Remote Coder Data Entry

Letty Criswell

Prairieville, La *****

***********@*****.***

Cell # 504- 331-7344

Efficient individual with 20 years of medical coding, HEDIS review experience currently seeking coding position, or any fields related. Background includes computer literacy in Excel Covititi, Cerna, Athena and Epic or most fields related to data entry hospital-based systems. Reliable person with ability to work independently. Monogram Health – Coding Auditor Contract worker

Jan 2023- Present

• Performs medical chart audits on prospective basis to identify, monitor and document claims and encounter coding information as it relates to Hierarchical Condition Categories (HCC).

• Queries physicians on inappropriate documentation.

• Perform coding abstraction and medical chart quality audits to ensure clinicians have accurate clinical documentation to support ICD-10 codes and are adhering to CMS Risk Adjustment guidelines.

• Assigned appropriate diagnosis and procedure codes.

• Educates clinicians on specific coding issues found in their charts and keeps them abreast of coding and documentation guidelines.

CVS/Aetna Insurance – Senior Remote Coding

Quality Auditor July 2017- Dec. 2022

• Review of medical charts and associated coding in support of the Medicare risk population using M.E.A.T.

• Performs audits of medical records which include hospital visits, office visits outpatient procedures and emergency room visit to ensure all assigned ICD-10 codes are accurate and supported by written clinical documentation.

• Responsible for the completion of the CMS Risk Adjustment Data Validation

(RADV)

• Participate in coder education by providing information on discrepancies that will enhance auditors coding of charts.

• Remain current on ICD-10 coding, CMS guidelines and company guidelines.

• Perform 2nd pass audit on codes that have been validated by 1st pass coders ALTEGRA HEALTHCARE INC. -Remote coder

March 2016- July 2017

RADV/ DVA/ IVA Risk Adjustment coder- Senior reviewer

• Perform RADV and IVA audits on 2015 Enrollment and Claim data for Altegra clients for submission to CMS on an audit platform.

• Audit primary coders submissions on audit platform for precise submissions and markups.

• Attend REGTAP meetings thru Webinex on updates for EDGE server

• Abstract pertinent information from patient medical records. Assign appropriate ICD-10- CM codes, creating HCC and/or RxHCC group assignments as applicable. Assign Altegra Health Flagged Event codes when documentation in the record is inadequate or otherwise unclear for medical coding purposes.

• Complete home health patient review of all CMS HCC, RxHCC and Non-HCC codes submitted to determine a PASS or FAIL status using DVA Coding and Supplemental Policies.

EMSI Health-Remote Contract worker

February 2016- March 2016

Hcc/Rxhcc coder Medicare Risk Adjustment

• Reviewed Commercial and Medicare Advantage patient visits for HCC and RxHCC conditions for Highmark Inc.

• Recorded productivity on a daily spreadsheet.

CSI Contract worker for Optum/United Healthcare Inc. HCC Contract coder

July 2015 -January 2016

• Reviewed Medicare electronic charts remotely for HCC (Hierarchical Health Conditions) and RxHCC conditions on a company-based laptop using ICD-9 and ICD-10 Diagnosis codes.

• Abstracted Physician Assessment visits forms for several different Insurance companies.

• Recorded productivity on a spreadsheet and on SharePoint. Humana Health Benefit, Inc.

March 2006- July 2015

Medicare Risk Analyst Certified Coder and HEDIS reviewer

• Increased Humana Risk scores up to 60% at several Internal Medicine clinics with high accuracy

• Review and analyze high volume of medical record information to identify accuracy of ICD 9 codes based on CMS HCC categories in hospital base settings and outpatient clinical settings which included over 70% traveling time to assigned territory

• Researched procedure codes in Humana’s claims system for Quality Assurance HEDIS reviews.

• Received several Star awards for completion of several RADV projects, completion of chart reviews before due time frame.

• Identify, and document claims and encounter coding information as it pertains to Clinical Condition Categories

• Conduct education for physician groups/offices to increase awareness and importance of accurate Medicare coding.

• Audit/verify the accuracy of the departments coded claims encounter submitted by other analysts.

• Complete appropriate paperwork/documentation/system entry regarding claims/encounter information.

• Update incorrect ICD-9 codes in Humana’s claims system from looking at patient’s visits and claim submitted for payment by physician’s office. Education

Uno Metropolitan College

• Medical Coding Certificate Program September 1993 Monthly/weekly Coding Conference Calls

• Continuing Education Units

• Attend AAPC Coding Conferences/ Meetings yearly

• HEDIS Clinical Learning and Development Classes

Additional Skills

• Strong knowledge of Microsoft Office XP products (Work, Excel, Access)

• HCC coder

Contact this candidate