Tasha Taylor, CPC, CRC
Denham Springs,LA
Summary
AAPC Certified Medical Coder with expertise in HCC Risk Adjustment coding, Data Validation auditing, and first and second level HCC reviews/audits. Prior experience supporting and educating 15 physicians in a busy multi-specialty medical office. Familiar with various records reviews using HCPCS, CPT, ICD-10, RADV, Risk Adjustment HCC and HEDIS. Involved with and currently run a regional chapter of a national volunteer organization.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Senior Medical Coder
Optum Health
09.2021 - Current
- Mentored junior team members, helping them to enhance their skills and knowledge in medical coding best practices.
- Provided valuable feedback on coder performance following audits, fostering environment of continuous improvement within team.
- Implemented new technology solutions with IT team designed to improve efficiency in code selection processes.
- Assisted in development of internal coding policies, promoting consistency across organization. Streamlined coding process for efficiency, resulting in higher volume of claims processed daily.
- Participated in relevant professional development opportunities to stay abreast of changes in medical coding standards.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures. Verified signatures and checked medical charts for accuracy and completion.
- Correctly coded medical claims for various hospital, outpatient, and nursing facilities as well as telehealth platforms.
HCC Coder Specialist
The CSI Companies (Optum Health)
05.2017 - 09.2021
- Maintained high accuracy, completeness, and charts per hour rates while auditing Critical Care Management and hospital charts.
- Selected for special projects due to high level of accuracy and completeness.
- Regularly recognized as being team player.
- Demonstrates knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
- Carefully reviews medical records for accuracy and completion as required by insurance company.
- Assigns additional diagnosis codes based on specific clinical findings in support of existing diagnoses.
- Assigns appropriate HCC and RxHCC diagnosis codes as needed for claims submission.
- Assists with special projects, overtime and audits as needed.
- Works from home in remote environment with limited supervision, maintains and exceeds work performance and ethics as required.
Senior HCC Coder Specialist, Risk Adjustment Data Validation
Intellis Healthcare for KPMG US
01.2020 - 03.2020
- Performed secondary validation audits and justifications of primary coders and initial validation audit coders on federal government level HHS-HCC RADV project.
- Identified and corrected problems to assist federal government in challenging incorrect diagnosis coding.
- Promoted from Primary HCC Coding Specialist role to Secondary Validation Auditor role after first week on project due to high attention to detail and diverse coding knowledge.
- Maintained high levels of accuracy and efficiency while working in remote environment throughout project.
- Identified fraudulent claims due to incorrect coding and demographical errors at a federal review level.
- Project was a short term project (under 6 months) while on furlough with another company.
Medicare Risk Adjustment Coder/ MRA Department
Humana, Inc
05.2014 - 12.2016
- Assigned appropriate HCC diagnosis codes as needed to claims for submission.
- Assigned additional diagnosis codes based on specific clinical findings in support of existing diagnoses.
- Assisted with special projects and audits.
- Worked offsite for 5 months coding in busy physician office as field coder, which included daily interaction with staff, patients, and other contractors.
- Ability to work remotely when opportunities were given, without supervision, and maintain work performance and ethics.
- Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
Certified Professional Coder/ Billing Charge Master
Primary Care Plus / Stanocola Clinic
06.2010 - 05.2014
- Coded Medical records with ICD-9, CPT-4, and HCPCS Level II Coding for 15 physicians.
- Utilized company software and input information into computerized patient record information systems.
- Handled a variety of medical claims including primary care, gynecology, radiology, cardiology, physical therapies, opthalmology, podiatry, allergy/rheumatology, pediatrics, and E&M.
- Reviewed charts for correct coding by physician and entered correct HCC and HEDIS codes.
- Prepared charges for scanning into billing system.
- Processed electronic claims, ensuring all aspects of charges were correct.
- Manually keyed any charges requiring entry into billing system and resubmitted claims.
- Prepared and sent primary paper insurance claims.
Education
Medical Billing And Coding
Remington College
Baton Rouge, LA06.2010
Skills
- Maintains strict confidentiality
- Team player with positive attitude
- Sound business ethics, creativity, discretion, and ability to teach and learn
- Ability to handle many different tasks simultaneously
- Ability to work remotely without supervision in either clinic or remote location
- Experience with RADV audits through plan and Federal audits, at both IVA and SVA levels of justification
- Thorough working knowledge of ICD10-CM, CPT-4 and HCPCS coding systems
- Knowledge of HEDIS and STAR requirements/ Medicare Patient Centered Medical Home Models
- Proficient in EMR systems, Microsoft Applications, and has ability to learn quickly
- 3M and HCC Coder encoder experience
Certification
American Academy of Professional Coders License , ICD-10 Proficient
Timeline
Senior Medical Coder
Optum Health
09.2021 - Current
Senior HCC Coder Specialist, Risk Adjustment Data Validation
Intellis Healthcare for KPMG US
01.2020 - 03.2020
HCC Coder Specialist
The CSI Companies (Optum Health)
05.2017 - 09.2021
Medicare Risk Adjustment Coder/ MRA Department
Humana, Inc
05.2014 - 12.2016
Certified Professional Coder/ Billing Charge Master
Primary Care Plus / Stanocola Clinic
06.2010 - 05.2014
Medical Billing And Coding
Remington College
American Academy of Professional Coders License , ICD-10 Proficient
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