Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Kala Baxter, CPC, CPMA

Murfreesboro,TN

Summary

Well-organized and detailed-oriented Senior Compliance Specialist with key experience in healthcare environments. Knowledgeable about researching, enforcing policies, and optimizing procedures for dynamic requirements. Focused on maintaining consistence, quality, and compliance in all areas.

Overview

10
10
years of professional experience
1
1
Certification

Work History

Senior Compliance Specialist

Sound Physicians
Brentwood, TN
12.2019 - 06.2024
  • Created educational materials on multiple components of the Compliance Program.
  • Conducted internal audits to identify areas of process noncompliance, documenting findings and recommending corrective actions for management review.
  • Scheduled and initiated appropriate follow-up action to ensure verification of correction for violations.
  • Meetings with Chief Hospitalist and Regional Medical Directors to discuss audits and findings.
  • Provide suggestions to improve management control weaknesses.
  • Managing and training team members to enhance audit department performance and increase operational efficiency.
  • Develop and implement comprehensive training programs for physicians on the requirements of ICD-10 implementation and CPT coding guidelines.
  • Worked closely with other departments such as Risk Management on various projects related to ensuring organizational compliance.
  • Advised department heads on best practices relating to legislative requirements or industry standards.
  • Evaluated current operating practices against applicable laws and regulations to identify deficiencies and recommend corrective actions.
  • Developed and implemented compliance policies, procedures, and processes to ensure organizational adherence to applicable laws and regulations.
  • Ensured effective communication of compliance policies and procedures throughout the organization.
  • Conferred frequently with specialists to stay current on compliance requirements and procedures.
  • Participated in meetings between senior leadership teams to discuss any potential violations or concerns about regulatory issues.
  • Pursued continuous learning opportunities regarding latest compliance and procedural changes.
  • Created plans to improve and correct operations in order to stay compliant.
  • Issued clear warnings to violators, outlining infractions, penalties and remediation steps.

Audit Specialist

Sound Physicians
Brentwood, TN
08.2018 - 12.2019
  • Conducted internal audits to identify areas of process noncompliance, documenting findings and recommending corrective actions for management review.
  • Scheduled and initiated appropriate follow-up action to ensure verification of correction for violations.
  • Worked closely with other departments such as Risk Management on various projects related to ensuring organizational compliance.
  • Advised department heads on best practices relating to legislative requirements or industry standards.
  • Evaluated current operating practices against applicable laws and regulations to identify deficiencies and recommend corrective actions.
  • Implemented compliance policies, procedures, and processes to ensure organizational adherence to applicable laws and regulations.
  • Ensured effective communication of compliance policies and procedures throughout the organization.
  • Conferred frequently with specialists to stay current on compliance requirements and procedures.
  • Participated in meetings between senior leadership teams to discuss any potential violations or concerns about regulatory issues.
  • Pursued continuous learning opportunities regarding latest compliance and procedural changes.

Medical Coder

Sound Physicians
Brentwood, TN
04.2018 - 08.2018
  • Coded diagnoses and procedures from patient medical records using ICD-10-CM and CPT-4 codes.
  • Validated accuracy of diagnosis codes as well as modifiers used on claims before final submission to payer and insurance companies.
  • Maintained confidentiality of patient information according to HIPAA regulations.
  • Researched discrepancies between documentation and billing information in order to resolve any issues prior to submission.
  • Reviewed patient medical records for accuracy, completeness and compliance with coding regulations.
  • Provided support for coding queries raised by coders or staff members regarding specific cases or coding issues.
  • Maintained up-to-date knowledge of coding changes, updates, and new rules.
  • Verified accuracy of procedure codes to ensure proper reimbursement levels.
  • Collaborated with other departments such as billing, clinical documentation improvement, quality assurance to ensure accurate coding practices are being followed.
  • Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
  • Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
  • Quickly responded to staff and client inquiries regarding CPT codes.
  • Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
  • Scheduled and initiated appropriate follow-up action to ensure verification of correction for violations.
  • Meetings with Hospitalist and to discuss audits and findings.
  • Implement comprehensive training programs for physicians on the requirements of ICD-10 implementation and CPT coding guidelines.
  • Evaluated current operating practices against applicable laws and regulations to identify deficiencies and recommend corrective actions.
  • Ensured effective communication of compliance policies and procedures throughout the organization.
  • Conferred frequently with specialists to stay current on compliance requirements and procedures.
  • Participated in meetings between senior leadership teams to discuss any potential violations or concerns about regulatory issues.
  • Pursued continuous learning opportunities regarding latest compliance and procedural changes.
  • Updated coding skills and knowledge through continuous education and training.
  • Utilized coding software and tools efficiently to expedite the coding process.
  • Maintained high accuracy rate on daily production of completed reviews.
  • Verified proper coding, sequencing of diagnoses, and accuracy of procedures.
  • Participated in coding team meetings to discuss challenges and best practices.
  • Maintained positive working relationship with fellow staff and management.

