BeldenMarie Gathman
Summary
- Current experience working in a fast-paced health care setting - Ability to work well remotely, independently and as a team player Always prepared for a change and/or update in policies.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Coding Quality Analyst
Optum-United Healthgroup
11.2022 - Current
- Work Independently with minimal supervision
- Review medical records to ensure accuracy and completeness of diagnosis codes
- Prepare and present feedback to coding staff and management
- Maintain knowledge of coding compliance
- Support process and quality improvement initiatives
- Ancillary Coder 11/24/22-11/04/24
Senior HCC Coding Support Specialist
NorthShore University Healthsystem
10.2019 - 11.2022
- Perform chart review and data analysis focusing on HCC (risk-adjustment) diagnostic coding for Commercial, Medicare, MA plans for IP and OP
- Analyze progress notes, op reports, pathology reports, radiologic studies, and various other health information documents for coding and billing accuracy
- Assign appropriate ICD-10 codes to medical record documentation by applying physician specialty coding rules, third party payor guidelines, APC billing rules and Medicare Policies
- Work closely with physicians to provide educational training in clinical documentation areas that need to be strengthened
- Perform Prospective and Retrospective audits in Epic as well as in QRC Analytics for IM and specialties
- Query providers when the appropriate documentation is missing to support HCC diagnosis in the charge and/or if there is clarification needed on the specificity of the diagnosis
Coding Specialist (profee OP)
Pediatrust-SperoMD
05.2019 - 10.2019
- Performed initial charge review to determine appropriate ICD-10 and CPT codes to be used to report physician services to third party payers
- Reviewed and Interprets all progress notes, discharge summaries and charge documents to determine services provided and accurately assign CPT and ICD 10 coding according to compliance with third party and regulatory guidelines
- Entered appropriate data into Epic
- Communicated with providers regarding any coding discrepancies found
- Worked in conjunction with other CBO staff to answer all inquiries regarding coding and billing for all client services
- Monitored and followed up with providers to ensure all appropriate E/M, Procedural and Lab services that can be billed are captured and coded
HEDIS Quality Auditor
Medix-BCBS
01.2019 - 05.2019
- Reviewed medical records for HEDIS data abstraction at 95%
- Inputted data via Quality Spectrum Hybrid reporter (QSHR) software
- Medical reconciliation performed on critical cases
- Reviewed data entry for accuracy, compliance to determine if quality measures have been met
- Coordinated medical record submission from various vendors
Senior HCC Coder
Cigna-Alegis Care
02.2013 - 10.2018
- Reviewed documentation and code adhering to the HCC value, ICD 10-CM Guidelines and HEDIS measure for Medicare, Medicaid and MA OP
- Query providers regarding any discrepancies found
- Maintained a 95% accuracy rate with a 10% monthly audit
- Worked primarily remotely, reviewed audit results monthly in the office with superiors regarding productivity accuracy and how to improve
Server/Hostess/Cashier
Lou Mitchell's Breakfast Restuarant
12.1998 - 01.2018
- Demonstrated strong multitasking skills by managing multiple tables simultaneously without compromising service quality.
- Served food and beverages promptly with focused attention to customer needs.
- Worked with POS system to place orders, manage bills, and handle complimentary items.
- Bussed and reset tables to keep dining room and work areas clean.
- Provided attentive service during high-volume periods without sacrificing attention to detail or guest rapport.
- Handled cash transactions accurately, contributing to balanced daily financial reports.
- Resolved customer complaints promptly and professionally to maintain positive reputation.
- Explained menu items and suggested appropriate options for food allergy concerns.
- Developed strong rapport with regular customers through genuine hospitality efforts leading to repeat business.
Server/Hostess/Cashier
Gulliver's Restuarant
06.2001 - 03.2010
- Demonstrated strong multitasking skills by managing multiple tables simultaneously without compromising service quality.
- Served food and beverages promptly with focused attention to customer needs.
- Worked with POS system to place orders for in house and delivery, manage bills, and handle complimentary items.
- Collaborated with team members during busy shifts for efficient workflow and excellent guest experiences.
- Maintained the Register from open to close
- Cashing in and out the servers and delivery drivers
- Performed opening and closing duties, ensuring the dining area was prepared for seamless service transitions.
- Maintained a clean and orderly dining area for an enjoyable guest experience.
Skills
- Multitasking proficiency
- Attentiveness
- Friendly and professional approach
- Quick and efficient
- Excellent Communication abilities
- Handles Pressure well
Certification
- CPC, Certified Professional Coder
- CRC, Certified Risk Adjustment
Systemsused
- NextGen
- EPIC
- 3M CRS
- IMO
- QSHR
- QRC Analytics
- Optum 360 Encoder
Timeline
Coding Quality Analyst
Optum-United Healthgroup
11.2022 - Current
Senior HCC Coding Support Specialist
NorthShore University Healthsystem
10.2019 - 11.2022
Coding Specialist (profee OP)
Pediatrust-SperoMD
05.2019 - 10.2019
HEDIS Quality Auditor
Medix-BCBS
01.2019 - 05.2019
Senior HCC Coder
Cigna-Alegis Care
02.2013 - 10.2018
Server/Hostess/Cashier
Gulliver's Restuarant
06.2001 - 03.2010
Server/Hostess/Cashier
Lou Mitchell's Breakfast Restuarant
12.1998 - 01.2018
- CPC, Certified Professional Coder
- CRC, Certified Risk Adjustment
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