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CPC, Broussard Melissa

Melissa Broussard, MBA, CPC

Houston, TX 77053

-c.346-***-**** or 409-***-****-

ad2l4z@r.postjobfree.com

C A R E E R O B J E C T I V E

Seeking a Healthcare Executive and or Leadership role in Clinical Administration: Nursing, Coding, Billing, Compliance, and or Health Information Management.

E D U C A T I O N

• Lean Six Sigma Black Belt, (LSSBB) San Jacinto College, Pasadena, TX (Graduated 2013)

• Project Management Certification, (PMP) Kaplan University-Chicago, IL (Graduated 2013)

• Microsoft Office Specialist (MOS) Houston Community College, Houston, Texas (Graduated 2012)

• Master Business Administration (MBA) Letourneau University – Houston, Texas (Graduated 2010)

• Bachelor Business Administration (BBA) Letourneau University, Houston, Texas (Graduated 2008)

• Associated Applied Science (AAS) Houston Community College, Houston, Texas (Graduated 2005)

• Certified Professional Coding (CPC) AAPC, Houston, Texas AAPC # 00087778- Certification 2004

• Practical Nursing (PN) (LVN) Louisiana State University @ Teche Area Campus, New Iberia, La (Graduated 1991)

MEDICAL CODING AND BILLING CERTIFICATION –

• Nationally Registered Certified Medical Assistant, (NRCMA) The College of Healthcare Profession, Houston, TX /Certification #204810, October 2021-October 2024

• Certified Professional Coding (CPC) AAPC, Houston, Texas AAPC # 00087778, September 2024 CODING COSULTANT (PROFEE, HCC, REIMBURSMENT, CONTRACT MANAGMENT)

Precise Home Health Agency – January 2011—PRN

DJR-Rehabilitation and Mental Health Clinic-January 2022-PRN C O R E C O M P E T E N C I E S

• 25 years of Healthcare Director

/Administrators /Management

• Inpatient/Outpatient Revenue

Cycle Management

• ICD-10-CM/CPT/HCPCS/Risk

Adjustment HCC

• Communication Skills.

• Clinical Auditing Documentation

Improvement Specialist

• Claims & Denial Specialist

• Healthcare Curriculum Training &

Development Specialist

• Insurance Verification

• Informatics/Project Management

• Excellent decision Maker and

critical thinking skills

• Ability to work independently

and in a remote team

environment.

• Conflict Resolution.

• Medical Coding Educator

• Abstracting applications and

EMR platform experience

• Multiple Specialty

Experience

• Appointment

Scheduling

• HIPAA, CPR & OSHA

• Team Building and

Delegation

• Epic/OncoEMR,

Optum, Microsoft

Office Suite

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CPC, Broussard Melissa

P R O F E S S I O N A L E X P E R I E N C E

Advanced Diagnostics Healthcare System / Billing and Coding Specialist August 2023-Current

• Assigning Codes based upon HRA questionnaire (health risk assessment), SDOH questionnaire (social determinants of health), CPT II codes (Hedis measures), and codes for vaccination.

• Maintains current knowledge of the basic and major medical, behavioral health, and prescription coverage plans.

• Maintains current knowledge associated with the billing methodologies of each plan.

• Performs insurance coverage and grant eligibility verifications by making field calls or using other verification tools.

• Compiles billing data from electronic health record system, practice management systems, and other databases.

• Utilizes the encoder or coding books to correctly assign all ICD-10-CM, ICD-10-PCS, and CPT codes for diagnosis and procedures.

• Sequences diagnosis and procedures to generate appropriate ICD-10-CM, CPT, PCS, and DRG codes for billing.

• Queries physicians to obtain clarification or missing elements in the record to be sure of correct coding.

• Utilizes other available resources for assignment of codes as necessary (e.g., Athena, Epic, MIQS, Cardio IMS, Logician, and coding reference materials).

• Demonstrates the ability to interact with others in a way that gives them confidence in one's intentions and those of the organization.

• Completes abstracts for records when appropriate. Checks discharge disposition and attending physician for correctness.

• Provides ICD-10 and CPT codes for Business Services and physician office requests regarding non-billed or non-reimbursed claims.

• Answers inquiries from outpatient clinics and ancillary departments for appropriate assignment of ICD-9- CM and CPT codes.

