Remote HCC Risk Adjustment and Medical Coder

Marcy Hollon, CPC #********

931-***-**** **********@*****.***

Certified Professional Coder with over 10 years of medical coding and billing experience. I’ve worked in hospital settings, private offices, and remote settings. I’ve completed accurate diagnostic coding in accordance with documentation and official guidelines. I am well-versed in all elements of outpatient, auxiliary, and mental health coding, as well as HCC Risk Adjustment and RADV coding. Credentialing, patient billing, insurance billing, AR/AP accounts, and backlogs are all areas of expertise. I efficiently handle extensive workloads with set deadlines with little to no supervision.

Skills

Comfortable with physician querying Excellent multi-tasking and time management

Solid knowledge of medical terminology Able to work independently

Exceptional data entry and management Self-Motivated

Clear and precise written or verbal communication Ability to solve and/or troubleshoot difficulties

Familiarity with Digital Communication Tools Embraces learning

Tech and Computer skills

-Microsoft Office (Word, Excel, PowerPoint, Outlook)

-Remote communication tools (email, phone, video conference i.e. Zoom, Skype, GoTo)

-File sharing programs (Google drive, Dropbox, SharePoint)

Experience

CostFirst, Inc

Auditor July 2022 – Jan 2023

●Drafted policies and procedures for a new HCC Risk Adjustment Model program being established for predictive modeling for workers compensation

●Assisted in developing a Quality Control Program by developing and implementing a Quality Assurance process

Audit bill for proper compliance with California Workers Compensation, which includes abusive and, excessive billing, inappropriate and unbundling of codes

APN Software Sep 2021 - Sep 2021 Hospitalist Coder for Franciscan Alliance

● In accordance with the Franciscan Coding Tier Matrix, accurately review and code patient records in the clinical areas of outpatient, inpatient service lines, and ambulatory level 3 specialty services.

●Meet established coding accuracy and production standards, and show a thorough understanding of coding guidelines, medical terminology, anatomy and physiology, reimbursement schemes, and Payor-specific guidelines.

●Reviewed and analyzed the content of medical records to appropriately assign ICD diagnosis procedure codes, CPT procedure codes, and modifiers to meet coding guidelines

Trust HCS Aug 2020 - March 2021 HCC Risk Adjustment Coder for Cotiviti

● Reviewed medical records for accurate, compliant, and complete diagnosis code abstraction for Medicare, Commercial and Medicaid risk adjustment from various chart types (physician, facility, and non-facility)

● Coded following the ICD-10-CM Official Guidelines for Coding and Reporting, AHA’s Coding Clinic and well as Cotiviti and client specific coding guidelines

● Regularly and consistently achieved over 95% quality accuracy

Equity Staffing July 2019 - Dec 2019 RADV HCC Coder for UnitedHealth Group

●Performed accurate chart reviews and assigned appropriate ICD-10 CM codes based on documentation in chart

●Identified and reported issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding guidelines

●Maintained consistent daily production of greater than 30-50 reviews per day @ 98% accuracy

Optum/Insight Global Sep 2016 - Dec 2016 and May 2017 - Jan 2018 HCC Risk Adjustment Coder (For both contracts)

●Deleted ICD-9-CM and ICD-10-CM codes that are not supported by documentation, validated code selection, and identified suspect conditions for coding

●Participated in coding department meetings and educational events

●Adhered to and maintained required levels of performance in both coding quality and productivity as established by Optum

Complex Care Solutions May 2014 - Dec 2015 Outpatient & HCC Coder

Reviewed provider notes to abstract, assign enter valid ICD-9-CM and HCC codes in the EHR platform

Performed medical chart reviews to identify and correct any missed or erroneous HCC codes according to HCC coding requirements

Worked with providers to gain clarification or provide feedback to resolve discrepancies identified during the coding process

Namaste OB-GYN July 2013 - Dec 2013 Outpatient Coder/Biller

Reviewed patient accounts to ensure accuracy and completeness of claims billing for maximum reimbursement

Followed up on accounts receivables with patients and third-party payers, rebilled claims, and initiated account correspondence or phone calls to patients and/ or third party payers

Determined appropriate I CD-9-CM and CPT codes for all charges and procedures

Medical Audit Resource Services Aug 2011 - March 2013 Outpatient/HCC Coder

● Assigned accurate evaluation codes, ICD-9 diagnosis, procedural terminology codes, modifiers, and quantities derived from medical record documentation for multi-specialties in each facility’s specific EHR

Stones Rives & Dekalb County Hospitals 2006 - 2011 Outpatient & ER Level Coder

● Coded all ER visits, ancillary charts, and other outpatient procedures for 2 facilities

● Translated medical information for claims processing, including confirming treatment with medical staff, identifying missing information, and submitting reimbursement forms to insurers

Education and Associations

Doctor’s Management - Certified Professional Coder #01046873 June 2006

●American Academy of Professional Coders (AAPC)

Contact this candidate