Hi, I’m
Jacqueline Payton
Compliance Coding Auditor
Gaffney,SC
Overview
25
years of professional experience
2
Certified Professional Medical Auditor (CPMA)
3
Certified Coding Specialist (CCS)
4
Registered Health Information Management (RHIA)
5
Certified Emergency Department Coder (CEMA)
6
Certified Evaluation & Management Auditor (CEMA)
7
Certified Physician Practice Management (CPPM)
10
years of post-secondary education
Work History
WellStar Health SystemMarietta, Georgia
Coding Compliance Auditor and Educator
07.2022 - Current
Job overview
- Perform Evaluation & Management (E&M) documentation and coding training for new clinicians as well as refresher training
- Write and prepare PowerPoint training presentations
- Responsible for reviewing the accuracy for clinician documentation for E&M and procedure billing
- Recommend process changes to improve the quality of performance for clinicians and auditors
- Communicate with peers and management
- Audited the following specialties: Cardiology, Endocrine, Gastroenterology, Internal Medicine, Family Medicine, Teaching Physicians (clinic & hospital), Pathology.
CaroMont HealthGastonia, North Carolina
Coding Auditor
07.2021 - 03.2022
Job overview
- Assign ICD-10-CM and CPT4 codes for diagnoses and procedures
- Conduct internal provider documentation audits and provide education to meet acceptable performance standards
- Facilitate provider onboarding physician documentation orientation and training
- Produce monthly newsletter alerting providers to relevant updates and changes concerning physician billing
- Complete monthly summary reports detailing auditing activities for the month and identifying trends.
Vidant Medical GroupGreenville, North Carolina
Compliance Auditor
08.2013 - 11.2020
Job overview
- Assign ICD-10-CM and CPT4 codes for diagnoses and procedures
- Vidant Medical Group is a multi-specialty physician agency with over 425 providers
- Professional Billing Experience with Family Medicine, Internal Medicine, Emergency Department, Psychiatry, Obstetrics/Gynecology, Gastroenterology, General Surgery, Neonatal/Pediatrics, Hematology/Oncology, Neurology (Sleep Clinic), Rehab, and Skilled Nursing Homes
- Conduct internal provider documentation audits and provide education to meet acceptable performance standards
- Communicate financial risk potential to upper management and develop corrective actions
- Collaborate with outside auditing agencies to ensure official coding guidelines are followed
- Assist with training new Coders
- Coordinate with Information Technology staff to develop templates for physician documentation
- Active participant on committees for process improvements and workflow studies.
Vidant Medical CenterGreenville, North Carolina
Case Management Assistant
09.2012 - 08.2013
Job overview
- Supported Case Managers with discharge placement options for patients before discharge
- Contacted agencies for placement availability
- Administered the Important Medicare Message (IMM) to Medicare patients
- Completed data requirements for PASSAR forms
- Arranged transportation for patients being transferred to extended care facilities
- Gathered and recorded demographic data for FA2 forms completion
- Updated Case Management training manual
- Developed a quality improvement process for manual training maintenance.
United Concordia Dental InsuranceWilliamsport, Pennsylvania
Commercial Claims Supervisor
01.2000 - 06.2012
Job overview
- Managed Dental Claims department with up to twenty-two employees that worked on-site and remotely
- Responsible for the daily running of the department with production standards requirements for revenue output
- Redesigned workspace for better workflow in new settings
- Hired employees and provided employment enrichment training assisting with yearly goals aligned with the organization's mission statement
- Responded to privacy breaches within the HIPPA guidelines and conducted privacy security checks for electronic media
- Worked with Information Systems for revisions and updates that allowed higher usage of macros to increase data input production.
Manor Care Health ServicesJersey Shore, Pennsylvania
Documentation Specialist
01.1999 - 01.2000
Job overview
- I reviewed patient records to ensure the documentation supported the Minimum Data Set (MDS) for billing
- Met with care team daily to verify treatment plans for patients
- Participated in process improvement committees
- Functioned as a liaison between the attached hospital and nursing home.
