Tiffany C. Dorris
Lithonia,GA
Summary
Training and experience in medical information technology in the healthcare setting as well as in the reimbursement arena has provided me with the wide range of skills involved in the healthcare delivery process. Continuous training and experience has allowed me to remain current, efficient and knowledgeable regarding coding, administration, documentation, regulations, laws, technologies, and other technical and clerical areas of healthcare. Corse work included: medical terminology, medical billing and medical coding. My career has also included Emergency Room experience where it was often necessary to communicate clinically with patients and to make quick and unrehearsed administrative decisions.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Outpatient Medical Record Technician (Telework)
Jesse Brown Department of Veterans Affairs Healthcare System
09.2015 - Current
- Coding outpatient encounters including diagnoses and procedural coding using experience and knowledge of coding principles and guidelines per ICD-10, CPT and associated VA coding policies and procedures.
- Knowledge of clinical documentation layout and experience with Medical Records.
- Experienced in general principles of Evaluation and Management (E/M) documentation, common sets of codes used to bill for E/M services and E/M providers.
- Experience with reading and reviewing Medical Records and verifying documentation matches CPT code from claim
- Skilled in using Microsoft Office: Excel, Word, etc. Adobe Pro and demonstrated ability to learn/adapt to computer-based tracking and data collection tools
- Responsible for creating and processing Prosthetic encounters, validating Diagnosis, CPT, and HCPCS codes, adding appropriate modifiers, and following all Standard Operating Procedures (SOP) for the Prosthetics package.
- Proficient with navigating and retrieving clinical information from an electronic medical record..
- Self-motivated, able to take initiative, and work independently with minimal oversight to meet timelines, with strong follow-through skills.
Claims Resolution Specialist (Telework)
Caduceus Health Inc.
02.2021 - 06.2023
- Conduct AR Follow-up both on front end scrubs and back end denials through best practices. Scrub charges for submission and launch appeals via the Athena billing platform.
- Demonstrate a detailed understanding of how to read and interpret EOB's and denials from all insurance carriers (including the financial components such as co-pays, deductibles, and co-insurance).
- Possess a thorough knowledge of appeals processing from end to end across all payer categories based on insurance denials.
- Contact insurance companies and utilize web portal and websites for appeal, eligibility, remittance, and payment information.
- Review and clear claim edits in the system. Types of edits to be worked include registration, insurance, charge, and related issues for high volume practices.
- Directed claims negotiations within allowable limit of $50,000.00 and supported successful litigations for advanced issues.
Remote Clinical HCC (Hierarchical Condition Categories) Coder
Outcomes Health Solutions (Altegra Health)
08.2013 - 11.2016
- Abstract pertinent information from patient medical records. Assign appropriate ICD-9/ICD-10CM codes, creating HCC and/or RxHCC group assignments.
- Assign all exception codes when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes.
- Remain current on medical coding guidelines and reimbursement reporting requirements.
- Check chart assignments every day and report accurately all hours worked on a weekly basis.
- Knowledge of HIPAA recognizing a commitment to privacy, HCC, CCC HEDIS, security and confidentiality of all medical chart documentation.
- Collaborate with the Coding Manager in providing expertise in the use and application of coding classifications such as ICD-9-CM and/or ICD-10-CM.
- Record documentation to ensure compliance in the collection of Outpatient/Inpatient diagnoses and services.
- Reports on the accuracy and consistency of the data in accordance with accepted and established standards.
- Work to improve the quality of coding documentation and data in the medical record and HCC database
- Perform ongoing analysis of medical record charts for the appropriate coding compliance.
- Attend conference calls as necessary to provide information and/or feedback.
- Developed and maintained coding standards to enhance data accuracy and consistency.
- Collaborated with cross-functional teams to ensure seamless integration of health information systems.
- Conducted thorough code reviews, identifying areas for improvement and ensuring compliance with industry regulations.
- Trained junior coders on best practices, fostering a culture of continuous learning and development.
- Implemented process improvements that streamlined coding workflows, reducing turnaround times significantly.
- Led initiatives to optimize coding practices, resulting in enhanced productivity across the department.
- Analyzed complex medical records to ensure precise coding for optimal reimbursement outcomes.
- Mentored staff on regulatory updates and changes in coding guidelines, promoting adherence to compliance standards.
- Maintained high coding standards by adhering to industry best practices and staying current with emerging technologies.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Facilitated knowledge sharing within the team by conducting regular code reviews, training sessions, and workshops on relevant topics.
- Delivered consistent results under pressure by prioritizing tasks effectively during periods of high workload or tight deadlines.
- Expedited project completion timelines with strong time management skills and adherence to deadlines.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Verified signatures and checked medical charts for accuracy and completion.
- Monitored changes in coding regulations to provide recommendations for compliance.
