communicating with healthcare providers as well as assigning and identifying the information by using and coding the accurate ICD-10-CM-PCS, HCPCS and CPT-4 codes.
- Educated providers on understanding documentation criteria guidelines; provide educational assistance and/or serves as a resource regarding coding and documentation issues, reviewed encounter form to ensure compliance and reporting information.
- Coded services visit using the EMR database and assigning the appropriate diagnosis and procedural codes.
HCC Medical Coder (Contract Remote)
CAC Solutions
Jamaica, NY
05.2023 - 05.2024
- Support all strategic tasks associated with the Risk Adjustment process
- Communicate with physicians and office staff on records needed for chart review
- Educate practitioners / clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process
- Serve as a Subject Matter Expert and resource in Clinical Documentation
- Perform chart reviews for appropriateness and completeness of diagnostic codes based on CMS HCC categories. Coding using ICD-10 diagnosis.
- • Review medical records and super-bill documentation for accuracy including physician notes in medical record compared to procedure codes, diagnosis code and modifiers submitted for billing on charge form documents using EMR and EPIC.
- Interact with a variety of internal and external healthcare executives, physicians, provider office personnel and hospital staff to review E/M level for accuracy and sufficiency.
- Knowledge and applying correct ICD-10 diagnosis codes and CPT, HCPCS codes for Emergency Room, E/M levels, Outpatient coding and same day surgery records in a hospital setting
- Perform, identify and resolve any claim delay issues that impact billing, collection and coding activities from different departments throughout the hospital.
- Research CMS Guidelines and CCI edits to resolve issues for Coding review in order to finalize accounts to ensure coding accuracy.
- Verified health care charges against established rates for diagnosis, treatment, services, and supplies; maintains patient accounts via Eagle Gold, EPIC and GE Centricity billing system, using standard industry codes to facilitate physician reimbursement from payers.
- Review and interpret payer remittances to determine appropriate action to be taken on denied claims based on basic proficiency in diagnosis coding (ICD-10) and procedural coding (CPT) may resubmit for coding correction.
- Trained EPIC end users how to use the Epic Hyperspace System by following a curriculum developed by Principal Trainer. Provided assistance with pre and post Go-Live support.
- Responsible for identifying, evaluating, analyzing and recommending changes in support of EPIC including ongoing production maintenance.
- Collaborate with physicians and internal staff in development of improved capabilities in the areas of documentation, coding and compliance issues.
- Correct inaccurate data as needed, reviews and evaluates existing coding and abstracted policies, policies, procedures and government guidelines to ensure compliance with various regulation, coding policies and third party payer requirements.
- Adheres to clean claims act and HIPAA policy and procedures.
- Analyze and reconcile claims to ensure medical necessity of services is documented, resolve coding and billing discrepancies problems regarding coding and compliance issues.
- Review and analyze information contained in the medical records to ensure accurate use of ICD-10-CM and CPT codes can be assigned for principal diagnosis, complications, procedures and surgery codes.
Education
High School Diploma -
The Bronxwood Preparatory Academy
The Bronx, NYNursing
Hostos Community College
Bronx, NYSkills
Time Management
Dedication
Multitask
Good communication
Certification
AAPC - CPC
Member ID: 02269105
Timeline
HCC Medical Coder Specialist
D&S Medical Auditing and Compliance Services
05.2024 - Current
HCC Medical Coder (Contract Remote)
CAC Solutions
05.2023 - 05.2024
High School Diploma -
The Bronxwood Preparatory Academy
Nursing
Hostos Community College