**** ******* 404-***-****

Court abkkon@r.postjobfree.com

Marietta, GA m

30008

Sherone Fentress, MBA, CPC

Objective Strive to develop a work environment that is

conducive to a satisfying and enriching career, and

maintain a positive interaction with professional

employees.

Experience Nov 2009-Present EDIWatch Incorporation

Alpharetta, GA

Medical Fraudulent Investigator/Data Analyst

Reviewed and examine suspicious claims for patterns

of up-coding, duplicates, duration, unbundling or

potential fraudulent billing from providers.

Created medical rules for a software database

technology system to discover new schemes and

enforce new government mandates.

Researched and analyze providers who have seen the

most patients, or who have been paid the most

within their specialty of procedures within their

area.

Reviewed details of specific transaction claims,

especially in conjunction with patient's history as

to why an irregular claim was valid or not valid.

Oct 2001-Nov 2009 Emory Healthcare Hospital

Atlanta, GA

Neurosurgery, Renal and Liver Renal Transplant

Coder, General Surgery, Internal Medicine Specialty

Coding.

Coded and maintained a working knowledge of CPT

procedural and ICD-9 Diagnosis coding principles,

government regulations protocols, with a third

party Payer requirements regarding, coding and

billing.

Processed managing denial backlogs, resulting in

maximum reimbursement and maintaining, financial

records and assist in monitoring daily revenue

reports..

Abstracted and coded Internal Medicines physicians'

evaluation and management (E&M) documents in an

outpatients services including admissions,

consults, follow up, procedure and diagnostic test.

Oct. 1998-Oct 2001 Wellstar Kennestone Hospital

Marietta, GA

Emergency Room Medical Coder

Responsible for reviewing productivity of 200

emergency room documents, but exceeding over the

amount daily.

Abstracted demographics and coding information

using the 3M-Encoder, and managed reports in a

secure and timely manner.

Educate staff with updated information for ICD-9,

HCPCS Level II, CPT coding documentations.

July 1998-Sept 1998 Metropolitan Hospital

Atlanta, GA

Outpatient Medical Coder

Assigned ICD-9 diagnosis and CPT procedure codes

for diagnosis in an outpatient setting.

Assisted front desk with patient insurance question

and concerns.

Verified all patient demographics, responsible

party and insurance information.

Education May 2009 Ashford University Clinton, Iowa

Masters of Business Administration with a

concentration in Human Resource Management

August 1994 Tennessee State University

Nashville, TN

Bachelor of .Science., Health Information

Management

Skills Certified Professional Coder (CPC), 3M Encoder, MS

Office/Word, Excel, PowerPoint, Access, Outlook

Express, IDX system, 15 years ICD-9, CPT, HCPCS,

Denied Claims Management (DCM) System, Epic Web,

and Healthquest experience, Intelligent

Investigation Technology System (II).

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