Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Heather Boerema

Free Soil,MI

Summary

Dynamic Coding Quality Analyst with a proven track record at Corewell Health, excelling in software quality assurance and defect tracking management. Recognized for enhancing coding accuracy and fostering team collaboration, I leverage my expertise in ICD-10 coding to drive continuous improvement and ensure compliance with industry standards.

Overview

21
21
years of professional experience
1
1
Certification

Work History

Coding Quality Analyst

Corewell Health
05.2023 - Current
  • Assessed code quality through comprehensive testing methodologies to ensure adherence to standards.
  • Assisted in documenting and maintaining quality assurance protocols for coding practices.
  • Conducted routine audits of code submissions to verify functionality and performance benchmarks.
  • Collaborated with developers to identify and resolve coding discrepancies during the review process.
  • Engaged in continuous learning of industry best practices for coding standards and quality analysis tools.
  • Provided feedback on code efficiency, contributing to improved development workflows and practices.
  • Maintained clear communication with cross-functional teams regarding quality issues and resolutions.
  • Assisted with the development of internal tools that streamlined the code review process, resulting in an increase in overall productivity for the team.
  • Reviewed and analyzed trends to advise and develop recommendations to achieve or modify program goals.
  • Created materials and educated coding team members via webinars, newsletters and other mediums.
  • Participated in ongoing professional development opportunities to stay current with industry trends and advancements in coding methodologies.
  • Maintained high levels of accuracy within projects by continually refining our approach to quality assurance based on feedback from colleagues, clients, or industry trends.
  • Bolstered staff retention rates by creating a positive environment that encouraged open communication and collaboration among team members.
  • Facilitated training sessions on proper coding techniques, ensuring all team members were well-equipped with essential skills for success.
  • Developed comprehensive reports highlighting areas of concern in coding quality, enabling management to make informed decisions about resource allocation and training needs.
  • Served as a valuable resource for peers seeking assistance with particularly challenging or complex coding issues encountered during their daily tasks.
  • Mentored junior team members in best coding practices, leading to improved individual performance and team cohesion.
  • Improved coding accuracy by conducting thorough quality analyses and providing constructive feedback to team members.
  • Established a reputation for thoroughness and attention to detail that positioned our department as a reliable resource for internal teams requiring assistance with code-related issues.
  • Promoted a culture of continuous improvement among colleagues by sharing insights into recent developments within the field of programming languages or frameworks relevant to our work as Coding Quality Analysts.
  • Assessed training needs and developed associated training.

Adjunct Professor

West Shore Community College
08.2018 - Current
  • Developed and delivered engaging course materials to enhance student understanding of complex subjects.
  • Guided diverse student groups in collaborative projects, fostering critical thinking and teamwork skills.
  • Evaluated student performance through assessments, providing constructive feedback to support academic growth.
  • Implemented innovative teaching strategies to improve classroom engagement and learning outcomes.
  • Developed engaging course materials to enhance student learning experiences.
  • Facilitated classroom discussions to promote critical thinking and collaboration among students.
  • Evaluated student performance through assessments, providing constructive feedback for improvement.
  • Implemented innovative teaching strategies to accommodate diverse learning styles and needs.
  • Collaborated with academic departments to align course objectives with institutional goals.
  • Taught medical coding and billing courses, providing instruction to up to 50 undergraduate students.

