Traveling
DeNisha L. Chatman
HCC Risk Adjustment Coder
Birmingham,AL
Summary
Certified Medical Billing & Coding professional with AHIMA/AAPC credentials and extensive experience in HCC Coding and medical record review. Demonstrated proficiency in ICD-10-CM coding and medical terminology, ensuring the implementation of accurate and efficient coding practices. Adept in utilizing Microsoft Office for streamlined administrative tasks. With a 20-year career, I have made significant contributions to the industry, starting with various roles in insurance verification, claims, and more. Eager to leverage skills and expertise in a fulfilling medical coding role. Professional with deep expertise in medical coding and risk adjustment. Proven track record in analyzing and interpreting complex medical records to ensure accurate coding and compliance with regulatory standards. Strong team collaborator focused on achieving measurable results and adapting to evolving requirements. Skilled in ICD-10, CPT, and HCC coding, with keen eye for detail and commitment to maintaining high standards of accuracy and efficiency.
Overview
20
20
years of professional experience
2
2
Certifications
Work History
HCC Risk Adjustment Coder
Optum
01.2023 - Current
- Review medical records to ensure the accuracy of diagnosis and procedural data, achieving a 95% coding accuracy rate by adhering to ICD-10 standards
- Analyze medical records to identify relevant diagnoses for risk adjustment coding and maintain high data integrity standards
- Ensure coded data accurately reflects services provided, enhancing compliance and efficiency
HCC Risk Adjustment Coder
Virtix Health
09.2024 - 01.2025
- Reviewed and coded medical records for outstanding charts, maintaining a 95% coding accuracy rate, and enhancing coding compliance and efficiency
- Analyzed medical records to identify relevant diagnoses for risk adjustment, ensuring compliance with ICD-10 standards
- Collaborated with team members to meet project deadlines, in a challenging environment for the holiday season
- Short Term Assignment
Medical Records Clerk Intern
Aspire Physical Recovery Center, LLC
06.2022 - 08.2022
- Prepared patient charts and documents, ensuring the medical record was correct and complete
- Maintained patient records systems by archiving, scaning and indexing important documents and files.
- Managed approximately 20 incoming calls, emails and faxes per day for ROI.
- Responded effectively to requests for medical records from legal representatives, insurance companies, and other authorized parties in a timely manner.
- Performed regular audits of stored medical records to verify accuracy, completeness, and adherence to documentation requirements.
- Collaborated with physicians and nurses, providing timely access to accurate and up-to-date medical records.
Network Development Coordinator
NaphCare, Inc.
09.2018 - 05.2022
- Negotiated contracts for the Federal Bureau of Prisons for inmate medical care
- Developed solid relationships with vendors to negotiate contracts and manage partnerships, ensuring seamless operations and collaboration
- Ensured customer satisfaction by resolving escalated complaints and answering queries related to policies, procedures, and payments, achieving a high satisfaction rate of 95%
- Reviewed diagnosis and procedure codes submitted by providers for services performed or needed for inmate care for accurate negotiations
- Maintained comprehensive records of the project's progress and milestones, ensuring accurate and up-to-date documentation
Appeals Analyst
Cahaba GBA
01.2016 - 06.2017
- Performed data analysis on DRG Medicare claim denials during the appeals process, reviewing a minimum of 45 appeals per day.
- Collaborated with other departments and external entities to obtain necessary information for appeal decisions, ensuring prompt and accurate resolution
- Collaborated with interdisciplinary teams to ensure accurate claims adjudication, reducing errors and inconsistencies in the review process.
- Maintained detailed records and organized documentation to facilitate smooth appeals processing, ensuring all relevant information was readily available for review.
- Navigated regulatory requirements for Medicare appeals proficiently, adhering to state and federal guidelines throughout the appeals process.
- Utilized CMS guidelines and review tools to conduct extensive research and analyze grievance and appeal issues.
Provider Enrollment Analyst
Cahaba GBA
01.2015 - 01.2016
- Verified provider credentials and licensure, ensuring compliance with regulatory standards, and contributing to the overall accuracy of provider data
- Maintained up-to-date knowledge of industry regulations, allowing for accurate assessment of providers'' eligibility for participation in various programs.
- Demonstrated adaptability within an ever-changing regulatory landscape, quickly adjusting strategies when new requirements were introduced.
- Collaborated effectively with other departments to address any discrepancies or concerns related to provider data.
- Reduced errors in provider enrollments with meticulous attention to detail during application reviews and follow-ups.
- Reduced errors in provider enrollments with meticulous attention to detail during application reviews and follow-ups when necessary.
- Processed and recorded a minimum of 30 new provider Medicare enrollment applications per day.
Project Management Analyst
Cahaba GBA
07.2014 - 01.2015
- Coordinated projects, ensuring performance met or exceeded CMS and project sponsors' expectations
- Provided daily workflow guidance for Medicare ZPIC investigators and addressed operational policy and procedure queries, enhancing team productivity by 12%
- Collaborated with multiple managers to develop and coordinate training programs for the operational documentation platform
Appeals Specialist
Cahaba GBA
03.2009 - 07.2014
- Managed roughly 45 or more redetermination inquiries per day from physicians, beneficiaries, attorneys, and other contractors, ensuring compliance with established CMS policies and regulations
- Reviewed Medicare DRG claims denials for adjustments based on medical record documentation.
- Maintained high levels of accuracy in all written correspondence, ensuring clear communication during the appeals process.
- Consistently met or exceeded performance metrics, demonstrating a strong understanding of the Medicare review process.
- Acted as a departmental resource on appeals matters.
Education
Associate of Applied Science - Health Information Technology
DeVry University
Chicago, IL01.2022
Medical Billing And Coding - Certification
DeVry University
Chicago, IL01.2021
Skills
- Medical Terminology
- Attention to Detail
- Electronic Medical Record (EMR)
- Microsoft Excel
- Claims Adjudication
- Self-motivation and discipline
- ICD-10 proficiency
- HIPAA compliance
- Healthcare Reimbursement
- CMS guidelines
- Excellent communication
- Microsoft Word
- Medical release of information ROI processes
Certification
- AAPC, Certified Risk Adjustment Coder (CRC), 10/01/24, 09/30/25, 02270639
- AAPC, Certified Professional Coder (CPC), Pending
- AHIMA, Registered Health Information Technician (RHIT), 09/01/24, 09/30/26, 252183
Affiliations
AAPC Jefferson County Alabama Chapter
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference
Work Type
Contract WorkPart TimeFull TimeWork Location
RemoteImportant To Me
Work-life balanceFlexible work hoursWork from home optionInterests
History
Languages
English
Native or Bilingual
Timeline
HCC Risk Adjustment Coder
Virtix Health
09.2024 - 01.2025
HCC Risk Adjustment Coder
Optum
01.2023 - Current
Medical Records Clerk Intern
Aspire Physical Recovery Center, LLC
06.2022 - 08.2022
Network Development Coordinator
NaphCare, Inc.
09.2018 - 05.2022
Appeals Analyst
Cahaba GBA
01.2016 - 06.2017
Provider Enrollment Analyst
Cahaba GBA
01.2015 - 01.2016
Project Management Analyst
Cahaba GBA
07.2014 - 01.2015
Appeals Specialist
Cahaba GBA
03.2009 - 07.2014
Associate of Applied Science - Health Information Technology
DeVry University
Medical Billing And Coding - Certification
DeVry University
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