TESS D. JOHNSON
Martinez
Summary
Results-oriented and detail-driven healthcare professional with comprehensive understanding of medical coding, compliance regulations, and revenue cycle management. Proven ability to ensure accuracy and adherence to coding standards, contributing to optimized reimbursement and operational efficiency. Recognized for exceptional organizational skills, precision, and commitment to excellence. Demonstrates strong leadership capabilities, with talent for mentoring, motivating teams, and driving performance outcomes.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Coding Compliance Auditor & Educator
Wellstar Health System
07.2022 - Current
- Conduct independent audits of professional fee coding. Assures appropriate and accurate coding assignments in accordance with federal coding regulations and guidelines.
- Create and communicates clear and accurate audit findings to physicians and charge review staff which include references for authoritative guidance.
- Prepare written reports of findings and lead meetings with providers to review the audit findings and recommend ways to improve when indicated.
- Use my knowledge of applicable regulations for Medicaid and Medicare, as well as the principles of physician documentation, coding, and billing in a variety of settings and specialties.
- Also responsible for aiding with coding inquiries from providers, coding, staff, etc.
- Have advanced knowledge of CPT, ICD-10-CM, and HCPCS coding systems. Responsibilities also include providing ICD-10-CM and EMR documentation training to physicians.
- Pursue education and training opportunities to assure compliance with current laws, rules and regulations by participating in professional education activities and obtaining and maintaining relevant certifications.
Professional Coding Compliance Manager
Augusta University Medical Center
02.2021 - 07.2022
- Responsible for the day-to-day management and operation of the Non-Surgical Coding section within the Professional Services Coding and Compliance Department for the Augusta University Health System.
- Responsible for reimbursement and denial follow-up
- Responsible for management of a lead coder, coding education specialists, and 31 professional coders who work on site and remotely.
Clinical Coding and Compliance Specialist
Dell Medical School/University of Texas at Austin
09.2017 - 01.2021
- Draft and maintain all coding compliance, policies and procedures for UT Health Austin. Responsible for implementing processes, updating policies, and training providers and staff as related to coding regulations.
- Assist IPU staff and providers with IPU build, as well as any billing/coding related questions. Conduct provider training sessions for both general and specific problem resolution in the coding, billing, and reimbursement areas. Assist with the implementation of special billing projects, as needed.
- Facilitate the process of identifying, investigating, and resolving all compliance issues within UT Health Austin related to coding, billing, documentation, and reimbursement activities. Respond to audit findings and make applicable coding additions or corrections, and provider reeducation. Monitor overall compliance in the coding, billing, documentation and reimbursement area to ensure compliance with federal and state regulatory bodies.
- Determine the final diagnoses and procedures stated by the physician or other health care provider are valid and complete. Perform a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and all other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered. Evaluate the record for documentation consistency and adequacy.
- Process all charges and review and clear all coding edits generated by the electronic health record (EHR). Review Medicare Local Coverage Determination and Payer Bulletin updates and accounts for specific coding nuances with specific payers as needed. Provide analytical and clinical support focusing on the research and provide findings of medical benefit offerings. Write up research, coverage determinations and present findings of impacts to benefits offerings. Assist in research and claims appeal process for all coding related claim denials.
- Implementing all training for 2021 E/M coding changes as well as drafting a 2021 MDM audit sheet for providers.
Certified Professional Clinical Coding Analyst
Accenture/TMHP
01.2016 - 09.2017
- Certified Professional Coder certification required ICD-10 certified with broad current outpatient billing/coding experience to assist in operationalizing medical policy development related matters or other projects as specified The Certified Professional Clinical Coding Analyst is a professional who applies a broad medical/dental, pharmacy, or program knowledge to research, write, edit and provide findings regarding impact of coding changes.
- Generally works under specific deadlines and frequently handles multiple complex projects, operating with minimal supervision.
- Provides analytical and clinical support focusing on the research and provides findings of medical benefit offerings. Writes up research, coverage determinations and presents findings of impacts to benefits offerings.
- Researches and identifies best practices and evidence based research studies in support of the coverage determinations.
- ICD-10 contact person for Texas Medicaid.
Coding Compliance Auditor
Austin Regional Clinic/CMS
07.2012 - 12.2016
- Conducts routine annual and focused chart review audits of clinically coded data in compliance with Official Coding Guidelines in ICD-9-CM/ICD-10-CM and CPT coding for 18 outpatient clinics with multi-specialty physicians, mid-level providers, support staff, and administration. Also including 80+ Hospitalists at 8 Inpatient Hospitals.
