CHA'VONDA BROWN
Houston,Texas
Summary
Experienced professional skilled in managing and organizing medical records, ensuring accuracy and maintaining strict confidentiality. Demonstrated expertise in enhancing data management processes, fostering team collaboration, and consistently achieving outstanding results. Proficient in utilizing electronic health record systems, coding procedures, and ensuring compliance with healthcare regulations. Recognized for exceptional adaptability and reliability in dynamic healthcare environments.
Overview
10
10
years of professional experience
3
3
Certification
Work History
Medical Records Technician (Inpatient Coder)
Department of Veterans Affairs
08.2023 - Current
- Abstracting medical record data and assigning codes using current clinical classification systems appropriate for the type of care provided
- Assigning codes to documented patient care encounters covering the full range of health care services provided
- Performing a comprehensive review of the patient health record to abstract medical, surgical, ancillary, demographic, social, and administrative data to ensure complete data capture
- Assisting facility staff with documentation requirements to completely and accurately reflect the patient care provided; provides technical support in the areas of regulations and policy, coding requirements, resident supervision, reimbursement, workload, accepted nomenclature, and proper sequencing
- Ensures provider documentation is complete and supports the diagnoses and procedures coded
- Utilizing the facility computer system and software applications to correctly code, abstract, record, and transmit data to the national VA database in Austin
- Conducting re-reviews of codes abstracted for patient encounters (inpatient) identified by the VERA committee to determine if based on the documentation the specific VERA coding requirements were followed; corrects coding as needed to ensure proper patient classification in the VERA program
- Identifying the principal diagnosis and principal procedure (when applicable) for every inpatient discharge; also identifies significant complications and/or co-morbidities treated or impacting treatment to correctly determine the proper Diagnosis Related Group (DRG)
Medical Records Technician (Inpatient Coder)
Department of Veterans Affairs
09.2022 - 08.2023
- Abstracting medical record data and assigning codes using current clinical classification systems appropriate for the type of care provided
- Assigning codes to documented patient care encounters covering the full range of health care services provided
- Performing a comprehensive review of the patient health record to abstract medical, surgical, ancillary, demographic, social, and administrative data to ensure complete data capture
- Assisting facility staff with documentation requirements to completely and accurately reflect the patient care provided; provides technical support in the areas of regulations and policy, coding requirements, resident supervision, reimbursement, workload, accepted nomenclature, and proper sequencing
- Ensures provider documentation is complete and supports the diagnoses and procedures coded
- Utilizing the facility computer system and software applications to correctly code, abstract, record, and transmit data to the national VA database in Austin
- Conducting re-reviews of codes abstracted for patient encounters (inpatient) identified by the VERA committee to determine if based on the documentation the specific VERA coding requirements were followed; corrects coding as needed to ensure proper patient classification in the VERA program
- Identifying the principal diagnosis and principal procedure (when applicable) for every inpatient discharge; also identifies significant complications and/or co-morbidities treated or impacting treatment to correctly determine the proper Diagnosis Related Group (DRG)
Medical Records Technician (Inpatient Coder)
Department of the Navy
09.2019 - 09.2022
- As a Medical Records Technician at NMCCL, assigns codes to documented inpatient encounters covering the full range of health care services
- Applies advanced knowledge of medical terminology, anatomy; physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection
- Selects and assigns codes from the current version of several coding systems to include current versions of the MHS and DHA coding guidelines, ICD, DRG, PCS and POA
- Adheres to accepted coding practices, guidelines and conventions when choosing the most appropriate diagnosis, operation, procedure, ancillary, or Evaluation and Management code to ensure ethical, accurate, and complete coding
- Monitors ever-changing regulatory and policy requirements affecting coded information for the full spectrum of services provided by the NMCCL
- Adheres to meeting the DHA coding productivity, timeliness and accuracy metrics
- No more than 3 time in a calendar year coder falls below 97% accuracy; Codes 3-4 inpatient records/hour or greater if possible/daily, 20-25 weekly and 400 monthly; Ensures all assigned inpatient encounters are coded within the 30-day timeframe
- Maintains coding credentials required for the position
