SHVONICA SMITH, CPC, CRT

**** *** ***, ************, ** 32208

904-***-****/ad2u8g@r.postjobfree.com

PROFESSIONAL EXPERIENCE

AQUITY SOLUTIONS Sep. 2015 – Present

Auditor/ Provider Educator for HCC

Assigned to MHC facilities over 3 different locations

Audit and Code charts including HEDIS, HCC DX, and HCC Complete Code Capture, Emergency Room, ENT, Reoccurring accounts

Work with Medicare and Medicaid accounts

Work with up to 15+ providers educating them through powerpoints, webex, phone calls, and email

Answering coding questions from providers and other coders also provide feedback on audit results

Maintain a spreadsheet for documentation corrections and errors.

Educate doctors and providers on any missing DOD, Medicare, Comm. Guidelines and train new coders

Review medical reports and encounters to assign CPT-4, ICD-10, HCPCS and modifiers based on payer

Efficient in systems including EPIC and Citrix

ADDISON GROUP Mar. 2021 – Feb. 2022

HCC Auditor (Contract)

Assigned to Centuari

Audit and Code Risk Adjustment charts including Commercial, Medicare, IVA, and RADV

Perform audits of coded medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation

Provide formal report(s) on audit findings and conduct education to internal and external coders based upon those findings

Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes

Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations

Consistently maintain a minimum 95% accuracy rate on audits by coding leadership

Meet minimum productivity requirements as outlined by the project terms

Performs other related duties as required or assigned

UNIVERSAL CODING SOLUTIONS Feb. 2013 – Sep. 2015

Remote HCC Reviewer and Provider Educator (Contract)

Assigned to Providence Hospital 408 bed Level 2 Trauma Facility

Provide Education, Audit, and Code charts including HCC Complete Code Capture, HCCDX, Emergency Room, and Hospitalist accounts

Maintained a working knowledge of ICD-10-CM and CPT coding principles, governmental regulations, official coding guidelines, and third party requirements regarding documentation and billing.

Work with Medicare and Medicaid accounts

Worked the review queue on a daily basis to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary

Provide audit feedback to the coders and physicians on a daily basis

Educating the providers and coders on the correct guidelines and codes

Work with up to 15+ providers educating them through powerpoints, webex, phone calls, and email

Assured that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes.

When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards

Efficient in systems including EPIC, Athena, Citrix

OUTCOMES HEALTH SOLUTIONS Nov. 2011 – Nov. 2015

Remote Hedis Field Reviewer/ HCC Auditor (Contract)

Assigned to multiple different facilities

Audit and Code charts including HEDIS, HCC DX, and HCC Complete Code Capture

Educate and provide feedback to the physicians and other coders regarding the correct guidelines and correct codes

Work with Medicare and Medicaid accounts

Classified diseases and conditions across all body systems

Identified the components of Risk Adjustment Methodology

Applied ICD-9-CM Official Guidelines for Coding & Reporting

Utilized clinical knowledge to assign diagnostic codes from patient’s medical record

Applied 2011OHIS-specific coding policies and procedures

Efficient in systems including Optum 360

PRESBYTERIAN MEDICAL SERVICES Apr. 2010 – Mar. 2011

Remote Coder

Code charts mainly focusing on Podiatry

Consistently and accurately assign the CPT-4 & ICD-10, tracker codes to each chart.

After training, applied preceding procedures to a minimum of 25 charts per hour.

Met routine deadlines and work timely & accurate completion of projects.

Applied accurate client manual information to daily assignments.

Supported & comply with company policies, business ethics and conduct.

ORLANDO MEDICAL REGIONAL HOSPITAL, Orlando Jan. 2008 – Mar. 2010

Medical Home/Onsite Coder

Ensured compliance through audit and research and provided quality monitoring for data integrity

Coded Nuclear Medicine reports for 7 radiologists for Oncology, using ICD-10 & CPT-4

Abstracted medical information from EMR

Worked with the AR personnel for feedback concerning insurances denials

MAYO HOSPITAL, Jacksonville Jan. 2006 – Dec. 2007

Coding Specialist

Audited medical denials before insurance payments.

Researched medical claims to determine correct diagnosis and procedures.

Performed coding and related duties using established coding policies in a timely manner.

Maintained a production rate of 150 claims/day & accuracy of 95%.

Identified opportunities to reduce denials and enhance revenue.

MedPro, Win XP, UNIX.

NAVAL HOSPITAL OF JACKSONVILLE Jul. 2005 – Dec. 2005

Coding Specialist

Surgical Coding & answering coding questions from providers.

Coded for 3 clinics General Surgery, Ophthalmology, ENT.

Maintained a spreadsheet for documentation corrections and errors.

Educated doctors on any missing DOD guidelines.

Reviewed medical reports and encounters to assign CPT-4, ICD-10, HCPCS and modifiers based on payer.

DOD software, Win2K.

NEMOURS Jun. 2004 – Jun. 2005

Medical Records Reviewer/Coder Analyst

Audited Evaluation and Management for different specialties.

Reviewed any existing problems before billing for each encounter.

Involved in developing mapping document indicating the source tables, transformation required, business rules, and target table’s columns and data types.

Demonstrate a commitment to integrating coding compliance standards into daily coding routines.

Identify, correct and report coding problems

Weblogic, Windows, UNIX.

PER-SE TECHNOLOGIES/MCKESSON Jan. 2002 – Feb. 2005

Coder/Team Leader

Supervised over 50 ER dept. coders.

Maintained monthly quality assurance reports.

ER coding and billing, HIPPA training, verified insurances, accounts.

Reviewed and released medical claims to be billed.

Verified doctors signatures, work unsupervised at home, coded 224 charts/day.

Quantim Pro, Windows, UNIX.

EDUCATION

RIVER GARDEN TRAINING CENTER

NORTH FLORIDA INSTITUTE OF FLORIDA

CONCORDE INSTITUTE

ADDITIONAL INFORMATION

Technical Expertise: CHCSII or Ahlta Software, QUANTIM/ENCODER, 3M Software, Medical Manager, Win9x/NY/2K/XP

CERTIFICATIONS

Associate Science Degree

Certified Professional Coder & Home Health Aide

Certified Respiratory Technician

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