Stephanie Baudhuin
Milwaukee,WI
Summary
Medical coder focused on HCC risk adjustment, RADV audit support, and CMS-compliant ICD-10 coding. Uses CDAT to validate member-level data, reconcile records, and identify documentation gaps that affect risk-adjusted submissions. Brings a strong mix of coding accuracy, insurance knowledge, and team support across clinical and administrative workflows.
Overview
1
1
Certification
28
28
years of professional experience
Work History
SR. Medical Coder
Next Step Technology LLC
03.2024 - Current
- Performed comprehensive Risk Adjustment Data Validation (RADV) audits by reviewing medical records, claims data, and provider documentation to ensure CMS compliance and accuracy of submitted risk-adjusted diagnoses.
- Utilized CMS CDAT (Central Data Abstraction Tool) to abstract, validate, and reconcile member-level HCC data, ensuring accurate alignment with CMS RADV requirements.
- Conducted highly accurate HCC (Hierarchical Condition Category) validation, identifying supported and unsupported diagnoses and providing detailed documentation of audit findings.
- Analyzed encounter data and provider documentation to ensure ICD-10 coding integrity, adherence to CMS guidelines, and complete clinical documentation for risk-adjusted submissions.
- Collaborated with coding, compliance, and quality teams to reduce RADV audit risks and enhance documentation practices across provider networks.
- Identified documentation gaps and provided targeted feedback to enhance provider accuracy and minimize future RADV exposure.
- Ensured data completeness and accuracy by reconciling source system data, provider records, and RADV submission files through CDAT workflows.
- Produced audit summaries, variance reports, and corrective-action recommendations to support risk adjustment initiatives and ensure compliance.
Medical Coder
CSI for Optum
10.2022 - Current
- Coded patient records using ICD-10, CPT, and HCPCS guidelines for Optum projects.
- Reviewed clinical documentation for accuracy, completeness, and coding compliance requirements.
- Applied payer rules and Medicare coding standards to assigned medical charts.
- Coding HCC Risk Adjustment claims. Bi-Monthly assessments. Conducted training sessions to improve team coding skills and ensure compliance with regulations. Ensured adherence to state and federal regulations and internal policies for accurate coding. Able to analyze coding information and medical records. Facilitated education on coding compliance to promote understanding and implementation among team members. Able to maintain 95% accuracy on assessments.
Service Authorization Specialist
Community Care Inc.
09.2014 - 10.2022
- Processed service authorizations from care teams into a proprietary computer system, ensuring accurate and timely entry. Answer and assist Care Team on payment issues and what is and is not covered under the program or Medicare. Guided providers in navigating the Authorization Provider Portal, enhancing their ability to manage authorizations effectively. Trained care teams on using proprietary computer system via telephone or fax. Ensure that all authorizations submitted by teams have correct coding and modifiers. Meets with Supervisor to discuss trends in healthcare. Acted as a resource for team members, addressing inquiries about coverage issues to support informed decision-making.
- Reviewed authorization requests for Community Care services and supporting clinical documentation.
- Verified member eligibility, benefits, and coverage requirements before processing requests.
- Coordinated with providers, nurses, and care teams on prior authorization details.
Senior Precertification Representative
Ascension SE Wisconsin (formerly Wheaton Franciscan)
07.2011 - 08.2014
- Addressed barriers to receiving and validating accurate HCC information, showcasing analytical and problem-solving abilities. Reviewed diagnostic and procedural terminology for consistency with accepted medical nomenclature, ensuring accurate coding and compliance. Consistently ensured proper coding, sequencing of diagnoses and procedures. Quickly responded to staff and client inquiries regarding CPT codes. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information. Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative. Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes. Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans. Performed insurance verification and pre-certification functions, facilitating timely approvals and patient access to care. Was a team preceptor with a team of five associates. Instructed new associates on departmental procedures and computer systems.
- Greeted patients and families using Ascension service standards
- Scheduled appointments across clinic calendars and provider templates
- Verified insurance coverage and updated patient demographic records
Ancillary Care Coordinator
Specialized Medical Services
11.2010 - 06.2011
- Led setup of new computer system, entering all information and claim data to ensure smooth transition and operational efficiency. Ordered all medical equipment. Filled out requisitions for Community Care patients for oxygen and medical equipment. Communicated extensively with Community Care case managers to ensure patients’ oxygen and medical equipment needs are met. Addressed barriers to receiving and validating accurate HCC information, showcasing analytical and problem-solving skills to enhance patient care delivery. Strictly followed all federal and state guidelines for release of information. Monitored shared email inboxes and ensured inquiries were addressed. Accurately entered procedure codes, diagnosis codes and patient information into billing software. Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information. Received, organized and maintained all coding and reimbursement periodicals and updates. Appropriately and correctly identified errors and refiled denied/rejected claims as they were received from the Patient Account Representative. Posted charges, payments and adjustments. Applied payments, adjustments and denials to medical manager system. Meticulously tracked and resolved underpayments. Performed quality control on data entry system, verifying claims and payments for accuracy to minimize errors and ensure compliance. Performed full-cycle medical billing in a fast-paced medical billing company. Efficiently performed insurance verification and pre-certification and pre-authorization functions.
