Kristina Nestor Walker
Taylor,USA
Summary
Highly motivated professional seeking a challenging role in quality assurance, auditing, and medical record coding. Strong background in these areas, dedicated to ensuring accuracy and compliance in all aspects of healthcare documentation. Experienced in conducting thorough reviews and assessments, possesses a keen eye for detail and a commitment to maintaining the highest standards. Seeking an opportunity to contribute expertise and drive for excellence in a dynamic and fast-paced environment.
Overview
14
14
years of professional experience
1
1
Certification
Work History
HCC Coder and Quality Review Audit Analyst
Cigna
12.2024 - Current
- Ensure proper determination and allocation of diagnosis codes for inpatient and ED services.
- Ensured accuracy of HCC validation for designated benefits under risk adjustment frameworks.
- Use longitudinal analysis to identify valid data elements and capture opportunities
- Conduct documentation and data audits, identifying inaccuracies or compliance risks for risk adjustment programs (e.g., RADV audits)
- Collaborate with internal and external teams on coding and risk adjustment education
- Coordinate with stakeholders to execute compliant risk adjustment programs and escalate risks or gaps to management
- Create and refine internal processes ensuring compliance with CMS/HHS regulations
- Contribute to updates on IFP coding guidelines and policies
Medical Billing and Coding Instructor
Washtenaw Community College
05.2019 - Current
- Instruct courses in the Medical Billing and Coding Program
- Align current coding updates with course content throughout the Medical Billing and Coding program
- Design curriculum and course materials to enhance learning and comprehension
CDI Specialist
Henry Ford Health System
10.2022 - 01.2024
- Utilize documentation and coding expertise to audit the quality and completeness of medical record documentation for outpatient encounters, clinic visits, outpatient surgical procedures, telemedicine, HCC coding and other ancillary services
- Review concurrent, prospective and retrospective documentation to evaluate, assimilate and audit Risk Adjustment Coding
- Correctly capture both HC and PC claims data
- Code OP complex records in accordance with audits, Local, State, and Federal coding guidelines and regulations
- Query physicians when nessesary
- Apply NCCI Edits, ICD-10CM, CPT, Hierarchical Condition Categories (HCC), compliance standards, and clinical knowledge to accurately abstract data from the EHR for OP CDI Education database
- Utilize data from monthly provider performance scorecards, revenue cycle projects, and KPI metric dashboards related to Revenue Cycle for performance improvement
Coding Coordinator of Quality and Education
Henry Ford Health System
04.2020 - 10.2022
- Coordinate and oversee the flow of medical record coded information for billing/reimbursement
- Evaluate coding education materials to meet compliance with industry coding standards
- Assist and support the Documentation & Coding Provider Education Program in the development and maintenance of coding education materials and process improvement plan
- Peform quality assuance on risk adjustment coding projects for HAP, Molina and CMS
Coder/Research Abstract Analyst
Henry Ford Health System
11.2016 - 04.2020
- Analyzed medical records for various research and quality projects
- Coded for acute care inpatient, risk adjustment and HCC coding projects
- Abstracted data for the Quality Oncology Practice Iniative, which includes cancer biology data and acute care inpatient records
- Worked with multiple databases, EMR’s and registries abstracting data
- Traveled to local physician offices and hospitals in order to capture HEDIS quality measure data
- EPIC and 3M encoder used
Coding and Billing Specialist
Heart and Vascular Institute
08.2016 - 10.2016
- Code physician billing using ICD-10 and CPT using various EHR systems-Cerner/Epic
- Create, review and appeal unpaid claims with various insurance providers and Web-DENIS
- Manage the facility’s Accounts Receivable and assist patients with billing questions
Program Director of HIT & MIS Programs
Baker College
04.2014 - 07.2016
- Hired, supervised, trained and mentored faculty for program specific courses
- Oversaw the Health Information Techology Program Advisory Board
- Carried out Program Orientation and mediated student-faculty issues relevant to the program
- Instructed ICD-10 Coding, Legal and Ethics, Healthcare Statistics and RHIT Preperation courses
HIT/MIS Clinical Coordinator
Baker College
11.2013 - 04.2014
- Coordinated student externship placement, recruited, and developed relationships with facilities
- Assisted with curriculum development
- Advised and mentored over 100 HIT program students academically and professionally
- Instructed classes in Medical Coding and Health Information Technology discipline
Internships
01.2011 - 12.2013
- Audited medical records in order to identify deficiencies
- Maintained quality results by following Medicare Hospice Conditions of Participation (CoPs)
- Assisted Medical Records’ Director with the retrieval of information and management of MPI
- Coded patient records using ICD-9 and CPT
Education
Bachelor of Science - Health Services Administration
Baker College
Allen Park, MI12.2013
Associate of Science - Health Information Technology
Baker College
Allen Park, MI12.2011
Skills
- ICD-10 proficiency
- Critical thinking capacity
- HIPAA compliance
- Effective communication
- HCC coding experience
- Risk adjustment principles
- Claims processing
- Insurance claims analysis
- Revenue cycle management
- Inpatient records coding
Certifications And Credentials
- RHIT
- CPC
- ICD-10 CM/PCS Certified Trainer
Certification
CPC, RHIT
Timeline
HCC Coder and Quality Review Audit Analyst
Cigna
12.2024 - Current
CDI Specialist
Henry Ford Health System
10.2022 - 01.2024
Coding Coordinator of Quality and Education
Henry Ford Health System
04.2020 - 10.2022
Medical Billing and Coding Instructor
Washtenaw Community College
05.2019 - Current
Coder/Research Abstract Analyst
Henry Ford Health System
11.2016 - 04.2020
Coding and Billing Specialist
Heart and Vascular Institute
08.2016 - 10.2016
Program Director of HIT & MIS Programs
Baker College
04.2014 - 07.2016
HIT/MIS Clinical Coordinator
Baker College
11.2013 - 04.2014
Internships
01.2011 - 12.2013
Bachelor of Science - Health Services Administration
Baker College
Associate of Science - Health Information Technology
Baker College
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