AFIYA RICHARDS CMA, CPC, CPMA

*** *. ******* **.

Sterling, VA 20164

757-***-****

adio2x@r.postjobfree.com

SUMMARY OF PROFESSIONAL EXPERIENCE

I am a strong leader with 17 years in the medical experience. I have been a Certified Medical Assistant (CMA), Phlebotomist, and Lab Assistant, as well as a licensed insurance agent. I have13 years of experience as a Certified Professional Biller and Coder (CPC), I have 9 years as an Auditor/Compliance Specialist and Physician Educator. I also was a Medical billing and Coding Instructor for12 years. Among that I possess nearly 22 years of customer service/ sales experience.

EDUCATION HISTORY

Prima Code Masters Remote

Inpatient coding, ICD-10 PCS, DRG’s, CCS Exam Prep.

HC Pro Oklahoma City, Oklahoma

Professional Medical and Billing Specialist

WellPoint (APAC) Wichita, Kansas

Licensed Insurance Agent

Applied Career College Springfield, Virginia

Registered Medical Assistant/ Registered Phlebotomist

HIGHLIGHT OF WORK EXPERIENCE

Performant Corp. Aug.19-Jan.20

Sr. Validator (Remote)

Conduct Humana RAC Audits for various procedures

Procedures were as follows:

oColonoscopy Procedures

oCataract Procedure

oChemotherapy

oSpinal Fusions

oModifier 73 and 74

oMultiple Procedures reported on the same DOS during same encounter

oHysterectomies

oTotal Knee Replacements

oArthroscopies (Shoulder and Hip)

oDialysis

oAnesthesia

oTTE/TEE

oEmergency Room encounters

oProcedures

oAs well as a wide variety of other procedures

Validate claims

Ensure correct coding and billing was reported

Determine if claim was a “Finding or No Finding”

Complete RRL to communicate the results of audit performed

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Gebbs Solutions Nov.18 – April.19

Sr. Validator (Remote)

Conduct Humana RAC Audits for various procedures

Procedures were as follows:

oColonoscopy Procedures

oCataract Procedure

oChemotherapy

oSpinal Fusions

oModifier 73 and 74

oMultiple Procedures reported on the same DOS during same encounter

oHysterectomies

oTotal Knee Replacements

oArthroscopies (Shoulder and Hip)

oDialysis

oAnesthesia

oTTE/TEE

oAs well as a vide variety of other procedures

Validate claims

Ensure correct coding and billing was reported

Determine if claim was a “Finding or No Finding”

Complete RRL to communicate the results of audit performed

Centura College (AHIMA Accredited Program) Oct.16-Present

HIT Lead Instructor/Externship Coordinator VA.Beach,VA

Secure externship sites for students

Supervise HIT Instructors

Supervise students while on externship

Instruct and supervise students in both Medical Assisting and Certified Medical Billing and Coding Program.

Subjects included: Pathophysiology, Anatomy and Physiology, Medical Terminology, Medical Law and Ethics, Computer Software Applications in Healthcare, Pharmacology, CCS-A Exam Prep, Medical Office Procedures, Success in the Workplace

Created Medical Billing and Coding Program Syllabi

Track attendance and grades

Created weekly lesson plans

Prepare tests, assignments, and power points lectures

Comfortably present to large audiences. Attendees would range from physicians, student and/or potential students, coworkers as well as potential investors.

Sentara Medical Group Oct.14-Oct.17

Outpatient Coder/ Abstractor Validator (HCC, Quality Management Population Health)

Codes Outpatient Diagnostics, Recurring and/or Emergency Department accounts.

When applicable abstract HCC codes from inpatient encounters.

Reviews clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM and CPT-4 codes for hospital reimbursement, medical necessity, mortality & morbidity outcomes, governmental compliance coding, research, statistics, and regulatory compliance.

Under the direction of the Health Information Management Coding Manager, accurately codes outpatient encounters diagnosis, procedures and/or modifiers that are supported by the health record in accordance with ICD-10-CM Official Coding Guidelines for Coding and Reporting.

