Latoya C Thomas
Queens,NY
Summary
Experienced Outpatient and ER facility professional certified Coder offering 13 years of coding expertise. Hardworking professional applies official coding conventions and rules established by American Medical Association and Centers for Medicare and Medicaid Services. Confident Medical Coder adheres to data confidentiality and privacy rules in all workflows and promotes dynamic interpersonal skills.
Overview
13
13
years of professional experience
Work History
Outpatient Coding Supervisor
Bellevue Hospital
05.2023 - Current
- Used problem-solving and conflict resolution skills to foster effective work relationships with team members.
- Developed, maintain, and evaluate documentation to reduce coding edits.
- Identified and resolves complex or recurring operational problems and consults with Revenue Integrity Director.
- Oversees daily workflow, staffing, orientation, training and developing of employees in collaboration with Department Director.
Medical coding Auditor
Kunsan Air force
07.2019 - 09.2020
- Reviewed inpatient and outpatient encounters in accordance with all AF and DOD instructions and guidance. Examples of such guidance are but not limited to AFI 41-210, TRICARE Operations.
- Patient Administration Functions; Military Health Systems (MHS) Coding Guidelines, or others as defined by AF and/or DoD.
- Current coding audit methodology is specific and outlines nature, timeliness, and occurrence of all audits, and contractor staff is required to follow specific methodology concerning audits.
- Conducted audits for MTF specific needs. These needs can be, but are not limited to, following:
- Data Quality related coding audits, new provider audits, clinical areas of concern regarding coding, problematic coding noted by particular clinical staff, and out-of- rotation audits.
- Responsible for conducting audits of medical records and all other pertinent documents for accuracy and completeness.
- Responsible for validating diagnosis, evaluation and management, procedure, and all other codes required to process encounter as complete and support billing office.
- Responsible for performing independent audits determining need for training of its employees and all clinical staff involved in documentation and coding process.
- Formal training plan will be developed to address: 1) new provider orientation, 2) recurring provider training as result of monthly coding audit findings, and 3) semiannually staff training.
- Formal training plan will be submitted to government within 30 days of hire.
- Formal training plans will be reviewed semi- annually.
- All training must be documented and maintained in file plan.
- Participated with monthly trainings based off of previous Air Force Medical Operations Agency (AFMOA) and provider audit findings.
- Responsible for ensuring all professional staff members are aware of their personal coding errors so corrections can be made. This should be completed whenever errors are noted.
- Required to ensure all professional staff members receive standardized guidance regarding coding on monthly basis.
- Provided internal monitoring and graphical metrics of audits and training and provide reports regularly and as requested by MTF and/or Commander.
- Required to conduct coding reviews of professional staff and other contract personnel (if applicable), on regular basis and report findings as deliverable to Commander.
- Attended regular data quality meetings and brief staff, provide metric data of coding activities, and provide other coding specific support within MTF.
- Required to attend training, briefings, clinical Staff Assistance Visits, and other meetings that may require coding expertise.
Outpatient Auditor Sr. OP Coder
Gibbs Healthcare Solutions
11.2018 - 04.2019
- Provided audit services including ICD-9-CM/PCS and ICD-10-CM/PCS Coding, CPT coding, abstracting and APC reviews in multiple health systems and facilities
- Ability to successfully perform coding quality reviews to validate correct coding, following GeBBS
- Corporate Coding Compliance Plan and Quality Review guidelines
- Provided feedback to coding staff on audit results and provide training on areas where coding compliance is not met
- Maintained ongoing communication with management, coding staff and clients to ensure target coding compliance goals are met
- Performed QA reports and prepare data to be used in report preparation
- Supported company Compliance Program by demonstrating adherence to all relevant compliance policies and procedures as evidenced by in-service attendance and daily practice; notifying management when compliance concerns or incident; demonstrating knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of patient information; promoting confidentiality and using discretion when handling patient information.
