Tomika Adams
Henderson
Summary
Experienced professional with 27 years in clinical coding, auditing, and data analysis. Seeking a role in healthcare data analytics to drive operational efficiency, enhance patient care, and support strategic decision-making. Skilled in leveraging data to improve processes and outcomes for healthcare organizations. Passionate about making a positive impact on the industry through continuous learning and professional growth.
Overview
20
20
years of professional experience
Work History
Clinical Coding Investigation Auditor - MSR, FWAE, SIU, E&I and Post Pay
Optum – United Healthcare
01.2022 - Current
- Identifies & builds consensus for facilitation of system and process standardization, utilization of best practices, work integration, change management, issue resolution, metric development and measurement, and communication related to the key components of coding operations.
- Implemented initiatives to enhance coding quality and efficiency, providing strategic oversight and driving continuous improvement in coding operations by 20%.
- Led a team of 12 auditors, providing training and feedback to enhance performance.
- Identified and resolved coding discrepancies, improving accuracy by 25%.
- Assists business services with maintenance of data files necessary to perform tasks and translate technical or complex issues.
- Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review.
- Working knowledge of clinical data domains and code sets (CPT, ICD, DRG, etc.)
Utilization Review Coding Denials Clinical Data Analyst
Far West Division- HCA Corporate
01.2019 - 01.2022
- Triage incoming inventory, validating appeal criteria is met in compliance with departmental policies and procedures.
- 80% of Medicare RAC recoupment requests successfully appealed, recovering over $500,000.
- Developed Tableau visuals that improved data analysis efficiency by 20%.
Analyst, Coder – Special Investigation Unit
Molina Healthcare, Inc.
06.2018 - 01.2019
- Detected and reported 50 cases of potential fraud, leading to regulatory investigations.
- Coordinated provider coding education as appropriate based on coding guidelines, contractual, and/or regulatory requirements.
- Analyze detailed preliminary and extensive investigation referrals to state and/or federal regulatory and/or law enforcement agencies when potential fraud, waste, or abuse is identified as required by regulatory and/or contract requirements.
- Advises with regulatory and/or law enforcement agencies regarding case investigations.
Care Assure Coding Coordinator – Far West Division
Far West Division- HCA Corporate
10.2005 - 05.2018
- Assists with developing and coordinating a multifaceted educational and training program that focuses on the elements of Coding & Compliance.
- Responsible for correct CPT-4 and ICD-10 coding for Medicare, Medicaid and Commercial payers by using CMS guidelines.
- Reconciles NCCI correct edits and discrepancies prior to final coding.
- Audit E/M billing for ER department to improve coding data accuracy for Medicare compliance.
Education
CPC & ICD-10/ ICD-11 Certified
American Academy of Professional Coders
06.2017
Data Analysis in Healthcare Course
ELVTR
06.2025
Skills
- Health data analysis
- Data interpretation
- Programming
- Database optimization
- Excel proficiency (VLOOKUP, pivot tables)
- Data visualization expertise
- Proficient in Power BI
- Analytical problem solving
- Analytical reasoning
- Detail-oriented approach
Timeline
Clinical Coding Investigation Auditor - MSR, FWAE, SIU, E&I and Post Pay
Optum – United Healthcare
01.2022 - Current
Utilization Review Coding Denials Clinical Data Analyst
Far West Division- HCA Corporate
01.2019 - 01.2022
Analyst, Coder – Special Investigation Unit
Molina Healthcare, Inc.
06.2018 - 01.2019
Care Assure Coding Coordinator – Far West Division
Far West Division- HCA Corporate
10.2005 - 05.2018
Data Analysis in Healthcare Course
ELVTR
CPC & ICD-10/ ICD-11 Certified
American Academy of Professional Coders
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