Heather Morrone CPC, CRC
Andover,CT
Summary
Dynamic Senior Coding Compliance Auditor with a proven track record at Commonspirit Health, excelling in HCC chart reviews and enhancing coding accuracy. Skilled in ICD-10 and CMS guidelines, I foster collaboration and education among providers, driving compliance and improving patient outcomes through innovative audit initiatives and effective communication.
Overview
1
1
Certification
18
18
years of professional experience
Work History
Senior Coding Compliance Auditor (remote)
Commonspirit Health
02.2024 - Current
- Prospective & Concurrent HCC Chart Review Process: Perform record review focused on the critical assessment of chronic conditions during Medicare Annual Wellness Visits (AWVs).
- Pre-Visit Auditing: Identify and present Hierarchical Condition Category (HCC) opportunities, HEDIS gaps, AI and frailty metrics, risk adjustment insights, and coding/documentation best practices for healthcare providers.
- Evaluated medical notes to verify that diagnosis codes on claims were fully supported and instructed providers to resolve missing documentation and required CMS AWV elements.
- Reviewed BCBS PAF and Cigna HMR forms for completeness and accuracy to facilitate payer acceptance; contributed to PAF/HMR initiatives correcting documentation errors, preventing payor recoupment.
- Actively engage in and contribute to pilot projects focused on both concurrent and retrospective reviews.
- Contributed to a new audit initiative recognized by national leadership and adopted across markets; assisted in interviewing and onboarding new team members.
- Designed educational presentations and tools for providers, staff, and leadership, delivering expertise via email and virtual sessions on risk adjustment, CMS AWVs compliance, and documentation/coding best practices.
Risk Adjustment Coder (remote)
Pop Healthcare
10.2023 - 12.2023
- Executed HCC production coding in a contract role, ensuring accurate documentation to support risk adjustment initiatives.
- Identified and captured all applicable risk-adjusted diagnosis codes within medical documentation, ensuring compliance with CMS regulations and internal guidelines to enhance coding accuracy.
Quality Care Coordinator/Risk Adjustment Coder (remote)
Eastern Connecticut Health Network
07.2022 - 09.2023
- Executed prospective and concurrent HCC chart reviews across multiple providers' Medicare AWVs, identifying HCC gaps to present on a pre-visit audit form and conducting post-visit claim reviews to record missed HCC opportunities, sharing results with management to enhance provider education.
- Analyzed healthcare data to identify open HEDIS gaps, facilitating targeted discussions with providers.
General/Surgical Dental Assistant
Day Hill Dental, Vernon Family Dentists, Dr. Thaddeus Michalski
11.2008 - 12.2021
- Assisted during oral surgery procedures and supported chairside workflow
- Sterilized instruments and maintained infection control standards throughout surgical care
- Captured dental radiographs and organized patient charts before treatment
- Mixed materials and prepared surgical trays
- Provided post-operative instructions to patients regarding care of oral tissues and wound healing.
- Conducted dental cleanings and checked teeth for cracked fillings.
Education
Certificate - Medical Billing & Coding
Tunxis College
01-2022
Degree - Allied Health & Sciences
Manchester Community College
01-2013
Diploma - Dental Assisting
Everest Institute
01-2008
Skills
- -ICD-10, CPT, HCPCS (Including Guidelines)
- -CMS Guidelines & V28 HCC Model
- -Encoders: 3M Encoder & HCC Coder
- -EHR systems: Allscripts, EPIC
- -Humana Payer Portal
- Cigna portal
- -BCBS Provider Assessment Forms
- -Suspect Conditions
- HEDIS & HIPAA
- -Data Mining/ Data Entry
- Microsoft Office Suite
- Google Workspace
- -Innovacer
Personal Information
Title: Risk Adjustment Coder & Compliance Auditor (CPC, CRC)
Certification
AAPC Certified Professional Coder (2022), AAPC Certified Risk Adjustment Coder (2023), Contempo Coding - Risk Adjustment Coding Course (2023)
Timeline
Senior Coding Compliance Auditor (remote)
Commonspirit Health
02.2024 - Current
Risk Adjustment Coder (remote)
Pop Healthcare
10.2023 - 12.2023
Quality Care Coordinator/Risk Adjustment Coder (remote)
Eastern Connecticut Health Network
07.2022 - 09.2023
General/Surgical Dental Assistant
Day Hill Dental, Vernon Family Dentists, Dr. Thaddeus Michalski
11.2008 - 12.2021
Certificate - Medical Billing & Coding
Tunxis College
Degree - Allied Health & Sciences
Manchester Community College
Diploma - Dental Assisting
Everest Institute