Sr. OP Coder Validator
Gibbs Healthcare Solutions
10.2018 - 11.2018
- Objectively and accurately conduct coding reviews on medical records for assigned client audit contract in accordance with statement of work while meeting compliance, productivity and quality expectations
- Conduct review of flagged claims and Fraud Waster & Abuse (FWA) referrals involving suspected up coding, un-bundling, anomalous coding, intentional miscoding, etc
- Timely review and disposition of suspected case referrals, including determination of inaccurate and/or inappropriate coding
- Appropriately refer reviews for clinical validation and communicate with and provide guidance for other Medical Review staff on needed documentation or clarification on coding and/or billing requirements
- Enter and update all contract and/or review findings supporting documentation into audit processing system
- Proof of concept development and data analysis of reports for potential edit development
- Monitor CMS and major payer coding and reimbursement policies
- Assist in identifying new issues/investigative strategies for audit, perform research to validate new issues, and provide new rules, regulations and applicable Medicare or program language and explanation
- Maintain certifications and training required to ensure eligibility to perform audits such as coding certification(s), as well as HIPPA and other compliance training
- Notify management of all correspondence indicating displeasure with Remittance Advice (RA), in over payment identification, or in recovery methods utilized, legal action, or government intervention.
Quality Improvement Specialist
Well care
01.2018 - 05.2018
- Outpatient/Inpatient Provider Coding
- Code, abstracts and analyzes Inpatient and/or Outpatient medical records using ICD-10
- Assisted In chart chase
- Contacted provider offices to place medical record request
- Performed power point presentations on correct coding
- Created excel spreadsheet for various projects
- Hedis / Stars experience.
Outpatient/Inpatient Medical Coder Trauma II
Memorial Sloan Kettering Hospital, Acute Care
08.2017 - 12.2017
- Analyzed medical records, extracting clinical, pathological, therapeutic and epidemiologic data in accordance with established ICD-10-CM coding principles and guidelines.
- Ensured data is optimally coded for research purposes, financial reimbursement, planning, statistics and regulatory reporting.
- Specialized in coding, Ophthalmic Oncology, Gynecologic Oncology, Neurology, Mesothelioma, head, solid tumors, Cell therapy.
- Pathology, Interventional Radiology, Chemo Infusions, and pumps
- Specialized in coding, Ophthalmic Oncology, Gynecologic Oncology, Neurology, Mesothelioma, head, solid tumors, Cell therapy.
- Pathology, Interventional Radiology, Chemo Infusions, and pumps.
- Extensive knowledge of coding of lymph nodes, Head & neck, intrathoracic, intraabdominal, axillary& upper limbs, inguinal, intrapelvic.
- Specialized in coding primary and secondary cancers of brain, lung, uterine, pancreas, liver, low grade glioma, retinoblastoma, melanoma, basal cell carcinomas, soft tissue sarcoma’s, Esophageal, adrenal, bladder, kidney, testicular, germ cells, prostate, breast, survivor-ship, Family and personal history of cancer.
Emergency Department Coder
Norwalk Hospital
09.2015 - 02.2017
- Extensive knowledge of medical terminology, anatomy and physiology, human disease processes.
- ICD-10-CM, CPT-4, and E&M codes/modifiers.
- Specialized in coding fractures, Lacerations, Shortness of breath, Pharyngitis, Dizziness, Headache, Pregnancies, Ulcers, Otitis media, Diabetes, CKD, Heart disease, Hypertension, CAD, Burns, Alcohol intoxication, Motor vehicle accident, Heart failure, Anxiety, Altered mental status, Alcohol use, Drug use, and Tobacco use.
- Tracked missing/incomplete charts and reconciles within 30 days of discharge.
- Proficient in use of 1995 guidelines
- Ensured all IV and hydrations are coded based on documentation provided.
Outpatient Coder II
Connecticut Children Hospital
04.2015 - 08.2015
- Facility expertise coding various adolescent mental issues such as, personality disorders, Anxiety disorders, Autism Spectrum Disorders, Eating Disorders, Mood Disorders, Schizophrenia, Depression, Disruptive behaviors, Suicide Ideation, Suspected and confirmed cases of rape, and child abuse, Circumcision, Lacerations, Otitis media, fractured teeth, Sprains, Open wounds, lacerations, Contusions, Splints, Cast, Reduction of fractures, Foreign body removal, Suture laceration, Ear wax removal, and Tooth Extraction, and Cerebral drainage.
