Renoma Town
Baton Rouge,LA
Summary
Results-driven Coding Auditor and Provider Educator at GI Alliance, skilled in internal auditing and audit reporting. Demonstrated attention to detail and critical thinking by enhancing compliance and identifying fraud prevention opportunities. Successfully educated providers/coding team on coding policies, improving documentation accuracy and reducing regulatory risks.
Overview
35
35
years of professional experience
1
1
Certification
Work History
Coding Auditor & Provider Educator -Remote
GI Alliance
07.2018 - Current
- Conducting internal audits to evaluate compliance with financial regulations for physicians, coding, and auditing team.
- Supported documentation review processes to ensure accuracy and completeness of records.
- Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control.
- Contributed to the preparation of audit reports by compiling relevant data and findings.
- Provides feedback to providers, coding, and auditing team regarding coding, billing, and documentation policies and procedures and educates on conflicting or non-specific documentation.
- Maintained organized records of audit activities for future reference and accountability.
- Maintained confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
- Collaborated with Coding/Compliance Managers of coding patterns identified within the audit process comply with guidelines and limit regulatory risks.
Surgical Coding Specialist II
GIA [Formally Known as Digestive Health Center - Gastroenterology Associates/Louisiana Endoscopy Center]
05.1998 - 07.2018
- Analyzed patient records for coding accuracy and compliance with regulations
- Abstracts and assigns the appropriate ICD -10, HCPCS/CPT codes, including level I & II modifiers as appropriate for all diagnosis and procedures performed in outpatient and inpatient settings.
- Collaborated with healthcare providers to resolve discrepancies in documentation
- Implemented best practices for coding procedures, and general surgery enhancing workflow efficiency
- Trained and mentored junior staff on coding guidelines and software systems
- Provided feedback to providers regarding billing and documentation policies and procedures and educated on all coding updates.
- Conducted QA audits of coded data to ensure precision and adherence to standards
- Collaborated/Queried with healthcare providers to clarify documentation, enhancing the accuracy of medical records.
Hospital Admissions Representative - Part Time.
Woman's Hospital
04.2004 - 06.2009
- Managed patient registration processes, ensuring accuracy and compliance with healthcare regulations.
- Facilitated effective communication between patients and medical staff to optimize service delivery.
- Implemented streamlined registration procedures to enhance patient experience and reduce wait times.
- Monitored data entry for completeness and accuracy, minimizing errors in patient records.
- Maintained accurate records by updating patient demographics, insurance, and financial information.
- Supported hospital compliance efforts by adhering to HIPAA guidelines and maintaining the confidentiality of patient information.
- Verified insurance benefits, processed payments, and issued receipts.
- Retrieved medical data for physicians and patients for the hospital admission process.
Insurance Claims /Enrollment Specialist
UHC [Formally MetraHealth] - Company Moved to Atlanta, Ga
02.1992 - 05.1995
- Review and verify medical claims for accuracy and completeness before processing. Ensure compliance with policies, and facilitating timely reimbursement for healthcare providers.
- Upheld a high level of accuracy by consistently double-checking figures, data entries, calculations, before finalizing any settlement documents or payments.
- Facilitated smooth transitions between departments during claim handoff processes to ensure seamless coordination among internal teams for prompt resolution times.
- Maintained compliance with industry regulations and standards by staying current on relevant laws, policies, and best practices for handling insurance claims.
- Enter patient information and medical claims data into the company's database, maintained accurate record of processed and pending claims.
- Determine patient enrollment/eligibility.
Housekeeper
Capital Nursing Home
07.1990 - 02.1992
- Disinfected and mopped bathrooms to keep facilities sanitary and clean.
- Cleaned and stocked guest rooms by replacing used towels and linens vacuuming floors, making beds, and restocking bathroom items.
- Collaborated with other housekeeping staff to complete tasks efficiently and effectively for new admits, and discharges.
- Vacuumed rugs and carpeted areas in offices, lobbies, and corridors.
- Used chemicals by following safety protocols and procedures to avoid burns and injuries.
- Hand-dusted and wiped down office furniture, fixtures, and window sills to keep areas clean and comfortable.
Education
No Degree - Accounting And Finance
Baton Rouge North Delta College of Arts And Technology
Baton Rouge, LA10-1991
High School Diploma -
West Feliciana High School
Saint Francisville, LA05-1988
Skills
- Attention to detail
- Audit reporting
- Decision-making
- Internal auditing
- Time management
- Multitasking and organization
- Critical thinking
- Ethical judgment
Certification
- COC [Certified Outpatient Coder]
- CPMA [Certified Professional Auditor}
- CGSC [Certified General Surgery Coder]
- CGIC [Certified Gastroenterology Coder]
- CUC [ Certified Urology Coder]
Timeline
Coding Auditor & Provider Educator -Remote
GI Alliance
07.2018 - Current
Hospital Admissions Representative - Part Time.
Woman's Hospital
04.2004 - 06.2009
Surgical Coding Specialist II
GIA [Formally Known as Digestive Health Center - Gastroenterology Associates/Louisiana Endoscopy Center]
05.1998 - 07.2018
Insurance Claims /Enrollment Specialist
UHC [Formally MetraHealth] - Company Moved to Atlanta, Ga
02.1992 - 05.1995
Housekeeper
Capital Nursing Home
07.1990 - 02.1992
No Degree - Accounting And Finance
Baton Rouge North Delta College of Arts And Technology
High School Diploma -
West Feliciana High School
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