Misty Glaze

• Coding chart review for HCC retrieval data for PS Medicare Plans. Collaborate with RA Manager and team to ensure review process and code capture is maintained and meets the Medicare regulations and guidelines set forth by CMS. Identify opportunities to improve provider documentation and deliver improvement recommendation to Manager as needed. Team collaboration several times per year for other ad hoc projects as assigned including audits.
• Strengthened interdepartmental relationships by participating in meetings, sharing insights from coding audits.
• Adhered to established coding project timelines and quality standards.
• Played an active role in professional development, including attending relevant webinars, workshops, and conferences to stay abreast of industry standards in Coding with the AAPC (American Academy of Professional Coders)
• Demonstrated flexibility and adaptability in response to changes in coding guidelines, software systems, or departmental priorities. Our team initially worked with Excel spreadsheets to log our coding validation and has recently switched to NLP (Natural language processing) through Veradigm
• Maintained strict confidentiality of patient information in accordance with HIPAA regulations while managing sensitive data.
• Followed up with staff regarding missing and innacurate information in patient records.
• Created PowerPoint presentations for Knowledge sharing for Coding tips and tricks for the team, sharing on a quarterly basis

* Daily Rebill claim queue including advance rebills, helped with Deductible/ OOP claims queue, troubleshoot denied claims that were received through our Appeals and Grievance Department for reply to members. Reprocessed claims after determination made.

• Maintained strict confidentiality by adhering to HIPAA guidelines
• Managed 48 turn around times and high-volume workloads effectively by prioritizing tasks according to urgency and importance while maintaining strict attention to detail.
• Served as a reliable resource for both Appeals and Grievance team and claims staff by offering expert advice on proper code selection based on diagnosis or treatment specifics provided in the documentation received.
• Worked in multiple coding systems and Coding manuals to research

• Responsible for Coding queue and feedback/education to providers at assigned PH Primary Care clinics. Created yearly random chart audits for up to 15 providers and met with them to provide scores and any coding and documentation education needed
• Met with onboarding physicians for these clinics to go over Coding practices, overall guidelines used and other orientation duties as needed.

* Delivered consistent results under pressure by prioritizing tasks effectively during periods of high workload or tight end of month/year deadlines.

• Interacted with physicians and other healthcare staff to ask questions regarding Coding or billing questions.
• Performed on-site coding audits to determine accuracy and compliance with coding guidelines.
• Researched and resolved medical record discrepancies.

• Took internal and external Customer Service calls regarding Preauthorization or claims questions related to coding Worked in many different assigned collaborative workgroups within department to streamline processes. Worked Retro claims queue and helped to resolve coding and modifier issues with Special Functions team Lead and RN. Worked closely with dept staff and Coding Advisory Team to discuss new emerging CPT codes. Worked High Dollar claim report and obtained claim information and requested documentation for Medical Director to review.
• Selected for ICD-10 Project team to best map and implement changes to processes/policies for company
• Boosted overall team performance through regular coaching sessions, tailored training programs. Helped to create PowerPoint presentations on Coding errors and learning opportunities and presented to dept staff

• Processed claims for self-funded plans for SBA. Sorted and entered incoming claims and helped answer Customer Service queue calls.
• Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
• Assisted with mail and fax distribution as needed

• Entered large bundles of Fee tickets from all primary care and urgent care clinics for OMG. Researched and assigned proper diagnosis codes through EMR system as needed. Troubleshooting of claims in workgroup. Weekly meetings with team to discuss coding issues or system errors.
• Maintained high coding standards by adhering to industry best practices and staying current with emerging technologies.
• Reviewed patient charts to better understand health histories, diagnoses, and treatments.