- Dependable in performing job-related tasks, finishing assigned projects, meeting deadlines and appointments
- Contributes to positive working relations and supports departmental and mission goals
- Works as a team player with other department personnel
- Assist with departmental workload when special projects are assigned
- Demonstrates active listening skills and effectively attends to customers and staff members; Communicates both verbally and in writing, in an accurate, clear, concise, and professional manner with internal and external stakeholders
- Accepts assignments or assists supervisor as requested
Medical Billing Specialist
RMS Healthcare Management
02.2018 - 09.2019
- As a Medical Billing Specialist at RMS Healthcare Management, composes month end reports for Definitive Quantitative Analyzer Drug Screens
- Responsible for reviewing health records to ensure that the date the specimen was taken matches the date that the patient received face-to-face time with the provider
- Composes spreadsheets and generates monthly reports that show each level of drug screens and the amount drug screens that are billable or non-billable due to errors, imprecise diagnosis codes, etc…
- Compares superbills with medical records to make sure that evaluation and management codes, labs, and procedures ordered and performed by the provider, are fully documented in the progress notes
- Reviews the patients’ charts to verify that all lab requisitions are scanned and annotated and that the charts contain the proper codes that are required by each specific payer
- If there is a diagnosis code that lacks proper specificity for reimbursement, the provider will be queried
- Updates Billing Manager and Revenue Cycle Management Director of any tendencies, inconsistences, and errors that are identified for nineteen clinics
- This includes checking for un-billable diagnosis codes, incomplete patient charts, unsigned patient charts, missing procedure codes, missing procedure documentation, etc…
- Performs internal audits to ensure the comprehensiveness and legitimacy of all patient charts before submitting claims for reimbursement to prevent external and third-party audits
- Ensures that all Current Procedural Terminology (CPT), Current Procedural Terminology (CPT) Category II codes, Healthcare Common Procedure Coding System (HCPCS), Modifiers, and International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes are properly assigned according to CMS and third-party reimbursement agency guidelines
- Meticulously prepare patient accounts for billing and collections for 20+ healthcare providers, adhering to billing guidelines mandated by the various insurance companies’ billing procedures, as well as HIPAA laws and Federal regulations
- Professionally handle inbound inquiries and makes outbound calls daily on patients’ accounts to collect on medical bills; diligently follow the established call model to collect the balance in full or to secure payment arrangements prior to the account moving to a collections agency; closely monitored all delinquent accounts and managed account activities; provide world class customer service at all times
- Accepts payment on patient accounts, including credit cards; writes receipts, and accurately makes change with cash payments
- Expedient in posting payments to patient accounts using multiple internal/external accounting software systems
- Expert in determining accurate diagnosis, procedure/supply coding for prompt billing/reimbursements; as well as resident expert in a multitude of healthcare accounting systems to assist the patients in resolving their accounts
- Very knowledgeable in assigning ICD-9 and ICD-10 coding requirements relating to Medicare and private insurance billing and reimbursement methodologies; provides accurate processing of third-party insurance claims; diplomatically resolved problems to reduce delayed billings and processes adjustments as needed
- Maintain outstanding working relationships with insurance companies; billed and contacted insurance payers to facilitate efficient cash collections; developed written appeals when necessary for underpayment and/or no pre-certifications or authorizations, and closely follow up on all outstanding revenue over 45 days
- Promptly completed all related requests and correspondence from insurance companies and submitted in a timely manner
- Conduct hundreds of thorough claim follow-ups for all patient accounts by other assigned payers
- Mentored new employees through on- the -job training and educated them on all aspects of Patient Account Representative’s responsibilities
- Serves as a Patient Advocate; professionally handle hundreds of patient inquiries/complaints/concerns weekly; conducts thorough research of patient account information and directly follows up on complaints to ensure patient satisfaction
- Diligently resolved system reports, such as aged accounts receivable and unallocated payment reports; reduced aged accounts receivable under 120 days in a three-month period
- Assist customers by providing in-depth information on deductibles, co-payments; seeking medical care within the providers’ network or medical care outside the covered network; investigating policy coverage; assisting them with the completion of healthcare enrollment forms, and providing healthcare pre-authorization confirmation letters
