Certified Professional Coder, Auditor, Abstractor

YOLUNDA SCOTT, CPC

P.O. Box ******, Lawrenceville, GA 30042-5911, 678-***-****, ********@*****.***

MEDICAL OFFICE SKILLS:

HCC Coding/HEDIS HIPAA, OSHA, JCHAO Regulations

Abstraction/Inpatient & Outpatient Charge/Payment Posting

Coding CPT-4/ ICD-9-CM/ICD-10-CM/

Government & Third-Party Payers HCPCS/DRGs

(TRICARE, Medicare & Medicaid) Quality Assurance, Risk Adjustment,

Insurance Verification Data Management, Abstraction,

Managed Care (HMO, PPO & POS) Auditing, Compliance, Health

Insurance Claims Administration

EHR/EMR

Worker’s Compensation Policies and

Procedures

CERTIFICATION:

American Academy of Professional Coders – Salt Lake City, UT

12/2011

Certified Professional Coder

EDUCATION:

Ultimate Medical Academy – Tampa, FL

Diploma in Medical Billing & Coding (June 2010 – 3.75 GPA)/Associate of Science in Medical

Billing & Coding (April 2014) – 3.9 GPA

Included applying CPT-4, ICD-9, and HCPCS diagnosis and coding procedures; ensuring forms

have the information needed for reimbursement; abstracting, auditing, processing medical

records and healthcare claims

EXPERIENCE:

Altegra Health-Alpharetta, GA 02/2015 –

Remote Clinical Reader

• Abstracts pertinent information from patient medical records; assigns appropriate ICD-

9-CM codes, creating HCC and/or RxHCC group assignments as applicable.

Assigns Outcomes flagged event codes when documentation in the record is

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inadequate, ambiguous, or otherwise unclear for medical coding purposes.

Remains current on medical coding guidelines and reimbursement reporting

•

requirements.

Complies with the Standards of Ethical Coding as set forth by the American Health

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Information Management Association and adheres to official coding guidelines; complies

with HIPAA laws and regulations; participates in testing and training as required by the

company

Wave Code Logix-Dalton, GA 08/2014 –

01/2015

Remote HCC Coder (Contract)

• Abstracted medical records on client’s members to assign/validate ICD-9 codes for HCC

(Hierarchical Conditional Categories) reporting supported by correct medical record

documentation

and reported in accordance with CMS payment guidelines using ERICOM/Chart Assistant

• Helped acclimate new coding recruits; completed audit summary worksheet that

includes all discrepancies and results with feedback for educational purposes;

documents audit results, actions, and outcomes in accordance with ICD-9 and Medicare

Risk Adjustment Payment System guidelines

Functioned as a member of a self-directed team to meet specific individual metrics

w/ability to effectively

communicate verbally and in writing

WellPoint, Inc.-Atlanta, GA

01/2014-05/2014

HEDIS Abstractor/CPC (Contract)

• Involved abstraction, auditing (overreads), quality assurance, data management, and

compliance of medical charts; utilized critical thinking skills/excellent skill set to conduct

research in a thoughtful and methodical search in order to locate specific claim

information; detected fraudulent/risk-filled activity

• Worked with the HEDIS team to collect member records, conducted reviews of these

records by contacting providers, and placed the results collected into a specific data

base;

• Developed and shared strategies to accomplish goals; based on WellPoint specific

platforms performed deep-dive research using immunization registries, local claims

system membership, and defaulted claim information

Aon e-Solutions-Atlanta, GA 08/12-

10/13

Workman’s Compensation Bill Review Analyst (Direct Hire)

• Utilized MS Word/Outlook, processed medical bills in accordance with the appropriate

jurisdiction’s workers’ compensation medical fee guidelines, contracted PPO discount

and/or special client instructions, ensuring the completion of the data entry process of

medical bills while identifying fraudulent/risk-filled activity

Utilized CPT-4, ICD-9-CM, and HCPCS coding knowledge to ensure correctness of codes

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used; ensured system data accurately reflected submitted billing information and made

any necessary corrections as needed while responding quickly and thoroughly to

questions and concerns while maintaining confidentiality and safeguarding proprietary

company information

Chatham Orthopaedic Associates – Savannah, GA

03/12-05/12

Specialty Medical Biller (Contract)

