TEALA D. GRAY
SUMTER,USA
Summary
Motivated medical coder with medical billing experience. Highly skilled in analyzing and validating patient information, diagnoses, and billing data. Over 6 years experience in CPT, ICD diagnosis codes, E/M Guidelines, CCI edits and billing requirements. Successful track record handling complicated assignments. Demonstrated leadership skills that enable the processing of high volumes of claims to achieve revenue generation goals. Specializing in Profec coding for Home Visits, Plastic and Reconstruction Surgery, General Surgery, Gastroenterology, Urology, Hospitalist, Intensivist, Acute Care (FHC), Radiology, Dermatology, Internal Medicine, Reoccurring Wound Care and Urgent Care.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Risk Adjustment Coder
Optum
Remote
07.2024 - Current
- Leverage understanding of disease process to identify and extract relevant details and data within clinical documentation and make determination or identify appropriate ICD-10 codes following CMS guidelines.
- Evaluates documentation to ensure that diagnosis coding is complete, supported, and meets specificity requirement to support clinical indicators, HEDIS and STARS quality measures, as required by client
- Identifies suspect/unreported HCC codes in the notes/records to reflect the severity of the patient's condition
Profec Coder/ Risk Adjustment Coder
TrustHCS/Corrohealth
05.2018 - 07.2024
- Verify and correct physician e/m, diagnosis, and CPT Category II codes per physician documentation
- Collaborated with healthcare providers to clarify documentation and ensure coding precision.
- Conducted regular audits of coding practices to enhance compliance and reduce errors.
HCC/RADV Retrospective Auditor (Contract)
Intellis
01.2020 - 03.2020
- Verify and correct physician e/m, diagnosis, and CPT Category II codes per physician documentation
- Collaborated with healthcare providers to clarify documentation, ensuring accurate coding and reimbursement rates
- Reviewed and resolved coding-related inquiries from payers, enhancing communication between departments
HCC Coder (Contract)
Advantsure
08.2019 - 01.2020
- Adherence to current industry standard, as defined in ICD-9, or ICD-10 guidelines for coding and reporting
- Verify supporting documentation to validate hcc codes for 2018 and 2019 dos
- Adhere to established policies, procedures and compliance for satisfactory audit rating
- Reviewed medical record information to identify all appropriate coding based on HCC categories
- Maintained 99.4 percent QA average and over 7 charts per hour productivity
HCC CODER (Contract)
Inovalon
01.2019 - 08.2019
- Confirm all risk adjusted diagnosis codes from acceptable provider documentation and in accordance with industry standards for coding and reporting
- Adherence to current industry standard, as defined in ICD-9, or ICD-10 guidelines for coding and reporting
- Maintain 95% accuracy and completeness in ongoing quality assurance reviews as required
- REMOTE
HCC CODER (Contract)
ADVANTMED
01.2018 - 05.2019
- Identify, collect, assess, monitor and document claims and encounter coding information
- Perform review of medical record information to identify all appropriate coding based on CMS HCC categories
- Demonstrate knowledge of ICD-10-CM and CPT coding guidelines, medical terminology and anatomy
- Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information
CODING SPECIALIST/ E&M CODER
MCLEOD HEALTH
Florence, SC
12.2017 - 06.2018
- Properly assign ICD-10-CM diagnosis codes to outpatient and inpatient visits for a variety of specialties
- Confidently and adeptly handle claim denials and/or appeals due to coding errors
- Review, analyze and manage coding of diagnostic and treatment procedures contained in outpatient and inpatient medical records
- Interact and maintain a working relationship with providers and other medical professionals regarding billing and documentation policies, procedures and regulations
- Perform and document daily coding audits for physicians
- Maintain department specific productivity standards with a 95% accuracy rate
- Performs other coding and backup duties in the department as needed
NON GOVERNMENT BILLER/MEDICAL CODER
Optum
West Columbia, SC
04.2016 - 11.2017
- Reviewed and corrected coding edits and denials
- Corrected an average of 10 coding edits per hour
- Identified CPT and ICD-9/ ICD-10 coding discrepancies for compliance and reimbursement accuracy
- Ensured prompt payment remittance by verifying correct coding and billing information for electronic claims transmission and hard copy billing
- Corrected codes and or modifiers, under the direction of the coder to minimize billing issues and ensure timely processing of claims
- Actively maintained current working knowledge of government regulation, protocols and third party requirements regarding billing
- Examined patients insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable
- Compiled monthly reporting spreadsheets for interim/ high dollar claims and ensured timely filing
- Obtained knowledge of the Government team billing guidelines and helped on special projects when needed
- Trained new employees on billing processes and procedures
Education
Bachelor of Science - Business Administration - Accounting
Winthrop University
Rock Hill, SC01.2007
Skills
- CPT
- Medical Terminology
- ICD- 9/10
- Payment Methodologies
- Insurance terminology
- Coding Guidelines
- HIPPA Compliance
- HCPCS Level II
Certification
- Certified Professional Coder (CPC) - AAPC, 2017
- Certified Risk Coder (CRC)-AAPC, 2018
Awards
Golden Gung Ho Recipient (March 2016- Palmetto Health), PALM Award Recipient (April 2016- Palmetto Health), Golden Gung Ho Recipient (October 2016- Palmetto Health), Elected to Who's Who Among College Students, Elected to The National Scholar Honor Society
Timeline
Risk Adjustment Coder
Optum
07.2024 - Current
HCC/RADV Retrospective Auditor (Contract)
Intellis
01.2020 - 03.2020
HCC Coder (Contract)
Advantsure
08.2019 - 01.2020
HCC CODER (Contract)
Inovalon
01.2019 - 08.2019
Profec Coder/ Risk Adjustment Coder
TrustHCS/Corrohealth
05.2018 - 07.2024
HCC CODER (Contract)
ADVANTMED
01.2018 - 05.2019
CODING SPECIALIST/ E&M CODER
MCLEOD HEALTH
12.2017 - 06.2018
NON GOVERNMENT BILLER/MEDICAL CODER
Optum
04.2016 - 11.2017
Bachelor of Science - Business Administration - Accounting
Winthrop University