ULYSSIA BRIMLEY
Milwaukee
Summary
Experienced and certified Coding Specialist with over 15 years of expertise in both public and private sectors. Currently seeking a part-time medical coding position. Possesses a solid understanding of medical coding principles and a diverse background in multi-specialty coding. Advanced knowledge of professional medical services in outpatient and inpatient settings, consistently achieving a 95% accuracy rate.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Legal Compliance Senior Analyst
CIGNA HEALTH GROUP
10.2022 - Current
- Provide research and other support services to ensure observance of official coding policies
- Ensure adherence to regulations, requirements, and standards as promulgated by Medicare, various state Medicaid agencies, and other accreditation bodies
- Contributed to and/or supervised coding investigations
- Developed and executed audits for designated subject areas
- Consistently executed necessary reporting and monitoring tasks to comply with program regulations.
- Monitor executive audit summaries; follow up with Executive Leadership for completed corrective action plans (CAPS)
- Provided compliance and process-related recommendations for medical coding issues
- Ensured consistent and accurate auditing of assigned areas within Compliance Department
Certified Coding Educator - Part-time
THE CODING NETWORK, LLC
03.2011 - 04.2025
- Perform routine and comprehensive audits for Quality and Risk Adjustment to ensure compliance with state and federal regulations
- Analyzed and coded medical records to ensure compliance with regulatory standards.
- Collaborated with healthcare providers to improve documentation accuracy and reimbursement processes.
- Conducted audits of coding practices, identifying areas for improvement and implementing corrective actions.
- Evaluated industry trends and updates to maintain compliance with changing regulations in medical coding practices.
- Work with prospective clients to understand their business and how their claim data will be analyzed
- Maintain current knowledge of AHA ICD-9-CM/ICD-10-CM and AMA CPT-4 coding conventions
- Employ the use of multiple coding software applications as a resource to verify and assign ICD-10-CM, HCC, HCPCS, and CPT-4 codes
- Identify incomplete medical record documentation and formulate a physician query to obtain missing/insufficient clinical data
- Maintain daily productivity and turnaround time as outlined in the Department's Performance Improvement Plan.
- Developed curriculum for coding education, enhancing student engagement and comprehension.
- Led workshops on programming languages, fostering hands-on learning experiences.
- Implemented assessment tools to evaluate student progress and improve instructional methods.
- Utilized advanced computer skills to navigate various software programs, further enhancing the efficiency of coding processes.
- Participated in regular performance evaluations and provided constructive feedback for continuous improvement within the team.
Sr. Business Analyst
UNITEDHEALTH GROUP
12.2020 - 12.2021
- Analyzed and validated data collected from HIOS (Health Insurance Oversight System), per HHS RADV program regulation requirements
- Researched and resolved discrepancies by employing the use of various Business Intelligence Tools, before SERFF submission
- Escalated unresolved discrepancies per internal SOPs
- Documented and disseminated educational materials to colleagues after attending monthly CMS CCIIO HHS RADV webinars, uploaded meeting notes to SharePoint
- Collaborated with internal and external stakeholders to discuss and review project timelines
- Examined data, performed queries, and provided weekly reports to management and external business partners
- Collaborated with external business partners to ensure prompt preparation and accuracy of Risk Adjustment Data Validation end-to-end process
- Successfully completed two calendar years of HHS RADV audits within one year
- Achieved 99.5% completeness, which supported quantity and quality questions with no Risk Adjustment Default charges
- Attained HCC validation at 84.6% for 2019, which was the highest of all RADV to date, exceeded the number HCC validated for 2020.
