Melissa McCabe
Stoughton
Summary
Certified Medical Coder with over a decade of progressive experience in the health insurance industry, including five years in leadership roles. Proven expertise in medical claims review, coding compliance, and fraud, waste, and abuse (FWA) detection. Skilled in interpreting regulatory and contractual requirements, analyzing clinical documentation, and ensuring alignment with national coding standards and payment policies. Adept at leading cross-functional teams, supporting state fair hearings, and educating providers on audit outcomes and documentation improvement. Brings a strong commitment to integrity, accuracy, and improving health outcomes through ethical claims adjudication and risk mitigation strategies.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Lead Medical Coder – Coding Integrity Unit
Quartz Health Insurance
02.2023 - Current
- - Oversight of conducting internal quality reviews of E/M and CPT/HCPCS coding logic to validate benefit accuracy and compliance.
- - Collaborate across Product, Clinical, and IT teams to resolve coding-related audit findings and improve adjudication accuracy.
- - Oversight of audit and maintenance of coding tools and documentation to ensure scoring tool precision and alignment with national standards.
- - Communicate audit results and provide education to stakeholders for continuous improvement.
- - Oversight of new hire selection and onboarding
- - Oversight of policy audits, and process improvement initiatives.
Senior Medical Coder
Quartz Health Insurance
10.2019 - 02.2023
- - Supported internal audits by reviewing escalated post-service claims for accuracy and adherence to benefit design.
- - Delivered audit feedback and training to configuration and product development teams.
- - Researched and applied complex regulatory mandates across Commercial and Medicare products.
Lead Quality and Coding Analyst
WPS Health Insurance
08.2015 - 10.2019
- - Conducted benefit coding crosswalk audits and policy evaluations to ensure consistency and compliance.
- - Led internal quality audits of medical necessity reviews and reimbursement policies.
- - Delivered audit findings and improvement recommendations to stakeholders and leadership.
- - Monitored coding performance metrics and supported appeals resolution processes.
Education
Bachelor of Science - Health Information Management and Technology
University of Wisconsin – Green Bay
05-2025
Associate Degree - Health Information Technology
Moraine Park Technical College
05-2019
Skills
- Effective team leadership
- - Coding Quality Audits & Documentation
- - CPT, HCPCS, ICD-10, CDT, ICD-PCS
- - Regulatory & Compliance Review
- - Audit Result Communication & Reporting
- - Policy & Benefit Coding Alignment
- - Cross-functional Collaboration
- - Claim Review & Payment Integrity Analysis
- - Data Analysis & Trend Identification
- -Provider Education
- Microsoft Office proficiency
Accomplishments
- - Spearheaded internal coding audit strategy that reduced configuration errors by 40%.
- - Developed audit documentation reference materials used across departments.
- - Designed and delivered audit-based feedback that improved provider coder performance and reduced recurring errors.
- - Recognized for accuracy and timeliness in responding to audit requests and coding inquiries.
- Developed cross-functional committee identify new coding edits and communicate effectively to providers.
- Successfully created and managed code edits resulting in over 23 million dollars in savings.
Affiliations
- - American Health Information Management Association (AHIMA)
- - American Academy of Professional Coders (AAPC)
- - Healthcare Leaders Association of Wisconsin
- - National Society of Leadership and Success
Certification
- - CCS – Certified Coding Specialist (AHIMA)
- - RHIA – Eligible 2025
Timeline
Lead Medical Coder – Coding Integrity Unit
Quartz Health Insurance
02.2023 - Current
Senior Medical Coder
Quartz Health Insurance
10.2019 - 02.2023
Lead Quality and Coding Analyst
WPS Health Insurance
08.2015 - 10.2019
Bachelor of Science - Health Information Management and Technology
University of Wisconsin – Green Bay
Associate Degree - Health Information Technology
Moraine Park Technical College
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