Medical Coder/Auditor Manager

The Pain Management Group and Tennessee Surgery Center
Nashville, TN
12.2015 - 03.2018
  • Created educational materials on multiple components of the Compliance Program.
  • Conducted internal audits to identify areas of process noncompliance, documenting findings and recommending corrective actions for management review.
  • Scheduled and initiated appropriate follow-up action to ensure verification of correction for violations.
  • Meetings with providers to discuss audits and findings.
  • Provided support for coding queries raised by coders or staff members regarding specific cases or coding issues.
  • Researched discrepancies between documentation and billing information in order to resolve any issues prior to submission.
  • Collaborated with other departments such as billing, clinical documentation improvement, quality assurance to ensure accurate coding practices are being followed.
  • Provide suggestions to improve management control weaknesses.
  • Managing and training team members to enhance audit department performance and increase operational efficiency.
  • Develop and implement comprehensive training programs for physicians on the requirements of ICD-10 implementation and CPT coding guidelines.
  • Advised department heads on best practices relating to legislative requirements or industry standards.
  • Evaluated current operating practices against applicable laws and regulations to identify deficiencies and recommend corrective actions.
  • Ensured effective communication of compliance policies and procedures throughout the organization.
  • Conferred frequently with specialists to stay current on compliance requirements and procedures.
  • Participated in meetings between senior leadership teams to discuss any potential violations or concerns about regulatory issues.
  • Created plans to improve and correct operations in order to stay compliant.
  • Maintained up-to-date knowledge of coding changes, updates, and new rules.
  • Issued clear warnings to violators, outlining infractions, penalties and remediation steps.
  • Developed and implemented strategic plans to achieve company objectives.

Medical Coder

Tennessee Orthopedic Alliance
Nashville, TN
01.2014 - 12.2015
  • Coded diagnoses and procedures from patient medical records using ICD-10-CM and CPT-4 codes.
  • Validated accuracy of diagnosis codes as well as modifiers used on claims before final submission to payer and insurance companies.
  • Maintained confidentiality of patient information according to HIPAA regulations.
  • Researched discrepancies between documentation and billing information in order to resolve any issues prior to submission.
  • Provided support for coding queries raised by coders or staff members regarding specific cases or coding issues.
  • Maintained up-to-date knowledge of coding changes, updates, and new rules.
  • Collaborated with other departments such as billing, clinical documentation improvement, quality assurance to ensure accurate coding practices are being followed.
  • Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
  • Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
  • Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
  • Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes.
  • Maintained high accuracy rate on daily production of completed reviews.
  • Resolved coding discrepancies and denials to maximize reimbursement.
  • Verified proper coding, sequencing of diagnoses, and accuracy of procedures.
  • Managed coding for multiple specialties, ensuring specific codes are accurately applied.
  • Participated in coding team meetings to discuss challenges and best practices.
  • Conducted audits to ensure compliance with federal and state regulations.
  • Utilized ICD-10, CPT, and HCPCS coding systems to process claims and billing.
  • Entered coded data into electronic health record (EHR) systems.
  • Maintained positive working relationship with fellow staff and management.

Education

Some College (No Degree) - Medical Coding And Billing

Tennessee College of Applied Technology
Murfreesboro, TN
04-2014

Skills

  • Auditing
  • Risk assessment
  • ICD-10 Coding
  • CPT Coding
  • Management
  • Compliance standards
  • Medical Terminology
  • MD Audit
  • EHR experience
  • Medical documentation
  • Designing educational materials
  • Ability to work independently or as a team member

Certification

  • Certificate for CPC - December 2014
  • Certificate for CPMA - October 2019

Timeline

Senior Compliance Specialist

Sound Physicians
12.2019 - 06.2024

Audit Specialist

Sound Physicians
08.2018 - 12.2019

Medical Coder

Sound Physicians
04.2018 - 08.2018

Medical Coder/Auditor Manager

The Pain Management Group and Tennessee Surgery Center
12.2015 - 03.2018

Medical Coder

Tennessee Orthopedic Alliance
01.2014 - 12.2015

Some College (No Degree) - Medical Coding And Billing

Tennessee College of Applied Technology

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Kala Baxter, CPC, CPMA