Senior Medical Coder

Corewell Health
05.2015 - 05.2023
  • Analyzed medical records to ensure accurate coding and compliance with regulatory standards.
  • Collaborated with healthcare providers to clarify documentation and improve coding accuracy.
  • Implemented updates to coding practices in alignment with changes in healthcare regulations.
  • Trained junior coders on best practices, coding guidelines, and software utilization for efficiency.
  • Utilized advanced coding software to streamline workflow and reduce processing time for claims submissions.
  • Maintained up-to-date knowledge of ICD-10, CPT, and HCPCS coding systems for optimal performance.
  • Provided strategic recommendations for improving revenue cycle management through accurate coding practices.
  • Reduced claim denials by identifying and addressing common errors in the coding process.
  • Maintained ICD-10 proficiency, leading to more accurate code assignments and fewer claim rejections.
  • Contributed to quality improvement initiatives by identifying areas for potential enhancement within the medical coding department.
  • Ensured compliance with industry regulations by staying updated on current coding practices and guidelines.
  • Participated in relevant professional development opportunities to stay abreast of changes in medical coding standards.
  • Collaborated with healthcare providers to retrieve missing documentation for accurate code assignment.
  • Resourcefully used various coding books, procedure manuals, and on-line encoders.
  • Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
  • Correctly coded and billed medical claims for various hospital and nursing facilities.
  • Reviewed patient charts to better understand health histories, diagnoses, and treatments.
  • Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
  • Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
  • Interacted with physicians and other healthcare staff to ask questions regarding patient services.
  • Utilized active listening, interpersonal, and telephone etiquette skills when communicating with others.
  • Verified signatures and checked medical charts for accuracy and completion.
  • Maintained accuracy, completeness, and security for medical records and health information.
  • Utilized electronic medical record systems to store, retrieve and process patient data.
  • Verified accuracy of patient information in medical records.
  • Communicated effectively with staff, patients, and insurance companies by email and telephone.
  • Reviewed medical records for completeness and filed records in alphabetic and numeric order.
  • Used classification manuals to gain additional knowledge of disease and diagnoses processes.

Certified Professional Coder

Cancer and Hematology Centers of Western MI
08.2012 - 05.2015
  • Analyzed medical records to ensure accurate coding and compliance with healthcare regulations.
  • Implemented coding best practices to enhance billing accuracy and reduce claim denials.
  • Collaborated with healthcare providers to resolve discrepancies in documentation and coding practices.
  • Conducted audits of coded claims to identify areas for improvement and implement corrective actions.
  • Developed and maintained comprehensive knowledge of ICD-10, CPT, and HCPCS Level II coding systems.
  • Streamlined coding processes through the adoption of advanced software tools, improving operational efficiency.
  • Maintained strict confidentiality by adhering to HIPAA guidelines and ensuring sensitive patient information was protected at all times.
  • Managed high-volume workloads effectively by prioritizing tasks according to urgency and importance while maintaining strict attention to detail.
  • Conducted thorough research on complex cases, applying advanced knowledge of medical terminology, anatomy, physiology, and pharmacology to accurately assign codes as needed.
  • Identified opportunities for process improvement, leading to a more efficient workflow within the coding department.
  • Utilized advanced computer skills to navigate various software programs, further enhancing the efficiency of coding processes.
  • Served as a reliable resource for both clinical teams and administrative staff by offering expert advice on proper code selection based on diagnosis or treatment specifics provided in the documentation received.
  • Supported the implementation of new electronic health record systems, providing expert guidance on coding best practices.
  • Optimized revenue cycle management with timely and precise code assignment for various medical procedures.
  • Reduced claim denials by attentively reviewing medical records and addressing discrepancies prior to submission.
  • Collaborated with medical staff to ensure accurate documentation and appropriate coding practices were followed.
  • Maintained up-to-date knowledge of industry regulations, ensuring compliance with all relevant guidelines and legislation.
  • Participated in ongoing professional development opportunities to stay current on changing coding requirements and advances in healthcare technology.
  • Coordinated with other departments to address any discrepancies or issues arising from billing-related matters promptly and professionally.
  • Developed strong working relationships with insurance companies, facilitating smoother communication and quicker claim resolutions.
  • Streamlined billing processes for improved efficiency and reduced errors in claims submissions.
  • Communicated with insurance companies to research and resolved coding discrepancies.
  • Followed up with medical staff regarding missing information in patient records.