- Resident expert on MEDICARE insurance coverage, policies, and plans (A, B, & D), as well as MEDICAID Insurance
Patient Intake Specialist
Coastal Carolina Neuropsychiatric Center
06.2017 - 10.2017
- As a New Patient Intake Specialist at the Coastal Carolina Neuropsychiatric Center; Jacksonville, NC (Jun 17 – Oct 17), diligently manned the patient registration desk by greeting the patients, verifying their patient information or accurately input ting their new demographic information in the automated patient registration database systems, as well as updated patient’s insurance information and initiated account adjustments
- Evaluated potential substance abuse or mental health clients as part of the screening process utilizing bio-psycho social assessment to determine each client’s need for treatment
- Coordinated with insurance and case management offices for approval of care reimbursements for clients; maintained great working relationships and clear communications with referral management resources regarding new clients to ascertain treatment history and goals
- Meticulously handled the disposition of all patient appointments, as well as categorized the appointments and ensured the scheduling of all new appointments within the required 1 to 30-day window
- Detail-oriented
- Performed timely and necessary edits in the scheduling module to avoid duplicate admissions or scheduling conflicts when there were sudden changes in the departmental scheduling calendar to ensure patients were not scheduled when clinical personnel were not available; always double-checked to ensure the patient’s medical record number matched throughout scheduling/pre-authorization process
- Promptly notified all patients of appointments for referrals/consults, immunizations, etc
- By telephone, typed correspondence, as well as made follow-up reminder calls regarding scheduled appointment
- Displayed compassion, empathy, and professionalism when dealing with members who were faced with frustrating health-related personal situations
- Expert in establishing case files and maintaining medical records, recording physician’s orders, and organizing patient records so that medical information can be quickly extracted; also resulted in successful audit compliances
Medical Biller
Hi-Desert Family Health Clinics
11.2015 - 12.2016
- As a Medical Biller at Hi-Desert Family Health Clinics; Yucca Valley, CA (Nov 15 – Dec 16), professionally answered telephone inquiries and/or scheduled patients for appointments to be seen by 6-8 providers weekly, verifying all of their demographic and insurance information and entering data in the patient registration/scheduling system; informs the physicians’ office staff or patient of any testing requirements according to the instructions and queries in the scheduling module
- Served as technical resource answering various inquiries via telephone or in person pertaining to health insurance benefit plans; well-versed in insurance company’s policies and procedures to intelligently respond to or make judgment calls to various inquiries pertaining to coverage plan selection; verifying and explaining benefits; pre-authorizations; approved providers; “sliding scale” provisions, as well as premiums and billing
- Meticulously handled scheduling of appointments for patients including Veterans Administration referrals, entering data in the automated scheduling module and ensuring pre-certifications/authorizations were received from various physicians’ offices and insurance companies prior to scheduled procedure; accurately entered information in the patients’ electronic medical record
- Maintained an open line of communication with the registration staff for unscheduled patients presenting for services to ensure appropriate testing is performed and times are available
- Managed billing and followed up with third party payers and patients for services; informed patients of any delays in claims processing; compiled the Aged Trial Balance Reports for aged accounts
- Highly skilled in managing timely and correct billing of all insurance and “patient pay” accounts; possess an in-depth knowledge of performing all collection-related accounting processes, including credit, bookkeeping, collections, and insurance, as well as cash positing functions for patient accounts in collections; posted cash payments in the E-MDs and Open Dental automated systems
- Maintained strict confidentially of patient records and personal identifiable information in accordance with HIPAA and Privacy Act rules and regulations
- Managed the agency’s account receivables and daily bank deposits, as well as handled the Medi-Cal and other private insurance payments with no discrepancies noted during tenure
- Collected co-pays and past-due amounts, as well as effectively counseled non-insured patients on available “sliding scale” payment options
- Resident expert on MEDICARE and MEDICAID insurance coverage, policies, and plans
- Developed accurate monthly, quarterly, and annual financial and accounting reports for the agency’s Chief Financial Officer
