Certified Professional Medical Coding Auditor and Educator

SYDNEY VANDERPOOL, CPC

Charlotte, NC

413-***-**** • *********@*****.***

www.linkedin.com/in/sydney-vanderpool-cpc-crc-47236a39

COMPLIANCE AUDITOR CERTIFIED PROFESSIONAL CODER

Customer focused auditor with career expertise in coding and ensuring compliance in the healthcare industry. Foster client relationships, lead teams, communicate and collaborate across functions and with all levels of leadership, executing concurrent projects that provide solutions to inform decision making, improve processes, create best practices, minimize risk, and enhance compliance and awareness with regulations and standards. Core competencies include:

• Profee Auditing • Provider education • Training and development • Policy / SOP writing • Risk analysis • Corrective action / compliance plans • Research • Collaboration • Client relationship management • Consulting • Medical Terminology • Process Improvement • Coding • Attention to Detail • Critical Thinking • Problem Solving • Healthcare Administration • Medical Reimbursement • ICD-10 CM

TECHNICAL SKILLS

EPIC ( EMR ) • 3M • MD Audit • Ingenix Encoder Pro • Cerner • Allscripts

EXPERIENCE

Hackensack Meridian Health, Remote July 24, 2023 – Present

Coding Quality Auditor and Educator (Profee)

Performs coding quality audits and provider education of all records (outpatient, inpatient, procedures, testing) to assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and provide ongoing feedback and analysis of the education needs for the providers and staff.

•Responsible for providing assistance with coding inquiries from providers, practices, Revenue Cycle Analyst staff, Training Team.

•Analyzes physician documentation in the medical record for clinical correlation for coding accuracy and queries physicians when code assignments are not straightforward or documentation in the medical record is inadequate, ambiguous, or unclear for coding purposes.

•Bring identified concerns to the department manager and Director for resolution.

•Works collaboratively with Coding Quality Educators providing audit results, coding references, and other materials associated with completed reviews of employed providers, including research, and associated research documentation.

•Assists in special projects when applicable such as in-house audits or audits pertaining to contract coders.

GHR RevCycle, Remote Jan 2021 – Feb 2024

Professional Fee Coder/Auditor

Review physician documentation and medical records for coding appropriateness and accuracy, maintaining expertise with payer and coding guidelines and payment systems.

•Provide feedback to coders and providers on coding corrections, appropriately citing authoritative resources.

•Execute reimbursements with the client's financial services, medical staff, and other departments.

•Ensure accurate and timely completion of client coding audits to meet client turnaround and quality expectations.

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Bon Secours Mercy Health, Remote October 2018 – August 2021

Corporate Revenue Cycle Compliance Auditor

Collaborated with the Director of Compliance Audit to create compliance auditing protocols that align with overall Corporate Responsibility Program and specific compliance responsibilities relative to Ensemble’s revenue cycle-third party billing services performed for Mercy Health and non-Mercy clients. Assisted in the review of client and non-Mercy client coding, billing and claims processing policies and procedures to prevent fraud, waste and abuse.

•Performs quarterly audit and provides education to providers of findings for the eastern market group for BSMH reviews for clinical correlation for coding accuracy of Evaluation and Management, Surgical, Diagnostic and all other services performed. Follow up to physician queries if the medical record is inadequate, ambiguous, or unclear for coding purposes.

•Developed educational content on documentation and coding and trending of non-compliant activities. Prepared presentations to facilitate discussion and meet current and emerging compliance challenges.

•Assisted in auditing and investigations requested by the Director, Compliance Audit. Assisted to develop compliance corrective action plans (CAP), oversight tools, and technical edit enhancements to support revenue cycle services compliance and privacy efforts. Tracked recovery and repayment discovered.

HCTEC, Tampa, FL March 2016 – August 2018

Contract Professional Fee Coding

Performed multispecialty abstract coding for Pediatrics, Primary Care, NICU/PICU, Rural health clinics, Teaching hospitals, Inpatient and outpatient Profee services, Evaluation and Management, General Surgery and Anesthesia.

•Contributed expertise with CPT & ICD-10-CM guidelines, professional fees auditing, monitoring, and analysis including provider utilization, statistical risk assessment and provider education.

Novant Health, Charlotte, NC February 2014 – March 2016

Medicare Risk Adjustment Coder II

Abstracted clinical documentation to assign Hierarchical Category Codes (HCC) diagnosis codes for Medicare payers using EPIC. Audited documentation to verify coding accuracy and to identify missing information.

•Applied diagnostic codes following official coding guidelines and HCC Risk Adjustment for HCC/ RXHCC 2015-2016 modules.

•Implemented all technical aspects to assign diagnostic and procedure coding according to the standards of AMA, CMS, NCQA, third party payers and other regulatory agencies.

Caromont Surgical Associates, Gastonia, NC

November 2012 – February 2014

Coding Specialist II

Performed Surgical coding and abstracting with timely reviews to validate documentation for accuracy in accordance to the federal regulatory policies and Medicare guidelines in Gastroenterology, breast procedures, wound care, Level one and Two Trauma services and Robotic assisted surgeries, Split/ Shared visits, Pre and post-operative surgical consultations, Critical Care and Initial and post op evaluation and management services.

•Audited provider documentation of ICD-9 CM and CPT-4 procedural coding guidelines as well as the Centers for Medicare and Medicaid Services.

•Trained and coordinated team for the medical record department.

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McKesson Corp, Remote May 2012 – June 2013

Evaluation and Management Coder

Certified medical coder responsible for coding E/M cases using knowledge of medical terminology and human anatomy and claims billing. Coded and entered data from hard copy or image copy.

•Abstracted clinical information from medical records and assigned ICD 9 CM and CPT codes to patient records.

•Maintained a 95% accuracy rate and productivity standards of 15 claims per hour.

Southeastern Institute, Charlotte, NC December 2011 – April 2012

Medical Coding Instructor

Planned, organized, and delivered instruction and training to maximize student learning in accordance with ACCOSC and Southeastern policies.

•Assessed student academic performance and maintained record of attendance, progress, and assignments.

Baystate Health Systems, Springfield, MA January 2011 – August 2011

Tumor Registrar

Performed abstracting, case-finding, follow-up, monitoring, and statistical reporting of reportable benign and malignant neoplasms diagnosed or treated, facilitated by American College of Surgeons Cancer Program Standards.

•Used ICD-10- CM and facility Oncology Data Standards, AJCC TNM / SEER Summary / Collaborative Staging, Primary & Histology Coding Rules, cancer conferences, and data submission.

•Implemented the Commission on Cancer Program Standards 2010, Revised FORDS 2011 and other State reporting requirements using Metrix and ERS cancer registry software.

American Career Institute, Springfield, MA March 2004 – December 2010

Lead Adjunct Medical Coding and Billing Instructor

Developed a teaching curriculum and performance development plan, which included instructor lead in-services.

•Delivered subject matter expertise covering courses required to pass the CPC exam governed by the AAPC, including Medical Terminology, Anatomy and Physiology, in depth Introduction to ICD-9 CM and CPT-4 Procedures, Medical Insurance Claims Processing, Medical Law /Ethics and Introduction to Pharmacology.

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EDUCATION

Certificate in Medical Coding and Billing, Springfield Technical Community College, Springfield, MA

Associate of Science ( A.S. ) in Medical Administration, Bryant & Stratton College, Syracuse, NY

CREDENTIALS

Certified Professional Coder ( CPC ) - American Academy of Professional Coders

Certified Adjunct Instructor - Medical Coding and Billing, American Career Institute

CCS Certification thru AHIMA (in progress )

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