Kristen Saunders-Denton

•Performs complex standard and non-standard processing, Medicaid pends and edits, and quality tasks in support of OH Medicaid Claims, utilizing appropriate sources of information, including eligibility, enrollment, state contracts, provider and facility contracts, and state and health plan billing manuals.
•Edits or Pends OH Medicaid Claims as needed according to DLP step edits and processes, handling company confidential data according to policy and guidelines while adhering to existing security policies and procedures.
•Performs analysis, interprets, audits and reconciles OH Medicaid Claims for accuracy or completeness.
•Maintains log records of all OH Medicaid Claim pends, edits, and pertinent data changes made to each OH Medicaid Claim.

• Maintained historical reference by abstracting and coding clinical data such as diseases, operations, procedures and therapies with standard classification systems.
• Reviewed assigned medical records to identify and abstract four measures relevant to annual state review for continued patient eligibility.
  •Documented and transcribed abstracted information into measures checklist within electronic medical records systems.
  •Audited each assigned medical record to ensure quality standards by proofreading documents for grammatical and correctness and adherence to standards and formats.
  •Completed an average of 20 records per forty hours (40 hours) in a work week to ensure compliance with productivity standards.

• Accurately coded patient charts at a rate of 14 charts per hour, compiling and abstracting patient data and vaccination medical reports, in remote environment using technical and soft skills, applying Certified MedDRA Coding, classification manuals and standard encoder systems.
• Additionally, functioned as, Medical Records Specialist, managing lifecycle of documents and patient record content by proof-reading, editing, collecting, analyzing, indexing, retrieving, storing, and processing health- related information into patient's EHR/EMR, filling records request and posting billings to patient records.
• Processed medical records requests from outside providers according to facility, state, and federal law.
• Maintained updated knowledge of coding requirements, Microsoft Office, Word, Excel, HIPAA, HITECH, Fair Claims Act, and Fair Debt Collection Act Compliance through continuing education.

• Interviewed residents in assigned areas to explain purpose of Census, ask questions and record answers.
• Applied technical and soft skills necessary for gathering and processing collected data.
• Actively conducted Interviews door-to-door, via telephone, and via mail-in questionnaires improving census response by 25%.
• Met with supervisor to review procedures, report issues or concerns and receive instructions.
• Maintained and submitted records of hours worked, miles driven, and expenses incurred to facilitate accurate reporting measures.

• Interviewed residents in assigned areas to explain purpose of Census, ask questions and record answers.
• Applied technical and soft skills necessary for gathering and processing collected data.
• Actively conducted Interviews door-to-door, via telephone, and via mail-in questionnaires improving census response by 25%.
• Met with supervisor to review procedures, report issues or concerns and receive instructions.
• Maintained and submitted records of hours worked, miles driven and expenses incurred to facilitate accurate reporting measures.