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Risk Adjustment & Quality Auditor

Tacoma, WA
November 23, 2018

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Jessica Smith

Risk Adjustment & Quality Auditor

**** * ******* **

Tacoma, WA 98409

(205) 335 - 3089


• AAPC Certified Professional Coder (CPC) - Five years coding experience (Risk-Adjustment HCC)

• AAPC ID #: 01382740

• Certified Patient Account Representative (CPAR)

• Skilled in quality analysis such as HEDIS measures

• Knowledgeable in HIPAA Regulations, Medicare/Medicaid, medical office billing, and medical terminology proficient

• Experience in basic computer programs (Power Point, Microsoft Word, Excel, & Outlook)

• Experience in EZ-CAP, EPIC, Medconnect, and other Electronic/EMR software

• ICD-10, CPT, and HCPCS Level II Code Set Proficient

• 60 wpm


Virginia College Birmingham, Alabama

Diploma – Healthcare Reimbursement

Graduation Date: March 27, 2015

President's List (December 2013 - March 2015)

University of Alabama

Pre-Med Psychology (2011-2012)

Cumulative GPA: 3.4


My strong efforts as the only risk adjustment coder within my current employer (HMSO) has led to over one million dollars in HCC recapture revenue for the year 2017 and recorded as the company’s “best year ever.” An overall 1.000 RAF score was also achieved by:

• Recapturing ICD-10 HCC diagnosis codes missed by providers

• Carefully reviewing providers’ documentation for discrepancies

• Educating providers on capturing all chronic conditions at least once per calendar year

(Comprehensive Physical Exam)

My additional efforts in coding and documentation education has led to an increased recapture rate of vascular diseases from all network providers:

• Visited every network provider for education beginning June 2018. By July 2018, there was a 1.2% increase on HCC 108 prevalence. The following month, August 2018, an additional increase 1.5% for HCC 108 prevalence.


Highline Medical Services Organization (HMSO) - remote work 80% of the week Seatac, WA

August 2015 – Current

Medicare Risk-Adjustment Auditor (MRA)/ Quality Coding Specialist

• Analyzes medical record documentation for accurate coding of diagnostic and procedural information in accordance to national coding guidelines & appropriate reimbursement requirements.

• Assigns accurate primary and secondary codes as well as Hierarchical Condition Category

(HCC) codes.

• Educates network providers on accurate medical documentation for quality and auditing purposes.

• Provides educational coding materials during presentations as well on request to in-network clinics.

• Reviews & audits network provider charts to ensure accurate HCC codes are captured along with feedback/corrections

• Consults with network providers in regards to any inaccurate record information and clinical coding questions for CPT/ICD10

• Collaborates with HMSO team for the development of educational tools/processes for seminars.

• Maintains and helps disseminate up-to-date knowledge of legal/regulatory information including all ICD-10-CM, CPT-4, HCPCS, and DRG changes.

• Assures compliance for all assigned records with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards.

• Manages and extracts HEDIS Quality measures including Adult BMI Assessment, Colorectal Cancer Screening, Breast Cancer Screening, Controlling High Blood Pressure, Statin Therapy, Comprehensive Diabetes Care (HbA1c, Eye Exam, Blood Sugar, etc), DMARD for RA, and Osteoporosis Management

• Audits Rainier Health Network’s charts for quality as a part of the Medicare Shared Savings Program (MSSP)

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