- Facilitated patient referrals between medical services and provider networks. across specialized medical services and provider networks.
- Oversaw insurance authorization processes for complex care plans and specialty treatments. for complex care plans and specialty treatments.
- Arranged appointments with physicians, clinics, and diagnostic service teams for patients. with physicians, clinics, and diagnostic service teams.
Subcontract Specialist
Aurora VNA
05.2003 - 08.2007
- Worked with patients to collect insurance information. Verified benefits and completed all preauthorization requirements. Coordinated with outside vendors to complete patient orders on time. Processed claim appeals. Collaborated with subcontractors to reduce outstanding account receivables from over $300,000.00 to under $100,000.00 in one month. Further decreased outstanding account receivables to less than $50,000.00 in the following month. Starting balance was over $300,000.00. Submitted invoices to subcontractors with correct contracted rates. Negotiated pricing with new subcontractors to establish mutually beneficial agreements. Received three Aurora Stars for my exceptional service to our inside and outside customers.
- Coordinated home health referrals and intake workflows for visiting nurse services.
- Managed patient records in electronic medical systems for Aurora VNA.
- Scheduled clinician visits and adjusted daily routes for field staff.
Benefits Coordinator
Knuoppel Healthcare Services
05.1998 - 05.2003
- Collected insurance information from patients to facilitate coverage verification. Verified benefits and completed all preauthorization requirements for all medical equipment technicians. Communicated benefits to patients to ensure they were aware of coverage. Managed subcontract relationship between Knuoppel and Aurora VNA to ensure compliance and service delivery. Worked with claim department to overturn denials and successful appeals. Conducted claim and file audits to ensure completion of all required government mandated paperwork.
- Coordinated employee benefits enrollment, eligibility, and plan changes for healthcare services staff.
- Processed medical, dental, vision, and retirement benefit paperwork with accuracy.
- Explained benefit options, coverage rules, and enrollment timelines to employees.
Education
B.S. - Healthcare management
Minnesota School of Business/Globe university
Skills
- Confidentiality maintenance
- Health insurance knowledge
- Knowledge of Provider Contracts
- Electronic Medical Record (EMR) software
- Patient-focused care
- Clinical knowledge
- ICD-10-CM coding
- CPT and HCPCS coding
- Interpreting instruction
- Medical Billing Concepts
- HIPAA compliance training
- Project management
- Deadline management
- Oral and written communication
- Judgment
- HCC Risk Adjustment methodologies
- Correct coding application
- ICD-10 coding
- RADV audits
- CDAT abstraction
- HCC validation
- CMS compliance
- Medical record review
- Risk adjustment
- Claims analysis
- Documentation review
- Problem solving
- Analytical thinking
- Written communication
- HIPAA compliance mastery
- Outpatient coding
- Critical thinking
- Anatomy and physiology
- Medicare regulations
- Documentation improvement
- Coding certification
- Ambulatory coding
- Team collaboration
- Coding software proficiency
- Electronic health records navigation
- Expert ICD-10 coding
- Revenue cycle management
- Auditing and quality assurance
- Medical terminology
- Reimbursement expertise
- Detail orientation
- Effective communication
- Workflow management
- Claim coding
- Coding error resolution
- Data entry and management
- Clinical documentation
- Data verification
- Medical record security
- Medical terminology
- Record assessment
- Certification maintenance
- Code assignment research
- Continuing education
- Regulatory guidelines
- Codification
- Data entry
- Medicare insurance regulations
- HIPAA compliance
- Insurance verification
- Diagnostic coding
- Classification systems
- Records management
- Anatomy
Personal Information
Title: CPC, CRC
Affiliations
- AAPC CRC certified 08/2024 License # 01941540
- AAPC CPC successfully certified 05/2022 License # 01941540
Certification
- CPC certification 01941504
- CRC certification 01941504
Timeline
SR. Medical Coder
Next Step Technology LLC
03.2024 - Current
Medical Coder
CSI for Optum
10.2022 - Current
Service Authorization Specialist
Community Care Inc.
09.2014 - 10.2022
Senior Precertification Representative
Ascension SE Wisconsin (formerly Wheaton Franciscan)
07.2011 - 08.2014
Ancillary Care Coordinator
Specialized Medical Services
11.2010 - 06.2011
Subcontract Specialist
Aurora VNA
05.2003 - 08.2007
Benefits Coordinator
Knuoppel Healthcare Services
05.1998 - 05.2003
B.S. - Healthcare management
Minnesota School of Business/Globe university