STEPHANIE Shofner
New Albany,USA
Summary
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
22
22
years of professional experience
Work History
HCC Coding Specialist
Virtix/CorroHealth
Phoenix, AZ
09.2024 - 02.2026
- Ensured accuracy in coding through regular audits, identifying discrepancies and areas for improvement.
- Provided timely feedback on coder performance metrics, helping individuals meet organizational goals related to accuracy and productivity.
- Applied official coding conventions and rules from private insurance clients and Centers for Medicare and Medicaid Services to assign diagnosis codes.
- Verified signatures and checked medical charts for accuracy and completion.
- Researched and resolved medical record discrepancies.
- Daily use of Tru-Brudge and Linx.
HCC (Hierarchical Condition Category) Auditor
Optum Health
Brentwood, TN
04.2019 - 08.2024
- Maintained thorough documentation of all assigned codes for future reference and audit purposes, upholding organizational standards for recordkeeping practices.
- Maintained strict compliance with HIPAA regulations, ensuring the privacy and security of patient information during the coding process.
- Enhanced coding accuracy by consistently reviewing and updating knowledge of HCC guidelines and regulations.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Utilized electronic medical record systems to store, retrieve and process patient data.
Clinical Guidance/Auditing Coder Specialist/ Record Retrieval
Humana
Louisville, Kentucky
01.2010 - 01.2018
- Facilitated onboarding for new associates by instructing on MRA daily operations and effective navigation of various systems.
- Coordinated efforts among team members to ensure successful achievement of collective goals.
- Conducted thorough assessments of education support records and claims to facilitate effective decision-making.
- Managed collection of medical records from various providers and organized uploads into database for efficient review by coding personnel.
- Achieved accurate medical record audits by effectively applying medical coding systems including Humana, CAS, Estar, and Verisk Health. Enhanced auditing efficiency through strategic use of 3M coding and reimbursement system and ICD-9 crosswalk.
- Utilized official coding rules from American Medical Association and Centers for Medicare and Medicaid Services to systematically assign diagnostic codes.
- Executed task prioritization to maintain consistent performance levels during periods of increased workload and stringent deadlines.
- Optimized project timelines by prioritizing tasks and ensuring compliance with established deadlines.
- Facilitated knowledge transfer and skill development among junior coders to ensure adherence to coding standards and best practices.
- Managed the scanning and uploading process of medical records, ensuring compliance with data integrity standards in electronic medical records system.
- Monitored and enhanced coding quality through strict compliance with industry standards and proactive engagement with new technologies.
Medical Bill Processor
Risk Management Services Company
Louisville, Kentucky
01.2004 - 01.2007
- Managed review and processing of medical bills for clients.
- Utilized CPT/HCPCS medical codes for accurate billing and documentation processes.
- Demonstrated proficiency in operating office equipment and providing reception relief.
- Facilitated daily communication with providers and physicians to ensure clarity on claim status.
- Facilitated transmission of electronic data interface (EDI) information for state reporting compliance.
- Managed processing of appeals and bill audits submitted by providers.
- Facilitated cross-departmental collaboration to enhance operational efficiency.
Health Claims Examiner
FirstSource Solutions, USA
Louisville, Kentucky
01.2007 - 01.2010
- Enters claims payment data into pc for adjudication purposes
- Works towards and meets production goals
- Handle claims in a confidential manner as specified by HIPAA
- Learn and understand specific client/ group health plan regulations
- Assist in Internal auditing of client claims for other processors
Education
Certificate of Certified Professional Coder - Professional Medical Coding and Billing
ATA Career Education
Louisville, Kentucky11-2007
Associates of Science Degree - Office Administration
Sullivan University
Louisville, Kentucky12-2003
Skills
Performance improvement
- Medical terminology
- Insurance coding (ICD-9 and CPT)
- Teamwork and collaboration
- Healthcare claim coding
- Continuing education
- Reliability
- Detail-oriented
- HIPAA compliance
- Medical claims coding
Medical claims coding
Continuing education
Training and mentoring
Coding error resolution
Medicare insurance regulations
ICD-10 coding
Attention to detail
Timeline
HCC Coding Specialist
Virtix/CorroHealth
09.2024 - 02.2026
HCC (Hierarchical Condition Category) Auditor
Optum Health
04.2019 - 08.2024
Clinical Guidance/Auditing Coder Specialist/ Record Retrieval
Humana
01.2010 - 01.2018
Health Claims Examiner
FirstSource Solutions, USA
01.2007 - 01.2010
Medical Bill Processor
Risk Management Services Company
01.2004 - 01.2007
Certificate of Certified Professional Coder - Professional Medical Coding and Billing
ATA Career Education
Associates of Science Degree - Office Administration
Sullivan University