Outpatient Medical Record Technician
Ann Arbor Department of Veterans Affairs Healthcare System
02.2015 - 09.2015
- Coding outpatient encounters including diagnoses and procedural coding using experience and knowledge of coding principles and guidelines per ICD, CPT and associated VA coding policies and procedures.
- Possess expert knowledge of VA coding guidelines as they relate to the AAVAHS coding and reimbursement process.
- Experienced in general principles of Evaluation and Management (E/M) documentation, common sets of codes used to bill for E/M services and E/M providers.
- Provided education to physicians new to the AAVAHS regarding documentation and coding guidelines.
- Work on team projects under the direction of the Supervisor participating in brainstorming, implementing objectives, and completion of project goal.
- Responsible for creating and processing Prosthetic encounters, validating Diagnosis, CPT, and HCPCS codes, adding appropriate modifiers, and following all Standard Operating Procedures (SOP) for the Prosthetics package.
- Specialize in Radiation Oncology, Emergency Room, Chemo-Infusion Therapy, Ophthalmology and Pulmonary coding.
- Ensuring that the critical information like Ambulatory Surgery/Anesthesia dates, name of the surgeon, and prescribed medications are entered into the systems in a correct way to avoid confusion and Re-examining the medical charts for acquiring accurate discharge or admission dates.
- Conducted detailed diagnostics to identify issues, leading to decrease in system downtimes.
- Reduced response times to technical issues, implementing prioritized troubleshooting protocol.
Remote Coder/Auditor: site (New York Harbor)
Managed Resources Inc. (MRI)
06.2010 - 10.2013
- Distributes quality coding using CPT and ICD-9 guidelines that are monitored through MRI’s VPN tunnel that connects to the Client Firewall system.
- Assures quality coding remains current by applying a timely 48-hour turnaround time on all case studies assigned.
- Provides detailed review of each encounter referred for audit
- Prepares a detailed audit report of the findings with recommendations and cross references to coding guidelines.
- Knowledgeable and utilize the general principles of E/M documentation.
Billing Specialist/Inpatient Medical Record Technician
Michigan Hospitalists, P.C.
09.2001 - 10.2006
- Knowledgeable of medical billing and collection practices
- Reviewed accounts for possible assignment and made recommendations to the Billing Supervisor, also prepared information for the collection agency
- Processed payments from insurance companies and prepared daily deposits
- Maintained strict confidentiality; adhered to all HIPPA guidelines and regulations.
Medical Insurance Biller
Balian Eye Center
05.2000 - 09.2001
- Evaluated patients’ financial status and established budget payment plans.
- Followed and reported status of delinquent accounts.
- Performed various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers.
- Knowledgeable of basic coding and third-party operating procedures and practices.
Information Registration Clerk
Pontiac Osteopathic Hospital
06.1996 - 06.2001
- Instructed patients to complete medical forms and reviewed patients’ account status.
- Updated information, including address, phone numbers and financial classifications.
- Answered all patients’ questions over the phone or in person as needed.
- Promoted a positive and cooperative work environment by communicating problems and workflow issues to supervisors, and handling conflict in an appropriate manner.
Education
Medical Insurance Biller -
Carnegie Institute
Rochester Hills, MI09.1997
American Academy of Professional Coders
Pontiac, MIMedical Terminology
Oakland Community College
Auburn Hills, MISkills
- Athena expertise
- Experience with Epic EHR
- Proficient in MS Windows XP
- Proficient in Microsoft Suite
- Proficient in Nuance Clintegrity 360
- WebVR development skills
- 3M Software
Certification
- Certified Professional Coder August 2005
- Certified ICD-10-CM Proficiency December 2015
Timeline
Claims Resolution Specialist (Telework)
Caduceus Health Inc.
02.2021 - 06.2023
Outpatient Medical Record Technician (Telework)
Jesse Brown Department of Veterans Affairs Healthcare System
09.2015 - Current
Outpatient Medical Record Technician
Ann Arbor Department of Veterans Affairs Healthcare System
02.2015 - 09.2015
Remote Clinical HCC (Hierarchical Condition Categories) Coder
Outcomes Health Solutions (Altegra Health)
08.2013 - 11.2016
Remote Coder/Auditor: site (New York Harbor)
Managed Resources Inc. (MRI)
06.2010 - 10.2013
Billing Specialist/Inpatient Medical Record Technician
Michigan Hospitalists, P.C.
09.2001 - 10.2006
Medical Insurance Biller
Balian Eye Center
05.2000 - 09.2001
Information Registration Clerk
Pontiac Osteopathic Hospital
06.1996 - 06.2001
Medical Insurance Biller -
Carnegie Institute
American Academy of Professional Coders
Medical Terminology
Oakland Community College
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