- Responsible for identifying incorrect coding services and preparing reports of findings to meet with providers and office staff to deliver education and training in documentation improvement and to ensure compliance throughout the company.
- Analyze and research various processes and develop strategies for improving the efficiency and accuracy of work flow. Assist IT in setting up and maintaining all pricing on procedure codes (e.g. E&M, surgeries, lab, x-ray, supplies, etc.) and diagnosis codes in EPIC.
- Gap Analysis auditing to prepare all providers for implementation of ICD-10 and compliant supporting documentation.
- Special Focus in Orthopedics, Surgery, Medicaid, Medicare and ADR’s.
- Provide ICD-10 training and support to all providers for go-live on Oct. 1, 2015.
Therapy Intake Coordinator
WellCare Healthcare
04.2011 - 06.2012
- Process incoming Physical, Occupational and Speech Therapy Prior Authorizations for all Medicare and Medicaid Members.
Accounts Payable Manager
Ellis Construction Company, Inc.
07.2008 - 03.2010
- Handled all open accounts with subcontractors and suppliers.
- Reconciled delivery tickets and invoices with purchase orders.
- Accurately processed and issued checks for accounts payable in a timely manner.
- Secured release of liens and other necessary paperwork from subcontractors.
- Used Timberline Software to close out accounts payable each month.
Receptionist
Ellis Construction Company, Inc.
07.2008 - 03.2009
- Provided administrative assistance to the President, Vice President/Controller, Owner, Office Manager, 4 Estimators and 2 Project Managers.
- Set up new subcontractor files for accounts payable and estimating department.
- Processed subcontractor’s monthly payment requests.
- Prepared closeout documents, maintained performance and payment bond status inquiries, and managed file of subcontractor insurance certificates.
- Kept Subcontractor Summary Log; reviewed and followed up when necessary.
- Inventoried and ordered office supplies.
- Managed vendor relationships, ensuring timely payment processing and efficient communication.
- Streamlined invoice approval process, reducing delays and enhancing operational efficiency.
Education
Diploma - Medical Billing & Coding
Ultimate Medical Academy
Tampa, FL01.2011
Communications
Clayton State College
Morrow, GA01.1992
Communications
University of Texas
Austin, TX01.1989
Skills
- Well organized with a keen ability to stay up to date on details and tight deadlines
- Able to work with diverse clients and staff
- Reliable and able to work independently with limited supervision
- Able to adjust priorities and manage time wisely in a fast-paced environment
- Enjoys pro-active problem-solving skills, able to generate win-win scenarios
- Strong verbal, written and interpersonal skills
- Skilled and competent in standard office functions and accounting procedures
- Organization skills
- Verbal and written communication
- Tech-Savvy
- Performance improvement
- Staff management
- Project management
- Professional and polished presentation
- Multitasking and prioritization
- Documentation
- Records maintenance
- Records management
Affiliations
- American Association of Professional Coders Member 2011- Present
- University of Texas System – Institutional Compliance Advisory Council (ICAC) Billing Subcommittee 2017-2021
- University of Texas System - Web-Based Risk Management Education (WBRME) Committee Member 2018-2021
Certification
CPC - Certified Professional Coder
CPCO - Certified Professional Compliance Officer
CPMA - Certified Professional Medical Auditor
Timeline
Coding Compliance Auditor & Educator
Wellstar Health System
07.2022 - Current
Professional Coding Compliance Manager
Augusta University Medical Center
02.2021 - 07.2022
Clinical Coding and Compliance Specialist
Dell Medical School/University of Texas at Austin
09.2017 - 01.2021
Certified Professional Clinical Coding Analyst
Accenture/TMHP
01.2016 - 09.2017
Coding Compliance Auditor
Austin Regional Clinic/CMS
07.2012 - 12.2016
Therapy Intake Coordinator
WellCare Healthcare
04.2011 - 06.2012
Receptionist
Ellis Construction Company, Inc.
07.2008 - 03.2009
Accounts Payable Manager
Ellis Construction Company, Inc.
07.2008 - 03.2010
Communications
Clayton State College
Communications
University of Texas
Diploma - Medical Billing & Coding
Ultimate Medical Academy
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