Hiking, home and yard renovation, reading
Martha Clausen
Coding Auditor
Ferron,UT
Summary
Results focused Quality Assurance Auditor successful at standardized review and correction in both the medical documentation and coding processes. Accurate and efficient team player with a passion for provider and coder education, process improvement, and relationship building.
Overview
11
11
years of professional experience
4
4
years of post-secondary education
1
1
Certificate
Work History
Quality Assurance Auditor
University Medical Billing
Salt Lake City, Utah
01.2019 - Current
- Performed quality reviews of professional services for medical departments including but not limited to Plastic Surgery, with focus on Gender Affirmation surgery, Orthopedics with focus on Hand, Foot, and Trauma, Ophthalmology, Adult and Pediatric Emergency Department, Urgent Care, Neonatology, and multiple pediatric specialties.
- Ensured that departments remained in compliance with coding guidelines and educated to optimize reimbursement within guidelines.
- Represented coding and auditing as part of first team to provide gender affirmation surgery to transgender population of the region.
- Compiled data into quarterly quality reports for multiple departments highlighting deficiencies in documentation, payer denials, and billing adjustments and recommending corrective actions.
- Educated multiple coding teams, individual providers, and departments using resources such as AMA and CMS Guidelines for CPT and ICD-10, and performed post-education accuracy reviews for coders to 95% accuracy.
- Maintained or exceeded 95% accuracy in coding CPT, ICD-10, HCPCS, HCC coding, and use of modifiers as well as overall accuracy of claim information.
- Represented Quality Assurance Team in provider and department Clinical Documentation Improvement meetings, as well as in coding and internal organization meetings.
- Arranged and facilitated provider-led trainings.
- Mentored coders and cross-trained auditors on individual basis when deeper understanding of department or procedure was required.
- Worked closely with Billing and Pre-Authorization Teams to resolve denials and identify workflows for efficiency/efficacy.
- Delivered third-party audit services at client locations, keeping operations in compliance with regulatory requirements and ISO standards.
- Currently pursuing certification as a Certified Professional Medical Auditor (CPMA) with anticipated completion in April 2022.
Coding Auditor
University Medical Billing
Salt Lake City, Utah
02.2017 - 01.2019
- Focused on physician documentation deficiencies, identifying and educating for improved accuracy.
- Used communication skills to develop respectful and effective relationships with providers, thus ensuring atmosphere of cooperation toward desired outcome.
- Developed specialty-specific training and education for new team of vendor coders related to multiple medical specialties. Followed training with auditing and feedback to 95% accuracy.
- Identified gaps in processes, procedures and systems through in-depth research and assessment and suggested methods for improvement.
- Mentored junior coders in coding, workflow, and communication skills.
Certified Professional Coder
University Medical Billing
Salt Lake City, Utah
02.2013 - 02.2017
- Used Epic and iCentra to assign procedure and diagnostic codes to patient records for billing purposes.
- Focused on Pediatrics, Plastic Surgery, Bariatric Surgery, Orthopedics, and Urology.
- Maintained or exceeded 95% accuracy in coding CPT, ICD-10, HCPCS, HCC coding, and use of modifiers as well as overall accuracy of claim information.
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Interacted with physicians and other healthcare staff to query regarding patient services and suggest alternative coding when more appropriate.
- Managed documentation issues such as unsigned notes, attestations, co-surgery and assistant surgeon statements, etc. prior to coding.
- Developed trusting and cooperative relationships between physicians/departments and coding.
- Mentored new coders, educating and auditing them in their assigned departments.
- Maintained Continuing Education Units for certification.
Certified Medical Coder
Utah Valley Pediatrics
Provo, UT
09.2011 - 02.2013
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures for office of ten pediatricians including Evaluation and Management, surgical, drug, and procedure coding.
- Maintained updated knowledge of coding requirements through continuing education and certification renewal.
- Guarded against fraud and abuse by verifying coded data accurately reflected services provided.
- Strategized with providers to reach reimbursement goals.
- Collaborated with billing team to resolve denials.
Education
Bachelor of Science - Speech And Language Pathology
Brigham Young University
Provo, Utah 08.1987 - 12.1991
Skills
Document Review
undefinedCertification
Certified Professional Coder, AAPC, 2011-present
Interests
Timeline
Quality Assurance Auditor
University Medical Billing
01.2019 - Current
Coding Auditor
University Medical Billing
02.2017 - 01.2019
Certified Professional Coder
University Medical Billing
02.2013 - 02.2017
Certified Medical Coder
Utah Valley Pediatrics
09.2011 - 02.2013
Bachelor of Science - Speech And Language Pathology
Brigham Young University
08.1987 - 12.1991
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