Sr. Medicare Audit Consultant
AETNA CVS HEALTH
09.2019 - 11.2020
- Developed and implemented policies and procedures to support work-flow processes
- Served as Subject Matter Expert (SME) for Medicare Managed Care Compliance Program for FDR (First-Tier, Downstream, and Related Entities) regulations
- Collaborated with Compliance and Legal teams for conflict resolution with Business Partners (when applicable)
- Reviewed delegate CPE/BCP (Compliance Program Effectiveness/Business Continuity Plan) policies and procedures, along with supporting documentation to ensure adherence to program requirements
- Facilitated meetings with delegates to discuss and review their internal policy discrepancies concerning CMS' FDR regulations
- Planned, executed, and reported FDR audits to Management, Senior Leadership, and Compliance
- Investigated root causes, conducted data analysis, identified trends, and issued audit findings to Delegate's Representative
- Issued requests for corrective action plans (CAPS), conducted follow-up investigations to ensure corrective actions were implemented
- Composed and presented reports with metrics for Compliance and Senior Leadership
- Evaluated and monitored corrective action plans to ensure objectives are met on time
- Achieved 95% passing rate for 2019 Medicare Compliance Program audits: Medicare Part C & D.
Medical Records Technician Auditor
CLEMENTE J. ZABLOCKI VA MEDICAL CENTER
05.2016 - 08.2019
- Served as Subject Matter Expert (SME) for CPT-4 and ICD-10+CM medical coding conventions and guidelines per CMS 1995/1997 Documentation guidelines
- Tracked and documented audit findings, provided results to Management
- Composed reports with data analysis to share and educate Clinical Staff, HIM (Health Information Management) Department Leadership
- Collaborated with VERA (Veteran's Equitable Resource Allocation) consultant to assist with data reporting and auditing structure for Senior Leadership
- Researched regulatory requirements to identify changes that may affect medical coding
- Conducted training sessions for new coding staff, retrained existing coding staff, when applicable
- Authored, revised, and reviewed quality communications (e.g., policies, procedures, and training) and provided recommendations
- Conducted educational sessions for clinicians and ancillary staff to improve their documentation efforts
- Successfully completed auditing of ~ 500 professional E/M services per month for three consecutive years.
Quality Review Analyst I & II
THE MEDICAL COLLEGE OF WISCONSIN
06.2006 - 03.2016
- Conducted routine focused and comprehensive audits for clinicians and coding staff according to CMS Documentation Guidelines for E/M services and procedures
- Assisted in the development and updating of procedures and work-flow processes to maintain standards for correct coding
- Monitored and reported coder productivity to management on a routine basis
- Aided with the development of corrective actions and monitor the implementation of those actions
- Researched and resolved Claims Manager Edits to ensure correct coding of medical services
- Partnered with Compliance Department to discuss and review annual audit results
- Identified opportunities for Quality Improvement in medical coding via streamlined workflow processes
- Maintained current knowledge of CMS documentation and insurer reimbursement guidelines for CPT-4 procedures, ICD-9-CM, ICD-10+-CM diagnoses, and HCPCS coding
- Facilitated monthly educational sessions for clinicians, coding, and management for five consecutive years
- Planned and executed organizational annual educational session for coding staff for five consecutive years.
Education
MBA -
CONCORDIA UNIVERSITY OF WISCONSIN
Mequon, WI01.2008
Bachelors - undefined
CONCORDIA UNIVERSITY OF WISCONSIN
Mequon, WI01.2005
Associates - undefined
BRYANT & STRATTON
Milwaukee, WI01.1995
Skills
- Certified coding specialist
- ICD-10 proficiency certification
- Clinical documentation analysis
- Healthcare vocabulary expertise
- HIPAA regulations knowledge
- Document organization
- Employee training
- Debugging code issues
Affiliations
- American Academy of Professional Coders
Certification
Certified Professional Coder
Timeline
Legal Compliance Senior Analyst
CIGNA HEALTH GROUP
10.2022 - Current
Sr. Business Analyst
UNITEDHEALTH GROUP
12.2020 - 12.2021
Sr. Medicare Audit Consultant
AETNA CVS HEALTH
09.2019 - 11.2020
Medical Records Technician Auditor
CLEMENTE J. ZABLOCKI VA MEDICAL CENTER
05.2016 - 08.2019
Certified Coding Educator - Part-time
THE CODING NETWORK, LLC
03.2011 - 04.2025
Quality Review Analyst I & II
THE MEDICAL COLLEGE OF WISCONSIN
06.2006 - 03.2016
Bachelors - undefined
CONCORDIA UNIVERSITY OF WISCONSIN
Associates - undefined
BRYANT & STRATTON
MBA -
CONCORDIA UNIVERSITY OF WISCONSIN
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