SHAKERA KNOX
Goose Creek,SC
Summary
Meticulous and dedicated individual eager to serve this company in the capacity of a Medical Coder. Knowledgeable skills in reviewing, processing and submitting medical claims. Strong understanding with medical terminology, Inpatient/Outpatient coding, ICD-10,CMS HCC Risk Adjustment, and CPT/ICD-10 coding guidelines. Excellent data entry skills allows for accurate coding of medical information and provided care. Meets deadlines and works with a high level of multicultural awareness and adaptability. Currently hold a Coding Certifications as a Professional Coder, Medical Auditor and Risk Adjustment Coder with eight plus years of experience.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Medical Coder III
Medical University Of South Carolina
10.2017 - Current
- Review medical records for the determination of accurate assignment of all documented ICD 10 codes for diagnoses and procedures
- Validate and correct coding errors for all aspects of the charge. Perform all other duties as assigned
- Investigate and recode any applicable denials after thorough research
- Provide real time dictation feedback, audit feedback and/or education/training to physicians, coders and other teammates on coding and clinical documentation and communicate for need for documentation to ensure accurate coding
- Demonstrate ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses and procedures
- Identify and communicate documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to Coding Manager for follow-up and resolution
- Evaluate and prepare as indicated daily, weekly and monthly reports indicating coding quality levels and opportunities for charge capture and revenue integrity
- Monitor, prepare and present reports including, but not limited to, coding accuracy, medical record deficiency, coding validation discrepancies or completeness of procedure report
- Stay current with AHA Official Coding and Reporting Guidelines, CMS, ACR, AMA and other agency directives for coding
- Attend coding seminars on annual basis for outpatient coding
- Perform other reasonably related duties assigned by the Coding Manager or other management
- Provide coverage when available or needed in the department
Medical Coder II
Maxim Healthcare
03.2019 - 05.2024
- Code Interventional procedures, along with the professional component for all imaging modalities in the Radiology Department. The scope will include Interventional, MRI, CT, ultrasound, fluoroscopy and radiography as well as fluoroscopic imaging and image guided procedures.
- Provide education/training to physicians, other providers and teammates on coding and clinical documentation.
- Communicate with nursing and ancillary services personnel for needed documentation to ensure accurate coding.
- Provide real-time feedback to Radiologists as it pertains to proper coding and clinical documentation of services performed.
- Engage in provider/department contact and education as the primary liaison for clarification of documentation and coding for radiological procedures including documentation deficiencies.
- Focus their work on radiological procedures as well as being an immediate liaison to documentation improvement and optimization of physician coding practices for compliance and revenue purposes.
- Audit of junior or vendor teammates and provide feedback to management of training opportunities or issues
- Perform other reasonably related duties assigned by the immediate supervisor or other management
Remote HCC Coder Consultant(Second Validation Auditor)
Intellis
01.2019 - 08.2019
- Reviews medical records retroactively and proactively including patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries in order to verify whether: The diagnosis codes are supported by the documentation and in accordance with ICD-10-CM Guidelines for Coding and Reporting. The diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe, and submitted with the appropriate HCCs.
- Writes clear, accurate and concise rationales in support of findings. Competency in oral and written communications particularly in the area of conflict resolution; ability to identify, define and explain coding errors identified through the second validation audit. Review medical record information to identify all appropriate coding based on CMS HCC categories.
- Complete appropriate paperwork/documentation/system entry regarding claim/encounter information. Provide support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards. Monitor Coding changes to ensure that most current information is available.
Coder II/Team Lead
Orangeburg Regional Medical Center
06.2017 - 08.2018
- Performing the work of coding inpatient, diagnostic ancillary, outpatient, emergency room, obgyn, and radiology. The diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe. Review for clinical indicators and query providers to capture the severity of illness of the patient.
- Sustaining the accuracy of data inserted in the company software and completing around 80 claims or more every day. Besides, ensuring that the productivity objectives determined by the company are met all times during the performance of the assigned duties.
- Assuring that the coding work performed is in coordination with the PA policies, CMS/HCC regulations, and the other general coding principles
- Ensuring that the critical information like surgery dates, name of the surgeon, and prescribed medications are entered into the systems in a correct way to avoid confusion.
- Sequences diagnoses and procedure codes as outlined in CPT, ICD and HCPC Coding Guidelines while adhering to local and national governmental payer guidelines.
