Tameisha Brunson CPC,CCS,CRC

**** *. ******* **

Phone: 708-***-****

Charlotte, NC 28273

E-mail: adg6yu@r.postjobfree.com

Experienced Coder, Auditor, and trainer with a strong coding background. ICD-10CM/PCS Proficent. Advanced skills in several EMR/EHR systems including; Epic, Meditech, Centricity, Cerner, 3M

Education

B.S, Health Administration (2012) University of Phoenix

Professional Experience

Senior Auditor (ED, Pro fee, Auditing, Risk Adjustment- HCC, E/M, Inpatient,Outpatient) Aug 2017 – current

Gorman Health Group

Performs concurrent ICD- 10 and CPT (including E/M) coding analysis of professional charges

Accurately abstracts from operative reports and physician’s daily activity logs

Provides written explanations to support or rebut audit recommendations

Resource educator to providers for medical record documentation

Perform special studies per audits, conducting office site visits

Develop and manage process improvement initiatives

Conduct, collect and analyze information and data from office site and/or medical record reviews

Improve the proper documentation and coding for members, to properly assign ICD10-CM codes to chronic conditions

Risk Adjustment auditing (Commercial and Medicare)

Profee, Inpatient, Outpatient hospital, Physician coding/DRG Auditing

Monitor changes, corrections and clarifications in applicable regulatory/accrediting body requirements

Conduct retrospective, concurrent, and prospective, semi-annual and annual audits, identify gaps and communicate results

Conduct continuing education to providers on STARS, HEDIS, and HCC Coding

Clinical Quality Auditor (Medicare and Commercial) (Aug 2015 – Feb 2017)

United Health Group

Performs clinical coding quality assurance review of medical record documentation to ensure the proper capture of CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement activities

Full Code Capture

Auditing and analyzing data collected conceived to provide solutions and recommendations

Provide adequate feedback for performance improvement

HEDIS Strategic record Abstraction (CDC, SPD, APP) Measures

Supplies correct CPT code on all procedures and performed services

Properly code professional services for hospital based procedural services

Conducts chart reviews of Optum Medical Network members - accomplished by traveling to the individual practices and performing the audit onsite

Coding of physician documentation for the purposes of risk adjustment utilizing the current Coding guidelines

Perform coding reviews and fulfills associated processes/documentation for CMS coding audits as required, e.g., Risk Adjustment Data Validation (RADV) audits

Outpatient facility, Profee, E/M, Ambulatory, General Surgery

Knowledge of STARS, NCQA, & TQM

Medical Billing/ Coding & Compliance Manager (Mar 2010 – Apr 2015)

VERUS Practice (Advocate Lutheran General Hospital/ Edwards Hospital) Outpatient Pro-fee, ED, HCC (multi-specialties)

Lead and manage billing and coding staff

Maintaining a comprehensive knowledge of contemporary health records

Outpatient Pro-fee/ Facility coding and Auditing

Establish policies and procedures related to coding functions

QA Auditing- referencing Coding Clinics and Guidelines

Provide coding support, education and training related to quality of documentation, level of service and diagnosis coding

Provider education on guidelines

Prepare revenue performance reports

Manage the coding staff by monitoring the functional area, providing guidance and leadership, developing methods of improvement, assure the work schedules are maintained and that productivity requirements are met

Education and Training – On-boarding new staff

Participate in the recruitment, interviewing, selection and orientation process of new employees

Facilitate coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs

Specialties: Surgery, Profee, E/M, Acute care, Ambulatory, HCC, Outpatient facility, ED

OB-GYN, Urology, Podiatry, General Practice, Behavioral Health

HEDIS Abstraction (CDC, BMI)

Full cycle billing using EMR systems (cash posting, Insurance follow-up, Insurance verification, Credentialing verification, Pre-Authorization, Denials, CCI & OCE edits)

E/M Coding Compliance Auditor Anthem (Aug 2012 – Aug 2013)

Emdeon

E/M Coding auditor

Reviewing medical charts to ensure coding guidelines are met

Providing rebuttal feedback to providers based on findings

Follow Coding clinics/guidelines

Educating providers and office staff coding guidelines

Ensure the maintenance of high-quality coding in order to comply with national standards

Fraud/Abuse training

Medical Billing and Coding Instructor (Oct 2007- Mar 2010)

Pinnacle Career Institute

Instructed the following online medical billing/coding modules:

Anatomy and Physiology

Medical Terminology/Medical Billing Coding

Health Insurance and Reimbursement

Medical coding (CPT, ICD-9 CM, HCPCS)

Facilitated communication with students via email, phone, or chat session

Prepared students for AAPC examination (CPC)

Instructed students on proper coding techniques using ICD-9 CM, CPT, and HCPCS manuals

Blackboard software for online classroom curriculum

Schedule and moderate small group online chat sessions as specified in the Faculty Handbook

Respond to student questions, interacting with the Lead Instructor or Program Director (academic issues) or Program Manager (administrative issues) on behalf of students where necessary.

Monitor and track student participation in the course, alerting the Program Director, Lead Instructor and Program Manager of at-risk students.

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