Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

Lora McCormick

Antioch,TENNESSEE

Summary

Dynamic Coding Specialist with extensive experience at RSource, specializing in comprehensive inpatient coding and clinical audits. Proven ability to lead teams and enhance DRG appeal strategies. Skilled in claims analysis and medical necessity, combining analytical prowess with effective collaboration to drive accuracy and efficiency in coding processes.

Overview

26
26
years of professional experience

Work History

Coding Specialist II/Team Lead I

RSource/Knowtion Health
01.2021 - Current
  • Performed DRG Audit Appeals and Inpatient denials
  • Coverage when Coding Manger was away
  • Reviewed Inpatient/Outpatient claims for medical necessity
  • Review for coding errors and make necessary corrections
  • Collaborate with management for any updated coding/billing guidelines
  • Team Leader I over Coding Team

Coding Specialist

RSource
01.2013 - 01.2021
  • Reviewed inpatient and outpatient claim denials for accurate coding
  • Reviewed medical necessity denials
  • Review for coding errors and make necessary corrections
  • DRG Appeals

Senior Recovery /Resolution Analyst

Ingram & Associates/Optum Health
Minneapolis, MN
01.2006 - 01.2021
  • Audit Medical Records to ensure billing correctly
  • Review Hospital accounts to make sure Insurance companies are paying the facilities per their contracts
  • Review for coding errors and make necessary corrections

Certified Coding Specialist

Tennessee Sports Medicines (TSMO)
Mt. Juliet, TN
01.2005 - 01.2006
  • Helped Implement inside billing office for group
  • Coding & billing for facility and physician’s hospital charges
  • Credentialing

Certified Coding Specialist

Nashville Medical Group
Nashville, TN
01.2002 - 01.2005
  • Coded and entered charges for 29 physicians
  • Corrected all coding errors, Insurance follow up, and chart auditing
  • Updated Physicians and staff on coding issues and changes

Financial Coordinator

Drs. Peeler, Scott, & Wise
Nashville, TN
01.1999 - 01.2002
  • Coded and entered hospital charges
  • Filed electronic and paper claims, posted all insurance pmts
  • Interim office manager for 6 months

Education

Certified Professional Coder -

Vanderbilt University
01.2004

Certified Medical Assistant -

Bryman College
01.1999

Skills

  • Comprehensive Inpatient Coding Expertise
  • Efficient Outpatient Coding
  • Clinical Audit Expertise
  • DRG Appeal Strategy Development
  • Claims Analysis
  • Medical necessity

References

  • Janet Westmoreland, Nashville, TN, Office Manager, (615) 872-7371
  • Sherry Simpson, Clarksville, TN, Office Manager, (931) 358-3868
  • Kathy Rogers, Pegram, TN, Medical Receptionist, (615) 792-9768

Timeline

Coding Specialist II/Team Lead I

RSource/Knowtion Health
01.2021 - Current

Coding Specialist

RSource
01.2013 - 01.2021

Senior Recovery /Resolution Analyst

Ingram & Associates/Optum Health
01.2006 - 01.2021

Certified Coding Specialist

Tennessee Sports Medicines (TSMO)
01.2005 - 01.2006

Certified Coding Specialist

Nashville Medical Group
01.2002 - 01.2005

Financial Coordinator

Drs. Peeler, Scott, & Wise
01.1999 - 01.2002

Certified Professional Coder -

Vanderbilt University

Certified Medical Assistant -

Bryman College
Lora McCormick