- Adheres to the organization and departmental guidelines, policies and protocols. Reviews all provider documentation to support assigned codes in the health information record so that all significant diagnoses and procedures may be captured for reimbursement and data purposes. Responsible for processing coding claim appeals and coding claim rejections, when applicable.
Medical Coder I
Roper St. Francis Hospital
08.2014 - 05.2017
- Assigns codes using (ICD), (CPT) and (HCPCS). Sequences diagnoses and procedure codes as outlined in CPT, ICD and HCPC Coding Guidelines while adhering to local and national governmental payer guidelines. Adheres to the organization and departmental guidelines, policies and protocols. Coded Radiology and inpatient physician side. Reviews all provider documentation to support assigned codes in the health information record so that all significant diagnoses and procedures may be captured for reimbursement and data purposes. Follows up and obtains clarification of inaccurate documentation as appropriate.
- Worked in a fast-paced medical office with multiple physicians specializing in different specialties. Interpreted medical terminology and pharmacological information for translation into the coding system. Utilized knowledge of CPT and ICD-10-CM to properly translate performed services into numerical code for insurance company reimbursements. Routinely communicated with insurance providers regarding submitted invoices.
- Entering charges, posting payments, following up on claims, interacting directly with Insurance companies, and assisting with insurance verification issues.Responsible for the collection and coding of simple physician encounters. Processes accurate coding and charge information by patient, including but not limited to ambulatory or clinic locations, to ensure that claims are submitted to insurance payers in the most compliant, efficient and expeditious manner possible.
Medical/Patient Administration
United States Army Reserve/VA
02.2010 - 04.2016
- Patient administration specialist is primarily responsible for supervising and performing administrative duties in the patient administration division of an Army hospital or other medical facilities, such as insurance, NDCs/LCDS knowledge, charge sheets, registration, policies & procedures. Help soldiers through the registration process, and follows up to make sure that the patient completes registration in a timely manner. Implement strategic plans to enhance operations leveraging knowledge of electronic health record (EHR) and practice management systems.
- Assist soldiers with their billing question, like the plan the choose with TRICARE, what the insurance will cover and won't. Attend classes twice a year on any new up-to-date information on guidelines and regulations.
- I was responsible for compiling data and preparing required statistical reports. Initiate correspondence pertaining to medical records, medical board proceedings, line of duty(LOD) investigations; and other records and reports pertaining to patient administration.
- Knowledge of medical terminology. Maintain a medical record tracking system within the medical treatment facility. Perform inventory and financial management procedures,making sure soldier has the correct and most updated documents to be seen.
Education
Some College (No Degree) - Medical Coder
Grow Your Own Coder
Ladson, South CarolinaAssociate of Applied Science - Criminal Justice
Trident Technical College
North Charleston, SC2015
High School Diploma - General Studies
Lincoln High School
McClellanville South Carolina2006
Skills
- Great personality
- Microsoft Office
- ICD-10, CPT/CMS HCC Coding Guidelines
- Attention to details
- Excellent work ethic
- Ability to use self judgement
- Expert Ancillary Coder
- Interventional Radiology Coder
- Orthopedics Coder
- Presenter
- Excellent oral & written communication skills
- Hierarchical condition category (HCC) Coding
- Educate providers
Accomplishments
- CPC/CPMA/CRC certified through AAPC
- 100% production score
- Team leader within my department
- Performance based 97% Accuracy
- Membership Development Officer- AAPC Orangeburg SC Chapter-2016-2019
- HCC/CMS Second Validation Auditor
- 2022- Leadership Committee
Certification
- Certified Professional Coder (CPC)
- Certified Professional Medical Auditor (CPMA)
- Certified Risk Adjustment Coder (CRC)
Timeline
Medical Coder II
Maxim Healthcare
03.2019 - 05.2024
Remote HCC Coder Consultant(Second Validation Auditor)
Intellis
01.2019 - 08.2019
Medical Coder III
Medical University Of South Carolina
10.2017 - Current
Coder II/Team Lead
Orangeburg Regional Medical Center
06.2017 - 08.2018
Medical Coder I
Roper St. Francis Hospital
08.2014 - 05.2017
Medical/Patient Administration
United States Army Reserve/VA
02.2010 - 04.2016
Some College (No Degree) - Medical Coder
Grow Your Own Coder
Associate of Applied Science - Criminal Justice
Trident Technical College
High School Diploma - General Studies
Lincoln High School
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