Elizabeth Workley
PLENTYWOOD,MT
Summary
Seasoned auditing professional knowledgeable about risk aversion strategies, cost reduction options and financial processes. Decisive and persuasive communicator with proven problem-solving, leadership and planning abilities. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Claim Quality Audit Specialist
Insight Global
10.2022 - Current
- Outpatient & Inpatient Audit & Coding Expert
- Investigate the client’s waste and error stopped claims by gathering information
- Researching state and federal guidelines pertaining to claims
- Perform daily clinical review of professional (or facility) claim vs
- Medical records to determine claim validity
- Maintain standards for productivity and accuracy at 95% or above
- Provide clear and concise clinical logic to the providers when necessary
- Attend and provide feedback during monthly meetings with assigned internal departments
- Serves as resource and subject matter expert to other coding staff
- Continue education pertaining to coding licensure
- Prepared working papers, reports and supporting documentation for audit findings.
- Initiated comprehensive account assessments to check viability, stability, and profitability of business operations.
- Collected and reported monthly expense variances and explanations.
- Partnered with auditors to track errors and add contributions to maintain accuracy.
Certified Coding Specialist
Caduceus Health
02.2020 - 10.2022
- Inpatient, Outpatient, Professional, & DRG Coding
- Creator of multiple training documents for new onboarding coding specialists
- Identified new methods to optimize medical records management.
- Daily use of programs Athena, NextGen, Cerner, Antrim, & Eclinical works
- Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications
- Analyzes medical records and identifies documentation deficiencies
- Verified accuracy of patient information in medical records.
- Reviews and verifies documentation supports diagnoses, procedures, and treatment results
- Identifies diagnostic and procedural information
- Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes
- Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines
- Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Verified signatures and checked medical charts for accuracy and completion.
- Developed and implemented new filing system for medical records to improve efficiency.
- Researched and resolved medical record discrepancies.
- Performed on-site coding audits to determine accuracy and compliance with coding guidelines.
- Monitored changes in coding regulations to provide recommendations for compliance.
- Generated reports to identify coding trends and discrepancies.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Utilized electronic medical record systems to store, retrieve and process patient data.
- Assisted in training new staff on medical record processing and filing procedures.
- Trained and mentored junior coders to support growth and development and apply high-quality coding practices.
Certified Coding Specialist
Biltmore ENT, Facial Plastics & Allergy
01.2017 - 02.2020
- Identified new methods to optimize medical records management.
- Verified accuracy of patient information in medical records.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Communicated with insurance companies to research and resolved coding discrepancies.
- Utilized active listening, interpersonal, and telephone etiquette skills when communicating with others.
- Processed and tracked requests for medical records from external organizations.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Input data into computer programs and filing systems.
- Created and maintained up-to-date patient medical records to enable tracking history and preserve consistent information.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Sorted and distributed incoming and outgoing medical records.
- Transcribed and entered patient medical information into electronic medical records systems.
- Assisted in preparation of medical reports for external parties.
Education
Skills
- Business Operations and Forecasting
- Compliance Checks
- Business Operations Analysis
- Best Practice Implementation
- Resource Monitoring and Control
- Critical Thinking and Analysis
- Client Representation
- Accounting Procedures Validation
- Accounting Policy and Control
- Administrative Oversight
Accomplishments
- 01716800, CPC
- Bachelor | 11/2020-GRAD DATE 01/28/2023 | university OF Arizona CAMPUS
- Major: Healthcare Administration
- Minor: Billing Administration
- Related coursework: Care delivery systems, operations of healthcare providers, role of finance in healthcare
- MASTERS | 12/2022-GRAD DATE 11/28/2024 | uNIVERSITY OF aRIZONA CAMPUS
- Major: Healthcare Administration
- Minor: Billing Administration
- Related coursework: Care delivery systems, operations of healthcare providers, role of finance in healthcare
- Associates Degree | 03/2019 | ultimate medical academy | Medical Billing & Coding
Certification
- CPC - Certified Professional Coder
Timeline
Claim Quality Audit Specialist
Insight Global
10.2022 - Current
Certified Coding Specialist
Caduceus Health
02.2020 - 10.2022
Certified Coding Specialist
Biltmore ENT, Facial Plastics & Allergy
01.2017 - 02.2020
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