Candace Brooks
Atlanta,GA
Summary
Inpatient and outpatient medical record coding and auditor specialist with ICD-9, ICD-10 and ASC coding expertise. Familiar with commercial and private insurance carriers. Seeking position of increased responsibility and authority. Hands-on professional offering a keen understanding of data confidentiality and HIPAA regulations.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Senior Coding Consultant
St Christopher Hospital For Kids
Philadelphia, PA
12.2015 - 06.2024
- Consistently maintained a 98% accuracy rate assigning ICD-10 and CPT4 codes for inpatient and outpatient charts
- Responsible for performing coding audits on peers
- Guarded against fraud and abuse by verifying all coded data accurately reflected services provided
- Reviewed charts and established correspondence with physicians for clarification of inconsistent documentation within the medical record for optimal coding validation.
DRG QUALITY CONTROL CODER
Ceris
Fort Worth, TX
03.2021 - 03.2023
- Reviewing medical records to determine accuracy of billing through verification of coding and supporting clinical documentation
- Conducting audits to ensure accurate charge capture, enhancing reimbursement and identifying potential savings
- Demonstrated knowledge of ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid with the ability to work independently with minimal supervision and demonstrate initiative
- Performing DRG validation (clinical/coding) reviews of medical records and/or other documentation to determine correct DRG/coding that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided.
CODER III
Piedmont Healthcare
Atlanta, GA
06.2016 - 01.2021
- Consistently maintained a 98% accuracy rate assigning ICD-10 and CPT4 codes for inpatient and outpatient charts
- Guarded against fraud and abuse by verifying all coded data accurately reflected services provided
- Reviewed charts and established correspondence with physicians for clarification of inconsistent documentation within the medical record for optimal coding validation.
Senior Coding Quality Analyst
Northside Hospital
Atlanta, GA
08.2018 - 06.2020
- Responsible for performing DRG audits on Medicare charts for all 3 hospitals within the organization
- Guarded against fraud and abuse by verifying all coded data accurately reflected services provided
- Reviewed charts and correspondence with physicians for clarification of inconsistent documentation within the medical record for optimal coding validation
- Provided medical coding education and updates for the department on a quarterly basis
- Participated in conducting peer educational reviews on coding guidelines, federal laws, and regulations.
Senior Coding Consultant
Himagine Solutions Inc. (formerly Kforce)
Jacksonville, FL
10.2009 - 06.2016
- Assumed full responsibility for consulting at various specialty hospitals (i.e Mayo Clinic and Boston Medical Center) while participating in performing DRG audits on Medicare charts
- Participated in conducting peer educational reviews on coding guidelines, federal laws, and regulations
- Consistently maintained a 98% accuracy rate, assigning ICD-10 and CPT-4 codes for inpatient and outpatient records.
Education
Bachelor of Science - Health Information Management
Temple University
Philadelphia, PASkills
- Health Records Analysis
- Policy Interpretation
- Staff Education
- Shift Supervision
- ICD-10/CPT-4 Codes
- Hospital Consulting
- DRG and APC Audits
- Solid knowledge and understanding of clinical criteria documentation requirements used to successfully substantiate code assignments
Certification
Registered Health Information Administrator, American Health Information Management Association
Timeline
DRG QUALITY CONTROL CODER
Ceris
03.2021 - 03.2023
Senior Coding Quality Analyst
Northside Hospital
08.2018 - 06.2020
CODER III
Piedmont Healthcare
06.2016 - 01.2021
Senior Coding Consultant
St Christopher Hospital For Kids
12.2015 - 06.2024
Senior Coding Consultant
Himagine Solutions Inc. (formerly Kforce)
10.2009 - 06.2016
Bachelor of Science - Health Information Management
Temple University