Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

NAVONNE T. WADE

Summary

Senior Coding Specialist with 20+ years in medical coding and auditing. Maintains an accuracy rate above 95% while collaborating with healthcare professionals to enhance documentation and maximize reimbursements. Focused on strategic oversight of operations and effective provider education initiatives.

Overview

23
23
years of professional experience
1
1
Certification

Work History

Caretaker

IHSS In Home Support Services
Lawndale, CA
04.2021 - Current
  • PROVIDE COMPASSIONATESUPPORT TO CLIENTS REQUIRING ASSISTANCE WITH ACTIVITIES OF DAILY LIVING (ADLS) INCLUDING PERSONAL CARE, HOUSEHOLD TASKS, MEAL PREPARATION, AND MEDICATION REMINDERS.
  • ENSURE SAFETY, COMFORT, AND HIGH-QUALITY CARE WHILE MAINTAINING CLIENT DIGNITY AND INDEPENDENCE.

Senior (Lead) Coding Specialist, Coding Specialist II, Coding Specialist I

Davita/Optum
El Segundo, Ca
01.2014 - 01.2021
  • Orchestrate/supervise/schedule both onsite and offsite audits i.e., CMS HCC RADV-Audits, Pre-Audits, E&M debriefings.
  • Prepared comprehensive reports on audit results and statuses to facilitate informed decision-making.
  • Proactively disseminate coding updates and reports to clinicians & healthcare professionals.
  • Schedule weekly coding/auditing meetings to ensure best practices are implemented for successful and accurate reimbursements.
  • Research and draft educational coding guideline memos from reliable news sources i.e., Coding News, CMS, ICD-9/ICD-10 guidelines.
  • Author and conduct coding classes for clinicians, clinical and business office staff.
  • Supported internal and external healthcare professionals by providing timely and accurate solutions to coding inquiries.
  • Train new hires placing emphasis on policies and procedures, software & additional training.
  • Highly ethical and confidential approach to patients' protected health information (PHI) in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

Business Analyst

Davita (formally Hcp)
Gardena, CA
01.2008 - 01.2014
  • Analyze and clarify member benefit plans for participants and healthcare professionals.
  • Developed comprehensive technical reports and spreadsheets analyzing information and business trends to support decision-making.
  • Compiled and analyzed data to prepare technical reports summarizing key insights and trends for stakeholders.
  • Proficiently apply analytical skills to detect and declare errors in the system design or setup.
  • Inspected and resolved electronic claim filing errors, quickly reporting errors while consulting with management.
  • Processed provider Notice of Changes (NOC) accurately to ensure compliance and timely updates.
  • Authored and communicated language in vendor contracts agreement to business associates.
  • Maintained professional and technical knowledge with continuing education workshops.

Claims Examiner III

HealthCare Partners
Gardena, CA
01.2004 - 01.2008
  • Adjudicated claims for the commercial unit according to contract and company guidelines.
  • Processed 120-250 claims daily; maintained 97-98.9% payment accuracy monthly.
  • Determined allowances on HCP payable claims and complete explanation of benefits with payment amounts and explanations of denials.
  • Verified service authorizations on claims to confirm prior or retroactive approvals.
  • Referred non-covered claims to support staff for issuance of appropriate denial letters and or referral to HMO.
  • Requested patient medical records when required to determine appropriateness of services. Handled incoming telephone inquiries to provide assistance to members and providers. relating to member claims from providers, members, etc. and documented calls.
  • Screened and completed preliminary data entry forms to ensure accuracy of information.
  • Assisted manager with training of examiners and the monitoring of general office support functions.
  • Assisted the supervisor with work distribution and completed additional special projects.

Education

Associate of Arts (AA) - Health Care Administration

University of Phoenix
Los Angeles

Graduate Certificate - Health Claims Examiner/Medical Biller

American Career College
Los Angeles
11.1977

Skills

  • DEBRIEFING / TRAINING
  • Auditing
  • ICD coding
  • TES and GE/IDX applications
  • RISK ADJUSTMENT
  • AUDITS
  • Risk adjustment coding
  • CODING GUIDELINES
  • E & M CODING
  • MS OFFICE SUITE PROFICIENCY
  • EXPERT MEDICAL TERMINOLOGY
  • INTERPRETATION
  • HIPAA COMPLIANCE
  • CPT coding
  • Audit reviews
  • CMS-HCC risk adjustment
  • Provider education
  • Regulatory compliance

Certification

  • NHA-CBCS certification-#w7s9b8s5(7/2025-Current)
  • NHA-CMAA CERTIFICATION-#c9k5b3p4-(6/2025-current)
  • AAPC-CPC Certification - #01274124 – (2013- Current)
  • AAPC ICD-10 Certification of Proficiency - (6/2015-Current)
  • AAPC-CRC Certification-#01274124 (2021-Current)

Timeline

Caretaker

IHSS In Home Support Services
04.2021 - Current

Senior (Lead) Coding Specialist, Coding Specialist II, Coding Specialist I

Davita/Optum
01.2014 - 01.2021

Business Analyst

Davita (formally Hcp)
01.2008 - 01.2014

Claims Examiner III

HealthCare Partners
01.2004 - 01.2008

Associate of Arts (AA) - Health Care Administration

University of Phoenix

Graduate Certificate - Health Claims Examiner/Medical Biller

American Career College
NAVONNE T. WADE