Shelly Carver
Lewiston
Summary
Dynamic professional with extensive experience in risk adjustment coding and compliance at Community Health Options. Proven ability to enhance coding accuracy through strategic planning and effective collaboration. Skilled in Excel and presentation development, with a strong focus on achieving high-quality results and fostering team success.
Overview
13
13
years of professional experience
2
2
Certifications
Work History
Working musician, substitute teacher
Self Employed
Lewiston
08.2024 - Current
- Composed and arranged original music across various genres.
- Performed live at diverse venues and events, engaging audiences effectively.
- Collaborated with other musicians to create dynamic performances and recordings.
- Managed booking, scheduling, and logistics for performances independently.
- Developed marketing materials to promote music projects through social media platforms.
Manager Risk Adjustment Strategy
Community Health Options
02.2022 - 08.2024
- Sole responsibility of risk adjustment coding compliance and best practices
- Responsible for running RADV audit and tracking progress until completion
- Managing vendor relationships for Medical record retrieval
- Staying up to date on industry trends in an ever changing industry and reporting changes to leadership
- Developing internal coding policies and procedures
- Vendor & provider audits & Maintaining vendor & provider relationships
- Providing feedback and education on proper coding practices
- Assisting in writing articles for the provider newsletter
- Responsible for assisting with HEDIS overreads
Home Health Caregiver
Elite Home Health Care
Lewiston
07.2021 - 02.2022
- Communicated regularly with family members about client needs and progress.
- Coordinated with healthcare professionals to ensure comprehensive care delivery.
- Provided personal care assistance to clients in their homes.
Risk Adjustment Coder
Central Maine Medical Center
Lewiston
02.2021 - 08.2021
- Worked on provider education, including PowerPoint presentations for target HCC education and Clinical Documentation Improvement.
- Maintained a high level of productivity while adhering to established standards of quality control.
- Analyzed provider documentation to ensure accurate coding of diagnoses and procedures according to CMS Medicare Risk Adjustment Coding Guidelines.
Medicare Risk Adjustment Coding Analyst/ Program Specialist
Martin's Point Medicare Advantage Plan
04.2015 - 02.2021
- Responsible for tracking and reporting success of Comprehensive Visit Form program that sent forms to provider practices annually
- Utilized knowledge of ICD-10 coding to ensure all possible HCC's are captured.
- Worked diligently to ensure that coding is compliant with CMS risk adjustment guidelines and AHA coding clinics
- Staying aware of industry trends as it relates to RADV audits
- Strong attention to detail with an average QA score of 98%
- Worked on a project to accurately find provider locations for medical record requests for HEDIS and Risk Adjustment/Collaborating with Network Management and Data and Analytics
- Managed mailings for Health Plan Quality initiatives
- Helped with Medical record requests and retrievals
Coding Specialist
Martin's Point
09.2014 - 04.2015
- Created claims and verified the proper use of CPT, ICD-9 and HCPCS codes.
- Audited clinical documentation quarterly and communicated results providing education for proper E/M coding to providers
- Worked in accounts receivable and corrected coding when appropriate
- Met with providers for onboarding, training and being a supportive resource for questions related to coding.
Patient Services Representative
Martins Point
08.2013 - 09.2014
- Registered new patients, managed patient and provider schedules.
- Responsible for patient check in and check out including assisting with the referrals process.
- Provided excellent customer service
- Participated in regular team meetings to improve office workflow
- Built strong working relationships with providers and all office staff
Education
Bachelor of Arts - General Studies
University of Maine At Augusta
Augusta, ME02.2026
Skills
- Excel and Word proficiency
- Presentation development
- PowerPoint expertise
- Professional demeanor
- Collaboration skills
- Task efficiency
- Progress tracking
- EMR experience
- Staff training and development
- Vendor management
- Strategic planning
- Team leadership
- Complex problem-solving
Major Qualifications
- Certified Professional Coder (CPC) including ICD-10, HCPCS and CPT codes
- Certified Risk Coder (CRC)
- Excellent knowledge of medical terminology, anatomy and physiology and pharmacology
- Strong communication and interpersonal skills with providers and all office staff
Additional Qualifications
- Proficient in Excel, Word, Powerpoint
- Ability to maintain a positive attitude while handling challenges
- Professional and approachable
- Proven ability to collaborate with others
- Works efficiently, tracks progress and completes tasks on time
- Experience working out of multiple EMR's including EPIC and Athena
Certification
CPC
Timeline
Working musician, substitute teacher
Self Employed
08.2024 - Current
Manager Risk Adjustment Strategy
Community Health Options
02.2022 - 08.2024
Home Health Caregiver
Elite Home Health Care
07.2021 - 02.2022
Risk Adjustment Coder
Central Maine Medical Center
02.2021 - 08.2021
Medicare Risk Adjustment Coding Analyst/ Program Specialist
Martin's Point Medicare Advantage Plan
04.2015 - 02.2021
Coding Specialist
Martin's Point
09.2014 - 04.2015
Patient Services Representative
Martins Point
08.2013 - 09.2014
Bachelor of Arts - General Studies
University of Maine At Augusta