ShaJuanda Daniels
Dallas,GA
Summary
Motivated purposeful Operations Manager with over twenty five years of experience in the Medical Industry. Proven performer and profit 'Maximizer' skilled in A/R, A/P, Surgery, Payments, and Charge Posting, Special Projects, and Cost Saving initiatives. Demonstrated success in patient/vendor relationship management with the ability to build genuine rapport and secure competitive contract wins. Firsthand experience in counseling, guiding, training employees, Purchasing/Budgeting, with a reputation for dedication, creative problem solving, and outstanding service. Medical Billing and Coding Specialist with 25 years providing administrative and patient support in hospital and medical office settings. Advanced knowledge of private insurance processes and codes.
Overview
24
24
years of professional experience
Work History
Coding Manager
Laureate Medical Group at Northside Hospital
03.2017 - Current
- Handle responsibilities of developing plans and organizing the workflow systems of health information systems
- Perform the tasks of preparing coding compliance plans and auditing the coder accuracy in handling coding activities to identify additional training
- Responsible for preparing annual budget, disseminating the coding changes, and updating the coding compliance manual
- Handle responsibilities of monitoring and supervising the day-to-day activities of the coding process to ensure that the standard coding guidelines are followed
- Assigned tasks, planning coding development programs to promote quality improvement processes
- Managed all the activities that are related to medical coding
- Determine appropriate Evaluation and Management levels and CPT codes for Urgent Care, Pulmonary, Cardiology, Family Practice, Adult Medicine, Pediatrics, Ophthalmology, Orthopedics, ENT, Neurology, Rheumatology, Injections and Infusions, Pain and Spine and Diagnostic Radiology
- Review medical records to ensure documentation accurately reflects and supports code selection based on the ICD-10 coding practices
- HCC Risk Adjustment Coding to ensure compliance with all government and contractual obligations
- Determine proper usage of modifiers when necessary
- Submitted clean claims to insurance companies electronically to secure payments
- Assist in training and monitoring of new hires and auditing new provider documentation
- Participate in internal and external audits
- Ensure strict confidentiality of financial and medical records
- Resolve daily coding scrubber edits to ensure accurate coding for correct billing
- Investigate and resolve claim denials related to coding errors; perform coding charge corrections and re-billing as required for the resolution of coding denials
- Advise providers regarding billing and documentation policies, procedures, and regulations; interact with provider staff regarding conflicting or non-specific medical documentation and obtain clarification when necessary
- Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses
- Assigned procedure and diagnosis codes for insurance billing using Allscripts electronic health record software
- Optum360 Encoder.
Remote HCC Coder
United Healthcare
05.2015 - 01.2017
- Assist with execution of Internal Risk Adjustment Coding Review programs
- Perform quality audits on vendor charts as well as Care Delivery coding teams as needed
- Provides support and assists Care Delivery with various coding initiatives as needed
- Ensure that Optum Coding Guidelines are consistently applied in all processes
- Identifies issues and trends in coding and documentation that affect provider risk adjustment factor scores
- Provides input and valuable feedback on audit results
- Provide ICD10 - CM coding training, as it relates to HCC coding, as requested
- Develop relationships with Care Delivery and coding guidelines and requirements of Risk Adjustment Payment System to ensure correct coding
- Cross - functional collaboration with multiple teams and functions.
Certified Medical Coder
Children's Orthopedics of Atlanta
05.2015 - 05.2016
- Complete day-to-day assigned build tasks incorporating account & charge review work queues
- Update and maintain HSD create/edit system automatic actions rule and work queue creation and maintenance, edits, Charge Router
- Create modifiers for claims; scheduled batch jobs; update security and access as needed; utilize data courier
- Ensure the integrity of the professional and facility revenue charge capture, identify trends, and make timely recommendations to change current related policies and procedures to improve operational efficiencies and accurate reimbursement from payors
- Create transition processing for the changes to Epic and help create and establish policies for correct billing, coding, and charging standardization.
- Coded APV charts at rate of [15 Charts] per hour.
