Tonya Trach
Bath,PA
Summary
Accomplished Quality Assurance professional with 18 years of expertise in HCC risk adjustment coding, recognized for mentoring coders, delivering targeted education, and driving quality improvements. Skilled in conducting detailed audits, identifying trends, and preparing education to ensure compliance with CMS guidelines. Known for fostering collaboration, building coder confidence, and enhancing team performance through clear communication and supportive guidance. Eager to bring proven quality oversight skills and leadership potential to a QA Supervisor role.
Overview
1
1
Certification
14
14
years of professional experience
Work History
Lead HCC Coding Specialist
Highmark, Inc.
Pittsburgh, PA
04.2024 - Current
- Execute comprehensive Quality Assurance (QA) reviews on internal coders and external vendors to ensure compliance and accuracy standards.
- Analyze complex coding scenarios and resolved staff inquiries.
- Create and facilitate coding education sessions to enhance team proficiency based on insights from QA review error analysis.
- Provide mentorship to new hires and internal coders, partner with leadership to refine coding protocols and drive process enhancements.
- Perform coding for retrospective chart reviews associated with Medicare Advantage (MA) and Affordable Care Act (ACA) projects contributing to meeting project timelines and compliance with regulations.
HCC Coding Specialist
Highmark, Inc.
Pittsburgh, PA
01.2023 - 04.2024
- Reviewed outpatient and inpatient records and interpreted documentation to identify ICD-10-CM codes and HCC disease categories for MA and ACA projects.
- Applied diagnosis coding guidelines and rules from Centers for Medicare and Medicaid Services (CMS) and Highmark's Policy and Procedures to assign Hierarchal Condition Categories (HCC) codes.
- Resourcefully utilized various coding tools, discussion boards, and Optum encoder to accurately assign codes.
- Maintained accuracy, completeness, and security for medical records and health information.
- Ensured high-quality outcomes by maintaining 97-98% accuracy and consistently exceeding productivity standards for all assignments.
Nurse Abstractor
ComplexCare Solutions
Bowie, MD
10.2012 - 10.2022
- Analyzed and validated medical records for risk adjustment projects, focusing on HCC, HHS-HCC, and Clinical Related Group (CRG) compliance.
- Conducted thorough reviews and abstractions of medical record data to support quality improvement initiatives related to Healthcare Effectiveness Data and Information Set (HEDIS) measures.
- Ensured adherence to accuracy standards exceeding 95%.
- Ensured adherence to productivity standards in alignment with project-specific guidelines.
- Enhanced understanding of coding standards to ensure compliance and maintain professional credentials.
Education
Certificate Advanced Medical Billing & Coding -
CDM Institute
Allentown, PA2010
Bachelor of Science - Nursing
Cedar Crest College
Allentown, PA2004
Diploma - Nursing
St. Luke's Hospital School of Nursing
Bethlehem, PA1990
Skills
- Certified Professional Coder
- ICD-10-CM
- Risk Adjustment
- Medical Record Review
- Inpatient outpatient records
- EMR Systems
- Protected Health Information
- Complex Problem-Solving
- Word processing
- Medical terminology
Affiliations
American Academy of Professional Coders (AAPC)
Certification
- CRC - Certified Risk Adjustment Coder
- CPC - Certified Professional Coder
- PA Registered Nurse License - 1991-present
Timeline
Lead HCC Coding Specialist
Highmark, Inc.
04.2024 - Current
HCC Coding Specialist
Highmark, Inc.
01.2023 - 04.2024
Nurse Abstractor
ComplexCare Solutions
10.2012 - 10.2022
Diploma - Nursing
St. Luke's Hospital School of Nursing
Bachelor of Science - Nursing
Cedar Crest College
Certificate Advanced Medical Billing & Coding -
CDM Institute