- Reconciled medical record documentation, coding, claims and reimbursement data.
- Made recommendations for changes and improvements.
St. John's Episcopal Hospital, Facility Acute Care
03.2010 - 01.2015
- Coded outpatient encounters at rate of 160 per day and 25 complex specialty coding.
- Experience coding, Pediatrics, Family practice, Internal medicine, Infectious disease, Wound care, Dermatology, Hematology, GU, GI, Nutrition, Obstetrics, GYN, Emergency labor and delivery, Podiatry, Orthopedics, Neurology, Endo, Cardiology, ENT, Pulmonary, Arthritis, Ophthalmology, Audiology, Oncology.
- Acted as liaison between business department, billers and third-party payers in resolving billing and reimbursement accuracy.
Coder
North Shore Long Island Jewish, Care Acute Care
11.2013 - 02.2014
- Provider and Facility Coding
- Performed facility coding and physician coding experience coding fractures, lacerations, diabetes, hypertension, MI, arthritis, cancers, pain, slip and falls, Motor vehicle accidents, pregnancies
- Analyzed and interpreted medical record in its entirety to ensure accurate, complete and consistent selection of diagnoses and procedures to assure production of quality health care data and accurate facility payment.
Education
Bachelor of Arts - Communications
Purdue Global
West Lafayette, IN06.2026
Health Information Management
Charter Oak StateCollege
New Britain, CT2011
GED -
Plaza College
Forest Hills, NYSkills
- CPC – Since 2017
- Systems/Software/Specialties
- Microsoft Word, Excel, PowerPoint and Adobe
- Trauma II, Critical Care, Acute Care, Children’s
- Acute Care, Outpatient, ED, Infusions and IV Coding, Teaching Facility
- EPIC, Medisoft, 3M, Meditech, Clintegrity, Eclipsys, Cerner, QSHR, Allscripts, Clintrac, NextGen,
- Optum 360, Soarian, Citrix, TruCode, Smart bins, CCE, CHCS/AHLTA and more
- Knowledge of HMOs, Medicare and Medicaid
- ICD10, 95 Guidelines, Ancillary, Anesthesia, Cardiac Surgery, Charge Entry/Validate, Claims Edits,
- Denials, ED/ER, EM Facility and Physician, HEDIS, Hospitalist, IVR, OB/GYN and more
- Ability to train, motivate and supervise subordinate staff
- Ability to address and manage conflict in a direct and professional manner
- Ability to build collaborative relationships with providers
- Demonstrated interpersonal skills
- The ability to lead and elevate the abilities and competencies of staff
- Excellent verbal and written communication skills
Timeline
Outpatient Coding Supervisor
Bellevue Hospital
05.2023 - Current
Medical coding Auditor
Kunsan Air force
07.2019 - 09.2020
Outpatient Auditor Sr. OP Coder
Gibbs Healthcare Solutions
11.2018 - 04.2019
Sr. OP Coder Validator
Gibbs Healthcare Solutions
10.2018 - 11.2018
Quality Improvement Specialist
Well care
01.2018 - 05.2018
Outpatient/Inpatient Medical Coder Trauma II
Memorial Sloan Kettering Hospital, Acute Care
08.2017 - 12.2017
Emergency Department Coder
Norwalk Hospital
09.2015 - 02.2017
Outpatient Coder II
Connecticut Children Hospital
04.2015 - 08.2015
Coder
North Shore Long Island Jewish, Care Acute Care
11.2013 - 02.2014
St. John's Episcopal Hospital, Facility Acute Care
03.2010 - 01.2015
Bachelor of Arts - Communications
Purdue Global
Health Information Management
Charter Oak StateCollege
GED -
Plaza College
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