- Represented the agency at community health fairs by facilitating public forums covering various health insurances, such as Medicare, the Affordable Care Act, uninsured options, etc
Medical Coder
UTC Health and Rehabilitation Center
09.2014 - 07.2015
- As a Medical Coder at UTC Health and Rehabilitation Center; Austin, TX (Sep 14 – Jul 15), provide education to providers to ensure proper completion of electronic health records and proper assignment of ICD-9, HCPCS, and CPT codes’ answered telephone and written inquiries from physicians, physician assistants, and registered nurses regarding patient care medical coding matters
- Managed hundreds of claim forms daily by organizing and properly assigning ICD-9, CPT, and HCPCS Level 1 and 2 medical office procedures coding, as well as diligently completed hundreds CMS-1500 claim forms weekly
- Tracked the scheduling reports for the next day to ensure departmental readiness in the event of unscheduled MEDITECH downtime
- Meticulously reviewed insurance claims that were elevated above staff level, for accuracy, completeness, timeliness, and correctness of payment from payers (Medicare, Medicaid, Managed Care, or specialty payers); accurately coded office procedures for providers to ensure proper reimbursement
- Audited elevated patient accounts; identified issues with claim forms; retrieved necessary documents for billing and rebilling; posted adjustments and resolved credit balances; and successfully resolved hundreds of rejections and denials through corrections and appeals
- Promoted teamwork and cooperative spirit, as well as mentored and trained other staff members in the MEDICARE claim processing
- Possess a sound understanding of the revenue cycle process for healthcare providers and the hospital billing/MEDICARE claim resolution through proper procedural coding
- Reviewed, analyzed, and assured the final diagnoses and procedures as stated by the practicing providers are valid and complete
- Maintained strict patient and provider confidentiality in compliance with all Federal, State, local, and medical treatment facility rules and governing regulations
- Managed all unpaid or denied claims by rebilling and negotiating with third party insurance carriers until the account was paid or placed under patient’s responsibility; accurately recorded any activity between the provider, patients, and third party payers in the electronic health record and billing database
- Recommends new approaches and procedures to influence continuous improvement to the agency’s efficiency and services performed
- Handled all pre-certifications and data entries in the ACS medical billing process portal for government employees in the Federal Workers’ Compensation Program
- Assisted in the planning, development, review, and assessment of departmental goals and objectives
Education
Technical or occupational certificate - Medical Coding Specialist
Coastal Carolina Community College
Jacksonville, NC05.2019
Technical or occupational certificate - Medical Billing and Coding Specialist
Ultimate Medical Academy
Tampa, FL08.2014
Technical or occupational certificate - Bookkeeping & Accounting Clerk
Palomar College
San Marcos, CA12.2012
High school diploma or equivalent -
John B. Connally High School
Austin, TX05.2003
Skills
- Medical Records Auditing
- HIPAA Compliance
- Patient confidentiality
- Healthcare Data Analytics
- Diagnostic Coding
- Insurance Verification
- Medical billing procedures
- Medical terminology proficiency
- Electronic Health Records Management
- Written and verbal communication
- Data Entry
- Medical billing and coding
- Staff education and training
- EMR / EHR
- Medical Coding
- Microsoft Office trained
- ICD 10 PCS/ICD 10 CM
Affiliations
- AAPC, Member/CPC/CRC
- AHIMA, Member/CCS
Jobrelatedtraining
- AAPC Certified Medical Coder
- HIPAA Refresher Training/ Privacy Act Training
- Certified Medical Coder Apprenticeship, 12/01/18
- Certified Risk Adjustment Coding, 05/01/19
- Medical Billing
- MEDICARE Policies and Procedures Training
Certification
- Certified Coding Specialist- AHIMA
- Certified Professional Coder-AAPC
- Certified Risk Adjustment Coder- AAPC
Timeline
Medical Records Technician (Inpatient Coder)
Department of Veterans Affairs
08.2023 - Current
Medical Records Technician (Inpatient Coder)
Department of Veterans Affairs
09.2022 - 08.2023
Medical Records Technician (Inpatient Coder)
Department of the Navy
09.2019 - 09.2022
Medical Billing Specialist
RMS Healthcare Management
02.2018 - 09.2019
Patient Intake Specialist
Coastal Carolina Neuropsychiatric Center
06.2017 - 10.2017
Medical Biller
Hi-Desert Family Health Clinics
11.2015 - 12.2016
Medical Coder
UTC Health and Rehabilitation Center
09.2014 - 07.2015
Technical or occupational certificate - Medical Coding Specialist
Coastal Carolina Community College
Technical or occupational certificate - Medical Billing and Coding Specialist
Ultimate Medical Academy
Technical or occupational certificate - Bookkeeping & Accounting Clerk
Palomar College
High school diploma or equivalent -
John B. Connally High School
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