Marie Waldron
Clovis,CA
Summary
Quality focused AAPC and AHIMA certified coder with 10+ years of validating and assigning ICD-10-CM, CPT, CPT II, HCPCS, PCS, DRG and modifiers. Experienced in inpatient, outpatient, risk adjustment coding following all coding principles and guidelines. Prior audit/quality experience in directing onboard orientations for new providers and training office staff quarterly. Specialties include: family medicine, pediatrics, palliative, internal medicine, obstetrics, gynecology and dermatology. Proficient in: various EMR systems; EPIC, PCIS, DSG, NextGen, Salesforce, 3M Encoder, OPTUM and Liquid.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Sr. CDI Specialist
Molina Healthcare
Long Beach, CA
04.2023 - Current
- Execute and manage annual visit and incentive program for provider groups in: AZ, UT/ID and WA
- Perform training and compliance activities.
- Define team directions and provide guidance to health plans.
- Utilize document management system to organize company files with up-to-date and easily accessible data.
RADV Validation Auditor
E4 Health
DeLand, FL
01.2024 - 03.2024
- Performed accurate and complete chart reviews for HCC/risk adjustment.
- Identified and communicated trends in provider coding and documentation
- Ensured all diagnosis were accurate and complete from medical record in accordance with ICD-10-CM guidelines
- Confirmed code to the highest level of specificity for maximum reimbursement.
Risk Adjustment Supervisor
Network Medical Management
Alhambra, CA
04.2022 - 12.2022
- Reviewed, tracked and assessed validity of HCC codes for current year Annual Well Visits.
- Acquired risk-related data from external and internal resources to create reports on open HEDIS/STARS and HCC gaps for targeted providers.
- Used reports to break down and analyze information to prepare education reports for providers on patterns/trend and missed opportunity.
- Performed statistical analyses to identify trends, variations, patterns and insight to share data during client monthly meetings.
Coder Educator
Northern California Physicians Network
San Jose, CA
08.2021 - 03.2022
- Reviewed provider completed Annual Health Forms for coding accuracy and Medicare Advantage reporting requirements.
- Extracted HEDIS/STARS and HCC codes from progress notes to excel spreadsheet for submission.
- Responded to coding questions from providers and office staff.
- Read through patient health data, histories, physician diagnoses and treatments for coding purposes.
- Communicated and provided in person education on provider missed opportunity to improve provider RAF score.
- Reviewed health plan reports and provided updated reporting to providers on open gaps in care and patients without office visits.
Medicare Coding and Quality Consultant
Optum
Minneapolis, MN
05.2019 - 02.2021
- Provided coding education and auditing services directly to providers and office staff.
- Maintained relevant productivity and turnaround time standards for completing medical records (e.g., charts, assessments, visits, encounters)
- Educated and mentored others to improve medical coding quality and overall patient care.
- Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports in clinical studies) in support of existing diagnoses.
RADV Validation Auditor
Intellis
Deland, FL
01.2019 - 04.2019
- Selected to redact payor‘s information designated by project guidelines
- Ensured all diagnosis and services were accurate and complete from medical record in accordance with ICD-10-CM guidelines.
- Confirmed correct code to highest level of specificity for maximum reimbursement.
- Performed accurate and complete chart reviews for HCC/risk adjustment.
Coding Specialist
CIOX HEALTH
Alpharetta, GA
7 2018 - 02.2019
- Reviewed medical record information to identify all appropriate coding based on client specific guideline for project.
- Maintained 95% coding accuracy rate on relevant abstracted codes from each chart.
RADV Validation Auditor
Intellis
Deland, FL
01.2018 - 5 2018
- Performed accurate and complete chart reviews for HCC/risk adjustment.
- Identified and communicated trends in provider coding and documentation
- Ensured all diagnosis were accurate and complete from medical record in accordance with ICD-10-CM guidelines
- Confirmed code to the highest level of specificity for maximum reimbursement.
HCC Coder
Synermed
, CA
1 2017 - 11 2017
- Identified, collected, assessed, monitored and documented encounter coding information as it pertains to Hierarchical Condition Categories.
- Verified and ensured accuracy, completeness, specificity and appropriateness of diagnosis codes based on services performed.
- Performed chart audits and health risk assessment reviews to validate information in physician-office medical records.
- Provided education and training, to internal departments and physician offices on Risk Adjustment Coding.
Medical Coding Specialist
CCFMG
Fresno, CA
8 2014 - 1 2017
- Audited inpatient records and other documentation to evaluate issues of coding (ICD-10-CM, PCS, and services rendered for DRG assignment accuracy
- Abstracted clinical information from medical records to validate principle and secondary dx to support accurate hospital charges
- Performed medical record and billing reviews including clinical documentation, medical terminology, codes (CPT, HCPCS, ICD-10-CM and revenue) and reviews for charge and reimbursement accuracy
- Directed coding/billing orientations for new physicians and nurse practitioners
Education
BBA - Healthcare Management
American InterContinental University
2016
Certification
AHIMA Certified Coding Specialist (CCS)
Credential ID: 2805618
AAPC Certified Professional Coder (CPC)
Credential ID: 01523470
AAPC Certified Risk Adjustment Coder (CRC)
Credential ID: 01523470
Timeline
RADV Validation Auditor
E4 Health
01.2024 - 03.2024
Sr. CDI Specialist
Molina Healthcare
04.2023 - Current
Risk Adjustment Supervisor
Network Medical Management
04.2022 - 12.2022
Coder Educator
Northern California Physicians Network
08.2021 - 03.2022
Medicare Coding and Quality Consultant
Optum
05.2019 - 02.2021
RADV Validation Auditor
Intellis
01.2019 - 04.2019
RADV Validation Auditor
Intellis
01.2018 - 5 2018
Coding Specialist
CIOX HEALTH
7 2018 - 02.2019
HCC Coder
Synermed
1 2017 - 11 2017
Medical Coding Specialist
CCFMG
8 2014 - 1 2017
BBA - Healthcare Management
American InterContinental University
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