Abstracts, codes and assigns necessary demographic and clinical data elements required for outpatient records. Effectively utilizes encoder software to ensure appropriate reimbursement and accurate APC assignment. Completes all work in accordance with defined productivity and quality standards.

As necessary, queries and/or submits request to the physician for additional information or clarification of diagnoses, co-morbid/secondary conditions, and procedures.

Assures coding practices fall within established compliance guidelines. Performs other related duties as requested by HIM management.

Sentara Medical Group Oct.14-17

Clinical Coding Auditor (Quality Management) Norfolk, VA

Performed audits for inpatient and outpatient settings.

Conduct audits for the following specialties:

Primary Care Physicians

Hospitalist

Emergency Department

Internal Medicine

Home Health Care

Palliative Care

Critical Care

Observation

Same Day Surgery

Perform a number of functions including those of physician education, internal auditing, coder education as well as conduct courses to prepare coders to obtain their CPC, management of AR queries/problems, and liaison with external auditors for corporate audits.

Assure optimal ethical reimbursement for Sentara's patients, and also assures that the coding practices fall within established compliance guidelines.

Display both ICD and CPT coding methodologies are used in the internal audit activity.

Exhibit competence in either APCs or DRGs, and is expected to achieve mastery of at least one payment methodology within one year.

Handle all queries that arise from the audit process that are managed by the Clinical Auditor.

Follow audit plan, completing numerous audits and providing follow-up to coders, management, and physicians.

Look for new problem areas, trends, etc., and advises Director of Clinical Coding of same.

Work with leadership regarding scheduling of internal and external audits.

Respond to all family medicine RAC audits in a timely manner.

HcTech (Contracted to Wake Forest Hospital) Oct.14-Dec.14

Remote Hospital Surgical Coder

Code inpatient surgical procedures for Wake Forest Hospital

Attend regular educational training

HcTech(Contracted to Sentara Medical Group) March-14-Oct.14

Perform a number of functions including those of physician education, internal auditing, coder education, management of AR queries/problems, and liaison with external auditors for corporate audits.

Assure optimal ethical reimbursement for Sentara's patients, and also assures that the coding practices fall within established compliance guidelines.

Display both ICD and CPT coding methodologies are used in the internal audit activity.

Exhibit competence in either APCs or DRGs, and is expected to achieve mastery of at least one payment methodology within one year.

Handle all queries that arise from the audit process that are managed by the Clinical Auditor.

Follow audit plan, completing numerous audits and providing follow-up to coders, management, and physicians.

Look for new problem areas, trends, etc., and advises Director of Clinical Coding of same.

Conducted Audits for the following specialties:

Primary Care Physicians

Hospitalist

Emergency Department

Internal Medicine

Home Health Care

Palliative Care

Critical Care

Observation

Same Day Surgery

Work with leadership regarding scheduling of internal and external audits.

Respond to all family medicine RAC audits in a timely manner.

Fortis College Oct-13- 14

Medical Billing and Coding Instructor Norfolk,VA

Instruct and supervise students in both Medical Assisting and Certified Medical Billing and Coding Programs

Subjects included: Pathophysiology, Anatomy and Physiology, Medical Terminology, Medical Law and Ethics, Computer Software Applications in Healthcare, Pharmacology, CCS-A Exam Prep, Medical Office Procedures, Success in the Workplace

Track attendance and grades

Create lesson plans

Prepare tests, assignments, and power points lectures

Verisk Health (HCC) July-12- 03-15

Auditor/ Remote Coder (Remote) (Richmond, VA)

Capture all applicable diagnosis from encounters billed. (Inpatient and Outpatient Coding)

Audit and review documentation for various insurance companies

Code all documentation for 2011-2013

Confirm all contractual requirements are being met for each company

Attend regular meetings and training

Adapt to daily requirements based on need

Review any errors made

MED-SYSTEM ASSOCIATES Feb-12 –Sept.13

Auditor/Compliance Specialist VA Beach,VA

_

Conduct audits for over 300 physicians and hospitalists

Primary Care Physicians

Hospitalist

Emergency Department

Internal Medicine

Home Health Care

Palliative Care

Critical Care

Observation

Same Day Surgery

Provide physicians with feedback and education after completing audits.