• Reviews coding denials to ensure coding is accurate per provider documentation. R.A.M. Healthcare LLC. / HIM Contract Coder May 2023-July 2023

• Review/abstract HCC codes to ensure they are coded accurately, to the highest specificity possible, and make sure the required M.E.A.T. is documented, resulting in the correct CMS-HCC risk score.

• Work all Medicare Annual wellness Visit (100% review) to ensure the correct code is being billed, including adding appropriate codes for chronic Condition Review, and or E&M/Procedure codes.

• Code the Fee for Service Profee encounters.

• Perform 100% chart review of assigned providers, including CPT/HCPS Codes (this also includes procedures, medications, vaccines, etc.), diagnosis, Place of Services, Providers (service and billing), Date of Services, provide feedback to providers when the level of service is not supported, or documentation is unclear.

• E/M leveling with appropriate modifiers if necessary (Evaluation & Management CPT codes).

• Sequencing diagnosis codes (note required with HCC). 3 P a g e

CPC, Broussard Melissa

Houston Community College System/ Adjunct Professor-Healthcare & Business Technology Professor/ February 2011-May 2023

• Part-time Online Adjunct Business Technology Professor in the program of Medicaid Coding & Billing Certified Professional Coder

• Train and Educate Current Students in Healthcare, Insurance, Billing, Coding, Computer Applications (MOS).

• Certification

• Researched benefit options for claims payment.

• Canvas LMS Certified Instructor. Remote Online Instructor, facilitating student in the courses: Medical Terminology, Medical Coding I Basic, and Medical Documentation Coding I & II –manage and update online courses, via virtual web training, white board, and interactively to meet the educational needs of the student success.

• Computer Application and Keyboarding online software for Microsoft Office 2010, hands-on, self-paced, online, and individualized instructional course.

• Communicate with students daily through Lab or Lectures.

• Deliver hands on training through MS Office 2020, computer hardware, various software applications, and procedures with practical overview of computer.

• Apply coding conventions when assigning diagnoses and procedure codes Identify the information in appendices of the CPT® manual.

• Explain the determination of the levels of E/M Procedures Codes in a Multi-Specialty variety of patient services using CPT®, ICD-10-CM, and HCPCS Level II code. Oncology Consultant/Coding & Compliance Educator July 2022-May 2023

• Plan, organize, monitor, and control all phone calls timely, conducting educational meetings, and providing excellent customer service to internal and external customers.

• Reviews and research billed unlisted procedure codes to determine if a more specific code exists and should be used.

• Develop and maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies as necessary or required.

• Effectively communicates with providers and staff to clarify diagnoses, procedure coding and documentation requirements.

• Create and deliver effective educational teaching meetings with providers and staff to improve coding and billing practices.

• Quality reviews assigned ICD-10-CM codes, which most accurately describe each documented diagnosis and/ or procedure according to established ICD-10-CM and CPT coding guidelines along with modifier usage and medical terminology.

• Monitor and tracks coding issues and reviews coding inaccuracies to highlight areas of improvement. Reports or resolves escalated issues, as necessary.

• Develop and presents comprehensive medical records documentation audit review to assure the presence of all component parts including patient and record identification signatures, dates where required, and other necessary data in the presence of all reports which are indicated by the nature of the treatment rendered.

• Monitors, audits, and reconciles all documents required for data entry, returns incomplete or questionable documents to generating location or provider.

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• Provides a prominent level of technical education and serves as a subject matter specialist regarding coding and documentation.

• Supports and educates team members about coding best practices and procedures to meet compliance and regulatory requirements.

• Reviews assigned payment denials, underpayments, and payment take backs for appropriateness and guides resolution by resubmission to the insurance carrier, patient billing, or appropriate adjustment.

• Collaborates with interdepartmental or cross-functional teams for assigned projects and provides departments with coding issues and updates to be shared with providers to ensure timely and accurate claim payment.

• Utilizes audit results to provide data-driven feedback to providers and management to improve coding accuracy and identify opportunities for improvement and re-training.

• Complies with organizational policies and procedures. The College of Healthcare Profession-Program Instructor Medical Coding & Billing July 2021-July 2022

• Full-time blended instructor providing a competency-based curriculum aligned with the CHCP model/style of the organization system delivery.

