Latisha Coles, CPC, CRC
Charlotte,NC
Summary
Dedicated and results-driven professional with a solid background in healthcare coding, compliance, and revenue integrity, adept at project management, data analysis, and client communication. Recognized for exceeding quality standards, enhancing operational efficiency, and driving successful project outcomes. Proficient in medical terminology, ICD-10-CM/PCS, and analytics tools, poised to leverage strategic leadership and technical proficiency for business success
Overview
12
12
years of professional experience
Work History
Risk Adjustment Medical Record Coder
BCBS Tennessee
01.2023 - Current
- Review provider documentation to abstract and confirm all diagnosis codes mapping to HCC categories, according to CMS Risk Adjustment diagnosis coding guidelines
- Assist with management of medical records retrieval and filing, confirming document quality to ensure correct processes
- Complete special projects as directed by management, allowing for maximum production and quality and the overall success of the project
HCC Medical Coding Integrity Specialist
E4 Health
11.2021 - 02.2023
- Maintained strict confidentiality with adherence to HIPAA guidelines and regulations.
- Investigated rejected and denied claims, correcting applicable coding.
- Submitted clean claims to insurance companies electronically to secure payments.
- Translated patient information into alphanumeric and numeric medical codes
- Utilized Level 1 HCPCS and Level 2 HCPCS systems to complete coding tasks.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Maintained updated knowledge of coding requirements, which included continuing education and certification renewal.
- 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.
- Communicated with healthcare personnel, including practitioners to promote accuracy.
- Assigned procedure and diagnosis codes for insurance billing using Epic and 3M Encoder.
- Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
- Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes.
- Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports) in support of existing diagnoses.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Verified proper coding, sequencing of diagnoses and accuracy of procedures.
- Quickly responded to staff and client inquiries regarding CPT codes.
- Carefully coded disease and injury diagnoses, acuity of care and procedures in outpatient and inpatient setting.
- Interpreted medical terminology and pharmacological information to translate information into coding system.
- Verified and abstracted all medical data to assign appropriate codes for outpatient records.
- Sought clarification from physicians for answers to needed coding interpretations prior to abstracting records.
- Verified final claim submissions by comparing account charges with documentation.
- Thoroughly reviewed remittance codes from EOBS/AR's.
- Acted as liaison between business department, billers and third party payers in resolving billing and reimbursement accuracy.
- Reviewed medical record information to identify all appropriate coding.
- Submitted and accurately processed insurance claims with related medical code verifications and assessments.
- Maintained high accuracy rate on daily production of completed reviews.
Medical Coder
Charlotte Eye Ear Nose & Throat Associates
02.2016 - 11.2021
- Applied HIPAA privacy and security regulations while handling patient information.
- Completed and submitted appeals for denied claims.
- Coordinated communications between patients, billing personnel and insurance carriers.
- Contacted insurance providers to verify insurance information and obtain billing authorization.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Organized information for past-due accounts and transferred to collection agency.
- Handled billing, waivers and claims for private and commercial clients.
- Submitted and accurately processed insurance claims with related medical code verifications and assessments.
- Maintained high accuracy rate on daily production of completed reviews.
Coding Audit Response Specialist
Novant Health/ Revenue Cycle Services
02.2015 - 02.2016
- Managed coding audit response process, including addressing audit findings, discrepancies, and appeal processing, ensuring prompt resolution and compliance with coding guidelines.
- Conducted comprehensive reviews of coding practices and documentation to identify areas for improvement and ensure adherence to coding standards and regulations.
- Developed and implemented corrective action plans in response to audit findings, working collaboratively with coding team to rectify coding errors and enhance accuracy.
- Facilitated communication of audit results and recommendations to coding team and relevant stakeholders, fostering ongoing education and training initiatives to support coding compliance.
- Stayed abreast of coding regulations and guidelines, including updates from CMS and other regulatory bodies, to ensure coding practices remained current and compliant.
- Provided guidance and support to coding team in achieving quality and productivity goals, offering continuous feedback and coaching to optimize performance.
- Served as a primary point of contact for appeal processing, liaising with auditing entities and other stakeholders to resolve coding-related issues and inquiries efficiently.
- Demonstrated strong attention to detail and analytical skills in identifying coding discrepancies, trends, and opportunities for process improvement.
Revenue Integrity Specialist
Carolinas Healthcare System/ Perspective Health &
04.2012 - 02.2015
- Managed revenue integrity processes, ensuring accuracy and compliance with coding and billing regulations within a concierge medical practice setting.
- Conducted comprehensive reviews of coding, billing, and documentation practices to identify potential areas of improvement and ensure revenue optimization.
- Collaborated with clinical and administrative staff to implement coding and documentation best practices, resulting in improved revenue capture and compliance.
- Developed and maintained effective audit and monitoring programs to proactively identify coding and billing discrepancies and address them in a timely manner.
- Conducted regular coding and billing audits to validate accuracy and compliance with coding guidelines, payer policies, and regulatory requirements.
- Provided training and education to clinical and administrative staff on coding, documentation, and billing practices to enhance revenue integrity and compliance awareness.
- Acted as a liaison between the concierge medical practice and payers to address billing inquiries, denials, and appeals, ensuring timely resolution and maximum reimbursement.
- Stayed current on industry trends, regulations, and best practices related to revenue cycle management, coding, billing, and compliance to inform decision-making and process improvements.
Education
Bachelor of Science - Health Information Technology
University of Maryland Global Campus
College Park, Maryland05.2026
Project Management - PPM
University of North Carolina At Charlotte
Charlotte, NC05.2024
Business Analytics
University of North Carolina At Charlotte
Charlotte, NC05.2024
Skills
- Medical History Recording
- Epic Systems
- Problem-Solving
- Patient Data Coding
- Verbal and Written Communication
- Interpersonal Communication
- Patient Data Abstracts
- Certified Medical Coder (CPC, CRC)
- Data Entry
- Attention to Detail
- Time Management
- Insurance Billing
- Documentation Oversight
- Knowledgeable in Epic, Cerner, 3M Encoder
- Healthcare Claim Coding
- ICD-10 Coding
- Records Review
- EMR Systems
- Patient Rights
- Protected Health Information
- Coding Error Resolution
- Doctor Communication
- Microsoft Excel
- ICD-9 Coding
- Power BI, Tableau, SQL
- Records Accuracy
Timeline
Risk Adjustment Medical Record Coder
BCBS Tennessee
01.2023 - Current
HCC Medical Coding Integrity Specialist
E4 Health
11.2021 - 02.2023
Medical Coder
Charlotte Eye Ear Nose & Throat Associates
02.2016 - 11.2021
Coding Audit Response Specialist
Novant Health/ Revenue Cycle Services
02.2015 - 02.2016
Revenue Integrity Specialist
Carolinas Healthcare System/ Perspective Health &
04.2012 - 02.2015
Bachelor of Science - Health Information Technology
University of Maryland Global Campus
Project Management - PPM
University of North Carolina At Charlotte
Business Analytics
University of North Carolina At Charlotte