Quality Assurance Medical Records

YOLUNDA SCOTT, CPC, CRC

*** **** ****** ******, *****, GA 30809, 678-***-****, ************@*****.***

MEDICAL OFFICE SKILLS:

Auditing/Abstracting/Compliance/Quality Assurance/Outpatient & Inpatient coding (various specialties listed below)/Data Management/Physician Queries/Risk Adjustment/Anesthesia/HEDIS

Commercial & Government Payers

Working knowledge of various EHRs/EMRs, Insurance Verification, Charge/Payment Posting

Worker’s Compensation Policies and Procedures

HIPAA, NCQA, CMS Regulations, LCDs/NCDs

EDUCATION:

Ultimate Medical Academy – Tampa, FL

Associate of Science in Medical Billing & Coding (April 2014)

CERTIFICATIONS:

American Academy of Professional Coders 12/2011 - Present

Certified Professional Coder

Certified Risk Adjustment Coder 10/2017 - Present

EXPERIENCE:

NAPA Anesthesia 09/2024 – 05/2025

Remote Revenue Optimization Auditor

Audited medical records to identify missed charges, incorrect coding, and other inconsistencies that result in missed billing opportunities; adhoc audits (full site and high risk) assigned and completed

Utilized different EMRs (AllScripts, Meditech, Cerner, Epic) missing patient information and medical documentation retrieved for billing; coding of unbilled records completed; resolution of missing documentation provided by requesting necessary documents (anesthesia records/operative notes)

Took initiative w/fellow teammate (on voluntary basis) to prepare PP presentations while updating educational documents

Summit Health dba CityMD 10/2022 - 02/2024

Remote RCM Professional Coding Abstractor

Performed auditing, quality assurance, and productivity reviews of coding vendors’ performances; abstracted surgical and office visit codes from orthopedics, pediatric orthopedics, and pain management medical records; was responsible for coding E&M services

Queried surgeons, PAs, NPs to clarify conflicting medical documentation; utilized research tools (Codify, Optum Encoder Plus, Novitas, CMS, etc.)

Participated on Teams calls with vendors to help them with principles and concepts of coding (procedural/diagnoses, modifier usage, etc.)

Emory Healthcare – Atlanta, GA 05/2017 – 05/2022

Remote Anesthesia Multi-specialty Coder II

Coded inpatient and outpatient medicine and ancillary services utilizing CPT (ASA)/Anesthesia Crosswalk/Relative Value Guide & ICD-9/ICD-10 CM coding; encompassed, influenced, and directed daily functions that contribute to service capture, charge capture, management of patient financial information

Performed auditing responsibilities including reviewing physician documentation; patient financial information (registration/insurance, referrals, pre-certs, etc.), and collection of patient service revenue (TES and denials management, payment variance, revenue performance tracking); sent email requests to MDs, CRNAs, other medical staff questioning contradictory/missing information (including validation and/or correction), special project involvement (including cross-coverage coding other specialties) in order to optimize revenue collections for the department; coding specialties included OB/GYN, Orthopedics, Nephrology, ENT, Spinal Surgery, Urology, Endo, Pain Management, Gastroenterology, General Surgery, Bariatrics, and Ophthalmology

United Health Group – Franklin, TN 05/2015 – 6/2017

Remote HCC Coder (Project)/Remote HEDIS Auditor/Abstractor (Project)

Maintained quality standard average of 95% and above; attended conference calls as necessary to implement coding and compliance changes

Researched and resolved coding projects as assigned with revisions to rules and regulations that govern inpatient and outpatient physician coding; assisted with review of client data as related to coding

Demonstrated ability to understand the clinical content of a health record (including the most complicated records); demonstrated knowledge of and utilized auditing skills related to coding quality and compliance

Altegra Health - Alpharetta, GA 02/2015 – 02/2016

Remote Clinical Reader (Project)

Abstracted pertinent information from patient medical records; assigned appropriate ICD-9-CM/ICD-10-CM codes, creating HCC and/or RxHCC group assignments as applicable

Assigned Outcomes flagged event codes when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes;

Complied with HIPAA laws and regulations and the Standards of Ethical Coding as set forth by AHIMA/AAPC and adhered to official coding guidelines; participated in testing and trained as required by the company

Wave Code Logix - Dalton, GA 08/2014 – 01/2015

Remote HCC Coder (Project)

Abstracted medical records on client’s members to assign/validate ICD-9 codes for HCC reporting supported by correct medical record documentation reported in accordance with CMS payment guidelines using ERICOM/Chart Assistant

Helped acclimate new coding recruits; completed audit summary worksheet that includes all discrepancies and results with feedback for educational purposes; documented audit results, actions, and outcomes in accordance with ICD-9 and Medicare Risk Adjustment Payment System guidelines

Functioned as a member of a self-directed team to meet specific individual metrics w/ability to effectively communicate verbally and in writing

QUALIFICATIONS:

Strong background in auditing, coding, abstracting, billing, claims management, transcription, and clinical support

Front and back office skills possessing a thorough knowledge of modern clinical practices and procedures with the ability to identify and address customer needs; capable of prioritizing workloads to meet deadlines

Technically savvy and familiar with many computer systems and applications such as Athena, Epic, Cerner, Meditech, Allscripts, NextGen, Navicure, MS Office Suite, Novitas, CMS, Codify, 3M, MediSoft, GE Centricity, McKesson

PROFESSIONAL PROFILE

Determinedly motivated, energetic, and articulate ICD-10-CM proficiently CERTIFIED PROFESSIONAL CODER seeking opportunities in medical coding while possessing forward-moving experience in the industry with excellent computer, prioritization, and provider/customer service skills

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