Certified Medical Coder
Atlanta Women's Healthcare Specialists
04.2005 - 01.2015
- Updated and maintained departmental quality control standards
- Implemented chart tracking/ chart deficiency computer system
- Coded all medical records using ICD-9-CM and CPT-4 coding systems
- Conducted all special projects required of the department
- Assisted and familiarized physicians with the Coding and proper documentation techniques to insure optimum reimbursement
- Collaborated with financial counselor in assessing the ability of patients to make payments
- Provided inpatient and outpatient coding backup during schedules/unscheduled employee absence or, backlog exists for 25 Physicians
- Prepared educational materials and conducted in-services teaching basic, intermediate, and advanced coding for coding staff, medical staff and medical records personnel, monthly reporting to business management of key performance indicators, trends & underlying causes, make patient calls to proactively assist in Paying invoices as necessary, maintaining the integrity of expert patient data, establish appropriate credit overpayments; manage credit holds and medical order releases as appropriate.
Billing Manager
Drs. Johnston, Croft, Wiskind and Kleiss
05.2003 - 09.2006
- Oversaw all Billing Operations, Mediated staff disputes, handled patient complaints, participated in staff recruitment, hiring, training, supervised front and back-office staff, Orchestrated practice events, patient relationships and provided exemplary service to all patients, staff, and vendors, investigated, and resolved all billing problems, demonstrated ability to maintain composure and work efficiently in a fast pace medical environment while preserving strict confidentiality.
Office Manager
Peachtree Gynecology
09.2005 - 03.2006
- Wholly responsible for day-day operations, including staff supervision, purchasing, A/P, A/R and surgical procedures, scheduled all surgical and outpatient procedures, oversee all patient daily charges for billing and coding accuracy, bank deposits, reconciled patient and insurance accounts, provided back up coverage to front office staff, interviewed screened and hired new employees, coordinated monthly staff meetings, demonstrated ability to work with all levels of employees.
Billing Manager
Oncology Hematology
08.2002 - 11.2002
- Key employee to assist with startup practice, processed billings and charges for physician, A/P and A/R, goal oriented, self-motivator, analytical and critical thinking skills, computer proficiency and to follow through with projects from inception to completion
- Interface with Physicians and other medical professionals
- Test, trouble shoot, and perform QA protocols and sophisticated instruments
- Laid groundwork for practice
- Cut excess cost
- Refocused practice initiatives and strategies
- Earned special assignments from Physician.
Billing Manager
Genesis Women's Diagnostic Center
06.2001 - 08.2002
- Credentialed new providers, post payments and charges, followed up with delinquent accounts, reviewed gross and net collections, inspected ICD-9 and CPT codes for billing accuracy, worked closely with Practice Administrator, implemented criteria for evaluating uncollectible balances, implemented strategic ways for marketing facility.
Billing Manager
Atlanta Urological Consultants
05.2000 - 04.2001
- Evaluated standards of Quality, Improved Accounts receivables within a six-month period, worked closely with Practice administrator, assisted with three satellites day-to-day operations, administered monthly, weekly meetings with staff and A/R representatives to resolve issues, developed strategies for target delinquent Payors
- Empowered employees to feel confident in their positions as well as their accomplishments, Supervised Collection Representatives.
Education
Medical Management -
Physician Practice Institute
Decatur, GA01.1997
Medical Administration -
Draughon’s Jr. College
Atlanta, GA01.1992
Office Administration -
Clayton State College
Morrow, GA01.1989
Skills
- Performance Optimization
- Application Development
- Mobile App Development
- Scrum Framework
Timeline
Coding Manager
Laureate Medical Group at Northside Hospital
03.2017 - Current
Remote HCC Coder
United Healthcare
05.2015 - 01.2017
Certified Medical Coder
Children's Orthopedics of Atlanta
05.2015 - 05.2016
Office Manager
Peachtree Gynecology
09.2005 - 03.2006
Certified Medical Coder
Atlanta Women's Healthcare Specialists
04.2005 - 01.2015
Billing Manager
Drs. Johnston, Croft, Wiskind and Kleiss
05.2003 - 09.2006
Billing Manager
Oncology Hematology
08.2002 - 11.2002
Billing Manager
Genesis Women's Diagnostic Center
06.2001 - 08.2002
Billing Manager
Atlanta Urological Consultants
05.2000 - 04.2001
Medical Management -
Physician Practice Institute
Medical Administration -
Draughon’s Jr. College
Office Administration -
Clayton State College
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