Provide new hires with coding education and compliance updates

Prepare power points for seminars

Assist with creating appeals for RAC audits and denied claims

Attend/Palmetto seminars to stay abreast on compliance issues

Complete reversals and retractions

Interpret Explanation of Benefits and Remittance Advice.

Navigate fluently through EPIC, PRISM and SRS systems

Trover Solutions April-11-April-12

Independent Auditor (Remote) (ProFee)

Review medical documentation for accuracy

Complete audits for BC/BS and Wellpoint, Medicare and Medicaid for inpatient and outpatient claims.

Conduct audits for the following specialties:

Primary Care Physicians

Hospitalist

Emergency Department

Internal Medicine

Home Health Care

Palliative Care

Critical Care

Observation

Same Day Surgery

Accept or Reject claims based on accuracy of documentation submitted.

Complete 7-10 audits an hour

Created audit forms to accommodate 95 & 97 guidelines

Centura College June-10- Feb-12

Medical Billing and Coding Instructor Norfolk, VA

Instruct and supervise students in both Medical Assisting and Certified

Billing and Coding Programs

Subjects included: Pathophysiology, Anatomy and Physiology, Medical Terminology, Medical Law and Ethics, Computer Software Applications in Healthcare, Pharmacology, CCS-A Exam Prep, Medical Office Procedures, Success in the Workplace

Track attendance and grades

Create lesson plans

Prepare tests, assignments, and power points lectures

Wichita Technical Institute (WTI) Aug.-06-Oct-09

Medical Assistant/Billing and Coding Instructor Wichita, KS

Instructor for the Medical Assisting as well as the Medical Billing and Coding Program

Subjects included: Pathophysiology, Anatomy and Physiology, Medical Terminology, Medical Law and Ethics, Computer Software Applications in Healthcare, Pharmacology, CCS-A Exam Prep, Medical Office Procedures, Success in the Workplace, Pharmacology, Clinical Procedure, Infectious diseases and Sterile Procedure

Assisted and Instructed instructor seminars and training related to HIPAA

and Electronic Health Records

Assisted with curriculum changes

Assisted with creating new programs for the college

Tracked attendance and grade

Created Lesson plans

Prepared tests, assignments, and power point lectures

Instructed and supervised over 30 students per class

Wellpoint (APAC) Sep. -05-June-06

Licensed Insurance Agent Wichita, KS

Successfully enrolled patients for Medicare and Blue Cross/ BlueShield

Complete over 60 customer service calls daily

Handled customer billing inquires

Interpreted insurance contracts for customers

Interpreted formulary lists for prescription plans

Woodbridge Family Practice (Dewitt) Feb-02-Oct-05

Registered Medical Assistant Woodbridge,VA

Triaged patients

Administered Vitals

Performed venipuncture

Administered injections

Handled patient inquires

Performed labs

Notified patients of lab results

Performed initial interview of patients for physicians

Transcribed electronic health records for a large army hospital

Experienced in Internal Medicine, Pediatrics, OBGYN and Front Office

Professional Skills

Seasoned in Microsoft Office and Publisher

Fluent in a wide variety of Electronic Health Record Systems (EPIC) among others

Proven ability to network and drive business

Ability to direct complex projects from concepts to fully operational statuses

Optimistic, goal-oriented, strong leadership abilities, organized, highly motivated, detail-oriented, problem solver

Proven ability to work in unison with staff, volunteers, and board of directors

RELEVANT EXPERIENCE AND ACCOMPLISHMENTS

Successfully obtained a Certified Professional Coder and Certified Professional Medical Auditor

As a Medical Assistant /Billing and Coding Instructor developed and implemented policies and procedures that promoted growth among students.

Volunteer at local chapter meetings by presenting information on various topics that assist coders in receiving CEU’s

Introduced students to fun and effective ways of learning, counseled students on defining career and work-related goals and objectives, formulated and implemented new student orientation manuals, provided students with on the-job training to help them secure positions in the medical field.

In Management and Supervision: Successfully contributed to recruitment and retention of new and existing students, trained students and new employees, managed and developed volunteer functions and fundraisers to benefit the community, and successfully refined and implemented new projects.

Previous short-term experience as a Phlebotomist

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