Michelle Pack
Kuna,ID
Summary
Results-driven Risk Adjustment Auditor with over 5 years of experience in risk adjustment coding and quality assurance. Known for strong analytical skills, attention to detail, and a commitment to mentoring junior staff to enhance team performance.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Risk Adjustment Auditor II
Cambia Health Solutions
Portland, OR
09.2021 - Current
- Performs HCC coding on projects for MA and ACA. Moves between various coding projects as needed.
- Performs CON-RADV and HHS-RADV audits.
- Performs 100% audit on deletes and net new codes as needed.
- Performs quality reviews of vendor coding in support of the risk adjustment process, provides coder feedback and education.
- Reviews medical record documentation to identify complete and accurate diagnosis code capture based on the official CMS- ICD-10 Coding Guidelines.
- Identifies trends in provider and vendor coding and documentation and partners with coding team manager and training lead to develop intervention strategies.
- Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements.
- Consistently meets departmental performance and attendance requirements.
Risk Adjustment Coder
Optum
Remote
08.2020 - 03.2021
- Conduct large volume risk adjustment audits monthly for HCC coding accuracy and compliance per CMS and the official ICD-10 coding guidelines.
- Abstract all risk adjustable diagnosis codes from an acceptable provider type and proper documentation.
- Reviewed coding practices, identifying areas for improvement and implementing best practices within the team.
- Maintained QA of 95% or higher as required.
Risk Adjustment Coder
Baylor Scott and White Health Plan
Remote
10.2017 - 05.2020
- Analyzed medical records and claim date to ensure accurate risk adjustment coding and compliance with regulatory guidelines, including CMS and the Official ICD-10 Coding Guidelines.
- Performed prospective and retrospective chart reviews for Medicare Advantage populations.
- Identify and correct coding discrepancies.
- Performed 100% delete audits and net new audits.
- Collaborate with coding team to develop training materials and discuss coding trends.
Outpatient Medical Coder
Baylor Scott and White Regional Medical Center
Remote
02.2014 - 10.2017
- Reviewed and assigned appropriate ICD-10 and CPT codes for outpatient professional services.
- Performed claim edits for varies issues including modifiers, accident/injury indicators also NCCI edits
- Ensured compliance with healthcare regulations and coding guidelines to maintain accuracy.
- Collaborated with healthcare providers to clarify documentation and coding discrepancies.
- Performed coding audits and provided appropriate feedback prior to ICD-10 implementation.
Education
High School Diploma -
Meridian High School
Meridian, IDSkills
- HCC/Risk Adjustment Coding
- ICD-10-CM/CPT/HCPCS
- CMS-HCC Model V24 and V28
- RADV experience
- Chart Review and Documentation
- Compliance and Quality Assurance
- EPIC, 3M, Encoder, Pulse 8, Quickchart, Edifecs
- Medical Chart Retrieval from Various EMR systems
Certification
- Certified Professional Coder (CPC)- AAPC, 2011
- Certified Risk Adjustment Coder (CRC)- AAPC, 2022
Timeline
Risk Adjustment Auditor II
Cambia Health Solutions
09.2021 - Current
Risk Adjustment Coder
Optum
08.2020 - 03.2021
Risk Adjustment Coder
Baylor Scott and White Health Plan
10.2017 - 05.2020
Outpatient Medical Coder
Baylor Scott and White Regional Medical Center
02.2014 - 10.2017
High School Diploma -
Meridian High School