Patient Account Representative

West MI Regional Cancer and Blood Center
11.2004 - 01.2012
  • Managed patient account inquiries, ensuring timely and accurate resolution of billing issues.
  • Coordinated insurance verification processes, enhancing efficiency in claims management.
  • Implemented improvements in patient communication protocols, increasing satisfaction rates.
  • Analyzed discrepancies in billing data, ensuring compliance with regulatory standards.
  • Oversaw collections process, streamlining workflows to maximize revenue recovery efforts.
  • Assisted colleagues during peak periods or absences, showcasing teamwork skills while maintaining personal workload demands efficiently.
  • Posted payments and processed refunds.
  • Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
  • Promoted a positive work environment by actively participating in team meetings and contributing ideas for process improvements.
  • Worked with outside entities to resolve issues with billing, claims, and payments.
  • Streamlined billing processes for increased efficiency in managing patient accounts.
  • Provided exceptional customer service, handling sensitive patient situations with professionalism and empathy.
  • Facilitated smooth communications between patients, providers, and insurers, fostering an atmosphere of trust and collaboration.
  • Conducted regular audits of patient accounts, identifying discrepancies and rectifying errors as needed.
  • Ensured compliance with healthcare regulations while processing claims and managing patient accounts.
  • Electronically submitted bills according to compliance guidelines.
  • Collaborated with the medical staff to ensure proper documentation and coding for accurate billing.
  • Enhanced patient satisfaction by promptly addressing inquiries and resolving account issues.
  • Identified trends in unpaid accounts, developing targeted solutions for improved revenue recovery.
  • Maintained accurate records of all transactions, ensuring timely payments from patients and insurance providers.
  • Achieved a significant reduction in aged accounts receivable through diligent follow-up efforts with both patients and insurers.
  • Responded to patient, family, and external payer inquiries.
  • Developed strong relationships with key contacts at insurance companies to expedite resolution of claim disputes or other account-related issues.
  • Utilized computer programs to create invoices, letters, and other documents.
  • Negotiated payment plans with patients experiencing financial difficulties, supporting them in meeting their obligations without undue stress.
  • Reduced outstanding balances by implementing effective collection strategies tailored to individual patients'' needs.
  • Monitored flags and resolved urgent items with accuracy and efficiency.
  • Educated patients on financial policies, promoting understanding of their responsibilities within the healthcare system.
  • Demonstrated adaptability in navigating complex payer guidelines to maximize reimbursement opportunities for the organization.
  • Contacted patients after insurance was calculated to obtain payments.
  • Maintained office inventory and organized supplies for efficiency and expected needs.
  • Reconciled statements with patient records.
  • Researched billing errors and discrepancies to initiate corrective action.
  • Responded to customer inquiries and provided detailed account information.
  • Developed and documented collection procedures and policies to comply with government regulations.
  • Entered client details and notes into system for interdepartmental access and review.
  • Generated and distributed monthly customer statements.

Education

Bachelor Of Applied Arts And Science - Health Services Administration

Baker College
Muskego, WI
06.2016

Skills

  • Interpersonal relationship building
  • Team collaboration aptitude
  • Software development lifecycle
  • Code review expertise
  • Time management
  • Attention to detail
  • Multitasking Abilities
  • Reliability
  • Excellent communication
  • Critical thinking
  • Organizational skills
  • HIPAA compliance
  • Verbal and written communication
  • ICD-10 coding
  • Electronic health records
  • Claims processing
  • Microsoft Excel
  • Medical documentation
  • Computer proficiency
  • Data entry
  • Insurance verification
  • Medical terminology
  • EMR systems
  • Invoice processing
  • Patient data confidentiality
  • Medical release of information ROI processes
  • Insurance billing
  • Records accuracy
  • Patient information verification
  • Confidentiality practices
  • Billing procedures
  • Records scanning
  • Patient health information Access
  • Patient medical records maintenance
  • Document management
  • Medical billing code accuracy
  • Epic systems
  • 3M encoder
  • Word processing software
  • Health information systems
  • Patient rights
  • Medical billing processing

Certification

Professional Coding certification

Timeline

Coding Quality Analyst

Corewell Health
05.2023 - Current

Adjunct Professor

West Shore Community College
08.2018 - Current

Senior Medical Coder

Corewell Health
05.2015 - 05.2023

Certified Professional Coder

Cancer and Hematology Centers of Western MI
08.2012 - 05.2015

Patient Account Representative

West MI Regional Cancer and Blood Center
11.2004 - 01.2012

Bachelor Of Applied Arts And Science - Health Services Administration

Baker College

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Heather Boerema