Shayla M Rielly
La Grande
Summary
Experienced Medical Coding Analyst with a strong background in the healthcare industry. Demonstrated expertise in professional coding for over seven years, specializing in cardiology for over six years. Meticulously matches charges to relevant medical records and operative reports, ensuring accurate code application and capturing all billable procedures. Known for an energetic and conscientious approach, consistently maintains high standards and pays close attention to detail.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Lead, Coding Services
R1 Rcm
01.2022 - Current
- Facilitated communication among coding staff through regular team meetings, fostering an environment of collaboration and knowledge sharing.
- Promoted a positive work environment by addressing coder concerns promptly and effectively while fostering open lines of communication among team members.
- Boosted team morale and performance, organizing regular training sessions and motivational meetings.
- Demonstrated commitment to the organization's core values, leading by example and fostering a culture of excellence.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Conducted internal audits of coded records to identify potential compliance issues or areas requiring additional training for coders.
- Maximized revenue recovery through effective management of denials related to incorrect or incomplete medical codes; collaborated with billing department to resolve issues promptly.
- Provided support when supervisor was out of office, completed supervisor tasks as needed.
- Supported continuous improvement initiatives within the department by actively participating in relevant conferences, workshops, or seminars related to medical coding best practices.
Medical Coding Specialist
MediRevv/Tegria
01.2019 - 10.2021
- Abstract, assign, and sequencing ICD-10-CM/CPT/HCPCS codes for diagnosis and procedures as supported by documentation.
- Resolved Epic Edits to ensure correct coding of services provided, including E/M leveling, diagnosis coding, bundling issues, and modifier usage
- Identified incomplete documentation in the medical record and formulated a physician query to obtain missing documentation and/or clarification and provide education to physicians to accurately complete the coding process
Coding Analyst
Providence Health & Services
01.2012 - 01.2019
- Responsible for accurate coding and abstracting of clinical information from medical records
- Assign ICD-10/CPT/HCPCS and modifier codes for both inpatient and outpatient professional services, with primary focus on cardiology
- Provided education to providers to ensure proper completion of EMR and the assignment of correct coding
Claims Examiner II
Health Net
01.2004 - 01.2009
- Processed medical claims for PPO, HMO, POS, and Individual health plans
- Examined both local and out of state claims, using on-line pricing systems to obtain current rate information
- Communicated directly with providers, doctors, hospitals and other insurance companies
- Obtained medical records, tax, and COB information
- Created training materials and guidelines to keep department up on current system and pricing changes
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
Medical Claims Analyst
Blue Cross and Blue Shield
06.1997 - 05.2003
- Maintained regulatory compliance by staying current with industry guidelines, state laws, and federal regulations.
- Mentored junior analysts within the team to promote professional growth opportunities amongst peers.
- Demonstrated a commitment to continuous improvement by actively seeking out opportunities for process optimization within the Medical Claims Analyst role.
- Reduced fraudulent claims by conducting thorough investigations and collaborating with the fraud detection team.
- Managed high-volume caseloads for optimal productivity while maintaining strict attention to detail.
Education
Medical Coding And Billing Certificate -
Mt. Hood Community College
Gresham, ORSkills
- HCPCS
- CPT
- ICD10
- EPIC
- Encoder Pro
- Microsoft Office
- Coder education and training
- Strong work ethic
- Team collaboration
- Goal-oriented mindset
Certification
- Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC).
Timeline
Lead, Coding Services
R1 Rcm
01.2022 - Current
Medical Coding Specialist
MediRevv/Tegria
01.2019 - 10.2021
Coding Analyst
Providence Health & Services
01.2012 - 01.2019
Claims Examiner II
Health Net
01.2004 - 01.2009
Medical Claims Analyst
Blue Cross and Blue Shield
06.1997 - 05.2003
Medical Coding And Billing Certificate -
Mt. Hood Community College
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