Education
Strayer UniversityMaryland Heights, MO
MBA from Business Administration
12.2019 - 05.2025
East Carolina UniversityGreenville, NC
Bachelor of Science from Health Information Management
05.1983 - 05.1988
AAPC Certified Professional Physician Manager (CPPM) – Knowledge of healthcare business process, workflow, and reform; medical office accounting, physician reimbursement, and revenue cycle management, human resource management, marketing, and business relationships, health IT, EMRs, and health information exchange.
2015
AHIMA Approved ICD-10-CM Trainer – Completed Chicago training course and examination
2014
AAPC Certified Emergency Department Coder (CEDC) – Knowledge of Evaluation and Management (both 1995 & 1997) Documentation guidelines; coding of surgical procedures performed by ED physicians, ability to abstract and code Emergency Department records utilizing ICD-9-CM, CPT-4, and HCPCS Level II
2014
Certified Lay Minister, The American Baptist Churches of Pennsylvania and Delaware
2007
North Carolina Insurance License
1996
AHIMA Certified Coding Specialist (CCS) – Skilled in classifying medical data from patient records, generally in the hospital setting, utilizing ICD-9-CM and CPT
1991
Registered Health Informational Administrator (RHIA)
1989
Accomplishments
- Speaker for the Pitt County Chapter for American Academy of Professional Coders (AAPC) in August 2017
- Conducted two virtual training session for local AAPC chapters in Georgia in 2023,
- President of local AAPC Chapter, Greenville, 2019-2020.
- Board Member of Greenville, NC Recreation Summer Performance, 2017-2020.
- Ran for Board of Education for Pitt County Schools, NC 2017.
- Chaplain for Young Women Association, Concord Baptist Church, Gaffney SC.
- Liturgical Dance Director for ages 6 to 12.
Affiliations
- American Health Information Association (AHIMA) Active Member
- American Academy of Professional Coders (AAPC)
- NAMAS Doctor’s Management Member
Additional Information
- Developed Split/Share Power Point Presentation for 2022 new guidelines.
- Produced monthly newsletter explaining September 2021 ICD-10-CM for 2022 updates.
- Successfully trained new providers for Evaluation and Management billing.
- Created new inpatient facility cheat card for physician services.
- Presented documentation requirements for interprofessional internet consultations for providers providing non-face-to-face services.
- Recouped missed funds for critical care neonatal services that were billed incorrectly for NICCU.
- Provided feedback to Coders for E/M services billed incorrectly and verified by outside coding agency.
- Verification billing for providers on mandatory review prior to claims released to third party payors.
- Communicate with Medicare RAC auditors for focused reviews.
- Revised Case Management Manual for nursing units describing steps for completing procedures when Case Managers are not available at nights and on weekends.
- Independent travel to different counties for physician and staff trainings.
Timeline
Coding Compliance Auditor and Educator
WellStar Health System
07.2022 - Current
Coding Auditor
CaroMont Health
07.2021 - 03.2022
Strayer University
MBA from Business Administration
12.2019 - 05.2025
Compliance Auditor
Vidant Medical Group
08.2013 - 11.2020
Case Management Assistant
Vidant Medical Center
09.2012 - 08.2013
Commercial Claims Supervisor
United Concordia Dental Insurance
01.2000 - 06.2012
Documentation Specialist
Manor Care Health Services
01.1999 - 01.2000
East Carolina University
Bachelor of Science from Health Information Management
05.1983 - 05.1988
AAPC Certified Professional Physician Manager (CPPM) – Knowledge of healthcare business process, workflow, and reform; medical office accounting, physician reimbursement, and revenue cycle management, human resource management, marketing, and business relationships, health IT, EMRs, and health information exchange.
AHIMA Approved ICD-10-CM Trainer – Completed Chicago training course and examination
AAPC Certified Emergency Department Coder (CEDC) – Knowledge of Evaluation and Management (both 1995 & 1997) Documentation guidelines; coding of surgical procedures performed by ED physicians, ability to abstract and code Emergency Department records utilizing ICD-9-CM, CPT-4, and HCPCS Level II
Certified Lay Minister, The American Baptist Churches of Pennsylvania and Delaware
North Carolina Insurance License
AHIMA Certified Coding Specialist (CCS) – Skilled in classifying medical data from patient records, generally in the hospital setting, utilizing ICD-9-CM and CPT
Registered Health Informational Administrator (RHIA)
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