Heather Lyons
Smoaks,SC
Summary
Assisted teams in navigating medical billing and coding guidelines. Supported cross-training initiatives for multiple clients on various analytics and systems. Collaborated with colleagues to process initial claims, reopens, and appeals efficiently.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Recovery Resolution Analyst Sr.
Optum
01.2021 - Current
- Repricing claims.
- Testing new production deployment.
- Reviewed appeals and updated the client’s system as well as Optum’s system.
- Learned the client’s computer programs for claim history, claim status and medical records not yet in our system.
- Trained OGA staff on our client’s guidelines and policies as well as auditing their work to prevent any future mistakes by giving correct feedback and guidance.
- Reaches out to help and encourage teammates.
- Led several projects to be completed timely and correctly.
- Uses pertinent data and facts to identify and solve a range of problems within area of expertise.
- Ensure adherence to state and federal compliance policies, reimbursement policies.
- Examine, assess and document business operations and procedures to ensure data integrity, data security and process optimization.
- Performs daily quality review of grievances.
- Conducts in depth research on issues in order to provide quality resolutions.
- Meets work and attendance expectations.
- Identifies over billing patterns and trends as well as waste and error.
- Maintains and manages daily case review assignments with a high emphasis on quality.
- Smoothly pivots and redirects with the client’s needs and expectations.
HCC Risk Adjustment Coder
Optum
06.2019 - 12.2020
- Remote Position.
- Coding experience in Commercial Coding as well as UHC coding.
- Coding and abstracting of medical records for risk adjustment purposes that mapped at a unique date of service level.
- Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
- Assigned appropriate medical codes with a 94 % accuracy rate and a 94% completeness rate.
- Maintained strict patient and physician confidentiality.
- Resourcefully used various coding books, procedure manuals and online encoders.
- Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories.
Remote Medical Coder
Coding Clarified
04.2015 - 06.2019
- Reviewed medical records to identify diagnosis/procedures.
- Coded all diagnostic and operative information from the medical record using ICD-10-CM, CPT and HCPCs coding classification systems.
- Scanned documents, researched coding and billing guidelines for procedures.
- Remained current on medical coding guidelines and reimbursement reporting requirements.
- Checked chart assignments every day and reported accurately all hours worked on a weekly basis.
- Participated in testing and training as required by the company.
- Complied with HIPAA laws, regulations and the Standards of Ethical Coding as set forth by the American Health Information Management Association and adhered to official coding guidelines.
Senior CSR/ Neo Trainer
1st Franklin Financial Corp.
08.2011 - 11.2015
- Answered an average of 200 calls per day addressing customer inquiries, solving problems and providing financial information.
- Greeted customers entering the establishment and helping each customer with what their particular situation pertained too.
- Handled all insurance claims and payments which included Life, Disability and unemployment insurance.
- Handled daily heavy flow of paperwork such as recording titles, breaking down legal documents and recording all insurance documents.
- Ensured excellent customer experience by addressing customer concerns, demonstrating concern as well as understanding and resolving problems on the spot.
- Maintained cash drawer and deposits successfully on a daily basis.
Education
Technical Accreditation School - undefined
Coding Clarified
Apache Junction, AZ01.2017
High School Diploma - undefined
Walterboro High School
Walterboro, SC01.2000
Skills
- Conducted comprehensive vulnerability and risk assessments to identify potential threats
- Conducted comprehensive risk evaluations to identify potential vulnerabilities
- Conducted comprehensive risk analysis to identify potential vulnerabilities and mitigate threats
- Executed comprehensive risk assessments to identify potential vulnerabilities
- Assessed and evaluated potential risks to inform decision-making processes
- Facilitated training sessions to enhance employee skills and knowledge
- Evaluated and analyzed appeals to ensure compliance with established guidelines
- Directed project initiatives, ensuring alignment with strategic objectives
- Enhanced computer skills to streamline workflow and improve efficiency
- Demonstrated rapid acquisition of new skills and knowledge in diverse environments
- Supported team initiatives to enhance motivation and productivity Assisted in organizing team-building activities to foster collaboration Contributed to maintaining a positive work environment through active participation
Certification
- Certified Professional Coder (CPC)
- Notary Public
Affiliations
- The American Academy of Professional Coders, 2017-01-01, Current
- Coding Clarified, 2017-01-01, Current
Personal Information
Title: Recovery Resolution Analyst Sr.
Timeline
Recovery Resolution Analyst Sr.
Optum
01.2021 - Current
HCC Risk Adjustment Coder
Optum
06.2019 - 12.2020
Remote Medical Coder
Coding Clarified
04.2015 - 06.2019
Senior CSR/ Neo Trainer
1st Franklin Financial Corp.
08.2011 - 11.2015
Technical Accreditation School - undefined
Coding Clarified
High School Diploma - undefined
Walterboro High School