• Employed CPT-4, ICD-9 CM, and HCPCS manuals to ensure correct coding of procedures

and diagnoses and follow up on unpaid claims (denials, appeals)/identified and billed

secondary or tertiary insurances/accounts were reviewed for insurance or patient

follow-up to resolution; detected fraudulent/risk-filled activity

• Processed and adjusted health insurance claims/checked each insurance payments for

accuracy and compliance with contract discount/called insurance companies regarding

any discrepancies in payments or non-payments

• Answered all patient and insurance telephonic or faxed inquiries pertaining to assigned

accounts/correctly provided detailed documentation in each patient’s account

MHUP Central Business Office – Savannah, GA

08/10-05/11

Physician’s Biller II (Contract to Direct Hire)

• Processed and adjusted health insurance claims; performed billing and collections/

posted payments from patients and insurance carriers/set-up patient payment

plans/utilized advanced medical terminology, CPT-4, ICD-9 CM, and HCPCS coding to

accurately manage claims/medical records filing; performed clerical duties

• Resolutely performed outgoing calls to insurance companies and patients while

productively responded to incoming calls regarding claims statuses and payments;

researched/gathered necessary information to generate refund entitlements

Enterprise Consulting Solutions, Inc. (ECS) – Phoenix, AZ

07/10-Present

Site Reviewer (PRN basis)

• Schedule appointments and collaborate with Medical Office Managers to conduct

credentialing reviews

• Ensure physician’s offices, hospitals, and acute care clinics maintain compliance with

state and federal regulations while utilizing advanced medical terminology,CPT-4,ICD-9-

CM,and HCPCS coding to ensure

accurate documentation

Care Core National, LLC. – Bluffton, SC 04/07-

01/10

Onsite/Remote CDS Representative (Direct Hire)

• Constructively and pleasantly interacted with physicians, office staff, and UHC members

to establish medical necessity for the purpose of performing costly radiological

procedures

• Utilized medical terminology, CPT-4 (Radiology), and ICD-9 coding and data

management systems to keep accurate documentation and facilitate radiologic

procedures

J&M Transcription Services – Hartsville, SC 02/05-

05/07

Remote Medical Transcriptionist (Direct Hire)

• Utilized advanced medical terminology and knowledge of CPT-4, ICD-9 CM, HCPCS

coding to accurately transcribe MD’s dictations including medical specialties, histories,

examinations, and diagnostics

• Worked with family practices, internal medicine, pediatric care, sports medicine, rehab,

and orthopedics

PGBA, LLC. – Florence, SC 05/95-08/06

Tricare/CHAMPUS/Blue Cross Blue Shield of South Carolina

Remote Health Claims Associate II (Direct Hire)

• Processed and adjusted health insurance claims; was responsible for detection of

fraudulent/risk-filled activity (abuse cases) and escalated such situations to the

appropriate department(s) for resolution

• Utilized advanced medical terminology, CPT-4 (E & M, Neurology, Anesthesia, Surgery,

Radiology, Pathology and Laboratory, and Medicine), HCPCS, and ICD-9 CM coding

manuals to verify that all claims were coded and keyed correctly, if not claims were

then coded correctly;

• Involved questioning and verifying the coding of claims subsequently generating letters

to MDOs, hospitals, and other insurance carriers requesting information to prove claim

accuracy to ensure proper reimbursement to the provider; utilized DEERS to access

military member information

QUALIFICATIONS:

• Strong background in Coding (including abstracting and auditing), Billing, Claims

Management, Transcription, and Clinical Support

• Front and back office skills possessing a thorough knowledge of modern clinical

practices and procedures with the ability to identify and address customer needs;

capable of prioritizing workloads to meet deadlines

• Computer savvy and familiar with many systems and applications such as DEERS,

AMISYS, Allscripts PMS, EPIC, NextGen, 3M Encoding, Cerner, Navicure, SRS Hybrid,

Kareo, Practice Fusion, Misys Tiger, MS Office Suite, ACM, McKesson, Horizon Patient

Folder, Horizon Practice Plus, MEDITECH, MediSoft, Macess, FACETS, Centricity,

ClaimFACTS

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