• Deliver excellent students learning-centered instruction by establishing an online blended and classroom environment conducive to learning and student involvement as well as effectively planning and preparing for classes and student success.

• Designed deliver excellent classroom instruction for a blended course setting through development of instructional plan to meet course competencies, the development of activities, which support lesson objectives and deliver the instruction as approved.

• Communicate weekly feedback to students, taking exceptional care to provide comprehensive feedback at the conclusion of the midterm mark, providing struggling students with opportunities to improve.

• Manage the learning environment through keeping accurate records, taking attendance, submitting grades and other.

• Create a comprehensive learning environment, geared toward training students to complete medical billing forms, filling medical claims accurately to meet up to a 98% accuracy rate.

• Provide a clear curriculum instructional path in various settings both manually and by automation using a virtual stimulation in a practical application of CPT-4, ICD-10, and HCPCS codes utilizing a steady self-paced.

• Attend Program Advisory Committee meetings once a year for the area of expertise. Montgomery Healthcare Billing- PRN Certified Profession Biller & Coder/Compliance Auditor March 2022-June 2022

• Prepare and submit billing data and medical claims to insurance companies.

• Ensure the patient’s medical information is accurate and up to date.

• Prepare bills and invoices, and document amounts due to medical procedures and services.

• Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.

• Researches and analyzes data needs for reimbursement.

• Analyzes medical records and identifies documentation deficiencies.

• Serves as resource and subject matter expert to other coding staff.

• Reviews and verifies documentation that supports diagnoses, procedures, and treatment results.

• Identifies diagnostic and procedural information.

• Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.

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• Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.

• Educator coding consultant to care providers.

• Identifies discrepancies, potential quality of care, and billing issues.

• Researches, analyzes, recommends, and facilitates plans of action to correct discrepancies and prevent future coding errors.

• Identifies reportable elements, complications, and other procedures.

• Serves as resource and subject matter expert to other coding staff.

• Assists lead or supervisor in orienting, training, and mentoring staff.

• Provides ongoing training to staff as needed.

TEXAS CHILDREN HEALTH PLAN –Certified Professional Coder/Provider Reimbursement June 2006-April 2020

• Monitor TMHP, HHSC, CMS, and TCHP Website for updates and changes concerning the Hospitals and FQHC/RHC encounter rates and Facility reimbursement rates.

• Develop and create a Change Forms and submit a provider letter with the TMHP reimbursement changes, to ensure accuracy of provider's contract rates.

• Audit Hospital Contracts to ensure that hospital contracts are loaded in accordance with the contract terms by conducting a full audit of all hospital contracts and all lines of business and reporting any discrepancy findings.

• Developed an Audit SOP, criteria and template for department policies and procedures.

• Confirm that provider contracts and fee schedule changes are submitted within 14 days of receipt.

• Attest that provider contracts are loaded with an accuracy rate of 95%

• Document contract pricing methodologies by creating tools including a hospital pricing matrix to use a departmental training tool. The tool should include high volume reductions and enhancements, UHRIP, PPC/PPR, etc.

• Develop and execute a personal training plan in collaboration with manager to include training in QNXT, Epic Tapestry, hospital pricing methodologies, contract language, FQHC/RHC pricing and other topics necessary to provide contract reimbursement interpretation.

• Acts as an internal and external liaison for TCHP to resolve managed care issues, contract implementation, contract interpretation, and maintaining positive relationships with providers and primary HMOs through understanding territory demographics and health service needs.

• Develop project plans for team projects and assignments and serve as team leader for various special projects.

• Assigns ICD-10-CM, ICD-10-PCS, and/or CPT codes.

• Reviews and interprets physician documentation to appropriately assign diagnosis and procedure codes.

• Completes abstracts for records as appropriate.

• Provides ICD-10 and CPT codes for Business Services and physician office requests regarding non-billed or non-reimbursed claims.

• Reviews charts for completeness

• Facilitates coding education sessions (webinars, audio conferences, seminars, lunch and learn, newsletters) by researching and presenting topics assigned by manager each month.

• Resolves coding and compliance issues to ensure physician documentation criteria are in compliance with State and Federal regulations and guidelines.

• Maintains concurrent coding for inpatient and outpatient records.

Contact this candidate