Zoe Sweeden
Oak Ridge,TN
Summary
Coding Specialist with a proven track record at Southeastern Retina Associates, excelling in E/M and surgical coding. Demonstrated strong attention to detail and effective communication skills, consistently surpassing quality benchmarks while ensuring HIPAA and payer policy compliance. Committed to enhancing data integrity and optimizing reimbursement processes through ongoing education and collaboration with clinical staff.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Coding Specialist
Southeastern Retina Associates
05.2024 - Current
- Enters charges daily for all physicians ensuring accurate coding (including E/M coding, retina / lens surgical coding, as well as HCPCS level II coding)
- Clinical documentation review / queries scribes regarding clinical documentation discrepancies
- Verifies injectable drug charges using PODIS and reports any discrepancies to billing manager
- Edits previously submitted charges as needed due to identified billing errors
- Verifies correct insurance policies are loaded in practice management system and bills charges in accordance with payer policies
- Manages high volumes of medical records efficiently while maintaining strict attention to detail during the coding process
- Follows up with clinical staff regarding missing information in patient records
- Participates in interdisciplinary meetings to discuss complex cases requiring specialized knowledge of coding principles and guidelines.
Risk Adjustment Coder
Summit Medical Group
10.2022 - 02.2024
- Analyzed medical records to assign accurate HCC codes, ensuring compliance with CMS guidelines.
- Collaborated with healthcare providers to clarify diagnoses, enhancing data quality and coding precision.
- Maintained up-to-date knowledge of coding regulations and payer-specific requirements through ongoing education initiatives
- Exceeded company benchmarks for both quality and quantity of coded records processed within specified deadlines, showcasing strong work ethic and commitment to excellence in role performance
- Verified signatures and checked medical charts for accuracy and completion
Coding and Billing Specialist
Contract Health Services
11.2021 - 10.2022
- Processed charge entries accurately within electronic health record systems
- Boosted customer satisfaction levels by addressing patient inquiries regarding their charges in a professional and respectful manner
- Ensured accurate reimbursement rates were applied during the charge entry process through consistent review of payer contracts
- Verified insurance eligibility and information to update database
- Reduced errors in charge capture by maintaining up-to-date knowledge of CPT, ICD-10, and HCPCS codes
- Ensured compliance with billing guidelines by staying current on relevant regulations, policies, and procedures
- Enhanced billing accuracy by diligently reviewing and correcting discrepancies in patient accounts
- Managed and responded to correspondence and inquiries from health plans
- Followed up on claim status with insurance carriers
Education
Associate of Applied Science - Health Information Managment
Roane State Community College
Harriman, TN05-2027
Skills
- CPT (HCPCS Level I)
- ICD-10-CM
- HCPCS Level II
- Ensures HIPAA compliance
- Proficient in fast-paced environments
- Strong attention to detail
- Provider / clinical staff querying
- Anatomy / Physiology (Roane State Community College - 2023-2024)
- Effective verbal communication
Certification
- CPC - Certified Professional Coder (2021)
- CRC - Certified Risk-Adjustment Coder (2023)
Timeline
Coding Specialist
Southeastern Retina Associates
05.2024 - Current
Risk Adjustment Coder
Summit Medical Group
10.2022 - 02.2024
Coding and Billing Specialist
Contract Health Services
11.2021 - 10.2022
Associate of Applied Science - Health Information Managment
Roane State Community College
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