HCC Coder auditor
Resume:
BRIDGETTE A. HILL, CPC
Coral Springs, FL 33076
Phone: 813-***-****
Email: ********@*****.***
SUMMARY
Reliable, personable and highly self-motivated Medicare Risk Adjuster Professional with experience in the medical coding and health insurance industry. Demonstrated expertise in providing exceptional accuracy in a production based environment. Energetic and self-confident professional recognized for consistently demonstrating a positive attitude.
AWARDS & RECOGNITION
●ECHO Ambassador Award
●Provider Termination Project appreciation
PROFESSIONAL EXPERIENCE
HUMANA METCARE, Boca Raton, FL. 2014- Present
Medical Coder- MRA
Identify, assess, monitor and document encounter coding information as it pertains to Clinical Condition Categories. Conduct chart audits for accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered and CMS HCC categories. Support and participate in process/quality improvement initiatives. Provide MRA guidance through provider education and individual trainings.
HUMANA, Tampa, FL 2012 – 2014
Clinical Correspondence Review Rep
Directly responsible for researching provider appeals correspondence for identification of coding and claim processing errors. Resolve provider claim inquiries by in-depth understanding of clinical condition categories and investigational skills. Make independent determinations based on research, contract language, benefit interpretation, CMS guidelines, in/out patient pricing systems, and Medicare fee schedule. Maintain above team standard 99% claims processing quality performance as well 100% financial accuracy within a monthly review period. Create clear and concise business communications that explain Humana’s review determination requiring strong written and verbal communication skills
*Served as member of the celebration committee promoting several associate building engagement activities.
*Coordinated and maintain weekly team building email to promote team engagement.
HUMANA, Tampa, FL 2008 – 2012
Medicare Customer Service
Directly responsible for resolving inquiries/ concerns and providing educational guidance, interpretation of claims processing errors, and account billing investigations. Maintain top quality performance adherence to business needs while providing accurate and reliable information in a high stress time sensitive environment. Daily navigation of up to 12 system tools simultaneously such as: custom company software, excel spreadsheets, Microsoft word & outlook documents, along with many other tools. Utilize strong awareness of various Medical terminology, HIPAA policy guidelines, HCPCS, I-CD9, CPT coding, (HCFA) CMS-1500, and UB04 forms.
*Took initiative to create and facilitate a refresher course for newly hired and senior associates.
*Served as a Subject Matter Expert offering support to over 60 associates.
MEDASSURANT, Miami, FL 2008 – 2008
Field-Based Data Research Representative
Perform chart abstractions of medical records and other associated medical-field materials at various care providers sites / facilities. Maintain accuracy in abstraction of data for purposes of provider site review, chart keeping standard reviews, HEDIS hybrid chart, Medicare risk adjustment, etc. Recognition and research of HCPCS, I-CD9, CPT coding.
UNITED HEALTHCARE Tampa, FL 2006 – 2008
Member Services/ CSR
Answered inbound calls in support of Medicare plan holder needs which includes: benefit confirmation & eligibilities, handling claims inquires/ issues, advise on procedure for pre-certification/referral, assist with pharmacy troubleshooting, enrollment and disenrollment procedures Conducted the navigation of several work-related customized software programs simultaneously, while adhering to HIPPA guidelines. Deciphered HCPCS, I-CD9, CPT coding, analyzed claims errors routing inappropriate claims for review and processing. Maintain adherence to schedule and performance guidelines and goals.
*Chosen to be up trained to handle bail out support for high dollar Key Account department.
EDUCATION
ICD-10 Proficient Certified, AAPC, 2014
Certified Professional Coder, AAPC, Tampa, FL 2013
Health Sciences courses, University of South Florida, Tampa, FL 2003- 2005
PROFESSIONAL DEVELOPMENT
Multiple Humana Online Courses:
Business Code of Conduct and Ethics
Ethics & Compliance - Risk Management
Information Security
CIS PRO for Medicare
CMS Complaint Handling
Medicare Prospective Payment System Rate File Consolidation
CMS Case Tracking System
TECHNICAL SKILLS
Proficient in MS Word, Excel, PowerPoint, Outlook
CAS, CCP, CI, CISpro
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