Auditor/Coder

Lanette Collins, CPC, CPMA

Woodbridge, Virginia • ***************@*****.*** • 240-***-****

www.linkedin.com/in/lanette-collins-cpc-cpma-87161429

PROFESSIONAL AFFILIATIONS and CERTIFICATIONS

U.S. Government Secret Security Clearance

American Association of Medical Coding Professionals (AAOMCP), Member in good standing

American Academy of Professional Coders (AAPC), Member in good standing

Certified Professional Coder, CPC

Certified Professional Medical Auditor, CPMA

Attended the AAPC Regional Conference in Washington, DC, 2023

Regularly attend local AAPC chapter meetings to remain current with coding changes

EDUCATION

AAPC

Currently enrolled in the AI in Medical Coding and Billing course

Certification Coaching Org (CCO)

Certificate of Completion, Certified Risk Adjustment Coder Course, 2022

Certificate of Completion, Inpatient Medical Coding Course, 2021, 2022

Prince George’s Community College

Associate Degree, General Studies, 2015

RELEVANT SKILLS and TRAINING

CPT ICD-9/10-CM HCPCS

DRG Standards Medical Terminology Anatomy & Physiology

Coding Guidelines HIPAA Policies Modifiers

Coding Payment Policies NCD and LCD Edits NCCI Edits

Documentation Guidelines Medical Chart Reviews Coding Educator

Compliance Fraud/Waste/Abuse Resolution Microsoft Office Suite

EHR and CODING SYSTEM PROFICIENCIES

3M AHLTA Allscripts

CCE Cerner CHCS

EPIC NextGen Optum

Computer Assisted Coding (CAC)

HCC CODING and AUDITING EXPERTISE

HHS Risk Adjustment HIX Risk Adjustment HCC Models

HCC Coding Processes Data Validation Audits (RADV) Data Mining

HEDIS Abstraction Clinical Risk Groups (CRG)

OUTPATIENT CODING and AUDITING EXPERTISE

Ambulatory Patient Visits (APV) Evaluation and Management (E/M) Dental

Emergency Department (ED) Gastroenterology (GI) General Surgery

Injections/Infusions Internal Medicine Nephrology

OB/GYN Orthopedics Otolaryngology (ENT)

Pediatrics Urology

PROFESSIONAL EXPERIENCE

Auditor, Visual Connections, 0/12019-05/2019

Facilitated second-look Risk Adjustment Data Validation (RADV) audits, confirming the completeness and validity of the selected ICD codes mapping to HCC classifications

Initiated audits of random encounters for Centers for Medicare and Medicaid Services (CMS)

Examined records, reports, operating practices, and documentation, confirming compliance with established internal control procedures

Coder II, Fresenius Medical Center, 07/2018-10/2018

Coded and audited medical records for the complete and correct assignment of CPT, ICD, and HCPCS codes, following strict guidelines for Nephrology and dialysis coding

Queried providers to obtain information and patient data to ensure compliant and complete patient documentation and medical records

Investigated and corrected billing edits to ensure clean claim submission, guided by extensive knowledge of Medicaid, Medicare and commercial insurance

HEDIS Reviewer, Equity Staffing, 01/2018-05/2018

Conducted on-site Healthcare Effectiveness and Data Information Set (HEDIS) audits, driving the overall direction, coordination, and implementation of provider medical record reviews for HEDIS and HEDIS-like measures

Completed quality control checks of charts coded by HEDIS abstractors, utilizing expertise in HEDIS Rules of Abstraction to verify data accuracy, document errors, and confirm guideline compliance

Met with provider offices, medical groups, and staff members of other clinical facilities to support team operations with benchmarking and improving quality

Inpatient Auditor, TeAM, Inc., 07/2016-12/2018

Inspected coded charts for Inpatient and Outpatient encounters, confirming the application of the correct DRGs, Evaluation and Management codes, and procedure codes while under contract with the Department of Defense (DOD)

Served as an interim supervisor, directing the team’s daily workflow to achieve optimal production and auditing quality, and providing coder education

Advised providers regarding opportunities for documentation improvement, sharing educational resources to ensure compliance, correct documentation, and maximum reimbursement

Remote HCC Coder, Inovalon, 01/2016-07/2016

Reviewed provider documentation to abstract and confirm all diagnosis codes mapping to Hierarchical Condition Category (HCC) conditions, initiating prospective coding and complete code capture across health assessments on geriatric patients

Performed overreads of previously coded charts and efficiently abstracted unknown HCCs for Medicaid, Medicare (CRG), and commercial insurance (HIX) payors

Maintained quality accuracy rate of 95% and greater while meeting and exceeding production goals

Outpatient Coder, Diamond Solutions Inc., 04/2015-12/2015

Abstracted and applied CPT and ICD codes to medical records for Ambulatory Patient Visits (APV) and Emergency Department (ED) encounters for U.S. Navy Hospital, Okinawa, Japan, adhering to DOD contract requirements

Initiated queries to providers regarding missing and conflicting documentation, obtaining all necessary information for clinical documentation code abstraction

Medical Coder, Complex Care Solutions, 10/2013-04/2015

Retrospective HCC abstraction specific to the geriatric population

Transitioned to Lead Coder

Contract Coder, Maxim Healthcare, 06/2012-11/2013, 2016

Cleared a six-month coding back log in 2 months, allowing for on-time coding and prompt reimbursement going forward

HCC abstraction

Coded Emergency Department encounters assigning all ICD, CPT and HCPCS codes

Contract Remote Coder, Coding IQ, 10/2012-03/2013

Audited new coders and overseas coders on HCC projects for various insurance companies

Contract Remote Coder, KForce 06/2011-09/2013

Coded and audited multiple specialty outpatient clinics for various healthcare systems and facilities

Provided education to providers on a weekly basis

Medical Coder, Altegra Health, 08/2010-09/2012

Audited documentation for HCC/Risk adjustment reviews

Provided feedback to insurance plans

Medical Coder, Wright Solutions Inc., 04/2008-02/2010

DOD contract in which I managed auditing and coding for 3 assigned outpatient clinics

Cleared a 3 month backlog in 7 weeks for Walter Reed Army Medical Center

Identified coding trends and improper documentation

Provided feedback and reports to supervisor and Command. Conducted monthly meeting to my clinics

Assisted in coding other outpatient clinics which included IBWA, and inpatient visits during downtime

Contract Coder, KForce, 07/2007-03/2008

Travel assignment to Kaiser in Colorado conducting outpatient auditing

Managed 6 clinics throughout the state providing education and documentation requirements to staff

Contract Coder, DOD, 06/2006-06/2007

DOD contract. Coded and audited outpatient clinics

Provided reports of coding errors and trends

Medical Coder, Kaiser Permanente, 01/2006-05/2006

Assisted the Tumor Registrar with backlogged claims

Audited OB/GYN clinic encounters

Medical Coder/Biller, Capital Home Health Care, 06/2003-02/2006

Managed “Company 2” accounts with over 500 claim submissions

Setup and established billing protocols

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