Julie Brown
Syracuse,UT
Summary
Certified Professional Coder with extensive experience in risk adjustment auditing, demonstrating strong command of ICD-10 and CPT coding procedures and guidelines. Proven ability to enhance coding accuracy and compliance, contributing to improved patient outcomes. Seeking to join a progressive organization that prioritizes employee development and fosters a collaborative work environment, allowing for continued professional growth and meaningful contributions. Committed to leveraging expertise in coding to support organizational goals and drive success.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Risk Adjustment Auditor II
Cambia Health Solutions
Portland, OR
10.2023 - Current
- Conducts comprehensive HCC audits to ensure compliance and accuracy in MRA and ACA initiatives.
- Executes CON-RADV and HHS-RADV audit processes to ensure compliance and operational integrity.
- Maintains up-to-date knowledge of industry regulations and standards, ensuring audit practices remained compliant.
- Maintains confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
- Streamlines audit processes, improving efficiency and reducing time spent on each audit engagement.
- Plans and executes follow-up audits at appropriate intervals.
- Manages multiple concurrent audit engagements, prioritizing tasks to meet deadlines without compromising quality.
- Develops and maintains productive relationships with clients, facilitating smooth audit processes and engagements.
Risk Adjustment Auditor II / Risk Adjustment Provider Educator
Baylor Scott & White Health
Dallas, TX
08.2021 - 10.2023
- Created engaging risk adjustment educational content and facilitated presentations for providers at assigned clinics.
- Conducted provider chart audits to identify incorrect coding, lack of support in documentation, and any compliance issues.
- Compiled comprehensive reports detailing audit findings and conducted one-on-one reviews with providers.
- Analyzed outpatient medical records retroactively and prospectively to ensure accurate claims and encounter coding for risk adjustment.
- Verified comprehensive capture of HCC diagnosis codes with MEAT criteria throughout the calendar year.
- Cultivated strong relationships with practice administrators and clinic operational managers to secure support for risk adjustment educational initiatives.
Coder II
Baylor Scott & White Health
Dallas, TX
02.2020 - 08.2021
- Performed comprehensive physician based coding for multi-specialties, both outpatient and inpatient, including E&M services, procedures, diagnoses and treatments.
- Applied working knowledge of insurance processes and reconciliation regarding the denial process.
- Maintained coding benchmarks for both production and accuracy.
- Maintained up-to-date knowledge of coding changes during the COVID-19 pandemic to ensure compliance with evolving standards.
- Queried providers when necessary to ensure proper documentation and support for the charges being billed.
Pathology Coder
APS Medical Billing
Toledo, OH
07.2018 - 01.2020
- Coded for pathologists from multiple report types – Surgical, Cytology, and Clinical.
- Collaborated with diverse clients nationwide to address unique documentation and specific billing requirements.
- Utilized OnBase daily to access reports and input relevant codes.
- Participated in numerous training workshops to enhance expertise in complex diseases.
- Contributed to team efforts in adhering to DOS/DOP schedule to ensure operational efficiency.
- Delivered consistent results by meeting established coding benchmark production metrics.
- Engaged in self-directed study of educational materials to deepen understanding of pathology coding and maintain current knowledge of CPT and ICD-10 updates.
Peds ED/Urgent Care Coder II
University of Colorado Medicine
Aurora, CO
07.2016 - 07.2018
- Applied coding expertise to meticulously extract and analyze diagnostic and procedural details from patient records, facilitating accurate billing and reimbursement.
- Reviewed and assigned appropriate ICD-10 and CPT codes for pediatric emergency and urgent care visits, ensuring precise documentation and billing accuracy.
- Executed detailed coding of consults across multiple specialties, including neurology, ENT, psychiatry, gastroenterology, surgery, urology, and ophthalmology, during patient ED or urgent care visits.
- Ensured consistent adherence to quality and quantity production standards on a monthly basis.
- Contributed to provider meetings focused on gathering educational information and strengthening collaboration between providers and coders during troubleshooting discussions.
- Engaged with Epic platform on a daily basis to retrieve and manage electronic medical records effectively.
- Coordinated and submitted physician queries to obtain necessary clarifications on documentation.
- Provided the essential function of coding in the revenue billing cycle for the University of Colorado School of Medicine for teaching providers and resident and fellow physicians.
- Recorded charges in Centricity Business for each patient encounter to ensure accurate billing.
- Performed a comprehensive review of documentation to ensure the inclusion of critical components, including patient identifiers, DOS, provider signature, appropriate tie-ins to residents and scribe attestation
- Reviewed edits on a daily basis and made corrections to ensure timely and accurate billing.
Remote HCC Medical Coder
Examination Management Services, Inc.
Irving, TX
11.2015 - 04.2016
- Analyzed historical medical records and executed documentation audits to ensure accurate coding and adherence to standards.
- Identified any missing chronic conditions for each patient and entered these diagnosis codes into the coding database that mapped to the optimal HCC category.
- Applied HIPAA privacy and security regulations to ensure proper handling of patient information, safeguarding confidentiality.
- Maintained greater than 95% coding accuracy
Education
BBA - Marketing
University of Iowa
05-1999
Skills
- In-depth understanding of medical terminology and disease processes
- Proficient with Microsoft Office Suite and healthcare applications including: Word, Excel, Outlook, PowerPoint, Teams, SharePoint, 3M Encoder and Epic
- Critical thinker with strong organizational skills
- Adept multi-tasker
- Understanding of Risk Adjustment methodologies including Hierarchical Condition Categories (HCC), RADV audits and Medicare Advantage reimbursement
- Excellent communication skills (verbal, written, interpersonal, presentation) with all types/levels of audiences
- Upholds strict confidentiality standards
- Proficient in prioritizing tasks to meet deadlines
Certification
- CPC - Certified Professional Coder
- CRC - Certified Risk Adjustment Coder
Timeline
Risk Adjustment Auditor II
Cambia Health Solutions
10.2023 - Current
Risk Adjustment Auditor II / Risk Adjustment Provider Educator
Baylor Scott & White Health
08.2021 - 10.2023
Coder II
Baylor Scott & White Health
02.2020 - 08.2021
Pathology Coder
APS Medical Billing
07.2018 - 01.2020
Peds ED/Urgent Care Coder II
University of Colorado Medicine
07.2016 - 07.2018
Remote HCC Medical Coder
Examination Management Services, Inc.
11.2015 - 04.2016
BBA - Marketing
University of Iowa