Risk Adjustment Medical Billing
Resume:
Yunika Shuff
**** ********* ** ************, ** *3068
Phone: 614-***-**** Email: *************@*****.***
Objective
Customer-focused healthcare professional with over 12 years of experience in medical billing, coding, case management, and customer success. Adept in HEDIS record collection, risk adjustment, and ICD-10/CPT coding. Seeking to leverage expertise in medical billing, claims resolution, and risk adjustment coding to contribute to the success of a healthcare organization. Proven ability to manage client relationships, streamline processes, and provide data-driven insights to improve outcomes.
Professional Experience
Medical Billing and Customer service representatives
CompManagement, LLC, Dublin, OH
January 2011 – 2014
Processed workers' compensation claims, ensuring compliance with billing standards and state-specific requirements.
Utilized ICD-10 and CPT coding to accurately process claims and ensure timely reimbursement.
Assisted with risk adjustment coding, analyzing patient data to ensure correct diagnosis codes were submitted for reimbursement.
Applied understanding of HEDIS measures to assist in record collection for quality reporting, ensuring compliance with healthcare standards.
Communicated with insurance providers to resolve billing discrepancies and ensured efficient claims processing.
Handled inbound calls from clients regarding workers' compensation claims, billing inquiries, and risk adjustment processes.
Delivered exceptional customer service through chat support, addressing inquiries and resolving issues with accuracy and efficiency.
Leveraged strong written and verbal communication skills to effectively engage with customers, ensuring clarity and satisfaction in all interactions.
Claims Examiner Sr.
CompManagement, LLC, Dublin, OH
2017 – 2022
Managed 200-300 workers' compensation claims per month, including accurate coding for medical services and risk adjustment.
Coordinated with healthcare providers, insurers, and legal teams to ensure comprehensive case management, focusing on accurate record collection for risk adjustment and quality measures.
Reviewed patient charts for coding compliance with HEDIS measures and risk adjustment guidelines to support accurate reporting.
Delivered education and training to clients regarding HEDIS data collection and risk adjustment procedures to enhance compliance.
Handled inbound calls from clients regarding workers' compensation claims, billing inquiries, and risk adjustment processes.
Provided timely, accurate, and professional responses to client concerns, ensuring high levels of customer satisfaction.
Documented and tracked customer interactions, ensuring all issues were resolved or escalated appropriately.
Client Relationship Manager / Customer Success Manager
CompManagement, LLC, Dublin, OH
2014 – 2018
Developed and managed strong relationships with clients, acting as the primary point of contact for claims-related inquiries, including risk adjustment and coding-related questions.
Assisted clients in understanding and navigating HEDIS measures and quality reporting requirements, ensuring accurate record submission.
Delivered presentations to clients on risk adjustment, HEDIS reporting, and healthcare cost management strategies.
Mental Health Specialist
Nationwide Children’s Behavioral Health Program (BHP), Columbus, OH
November 2021 – Present
Delivered behavioral support and assisted with data collection related to patient care, ensuring accurate documentation for quality reporting purposes.
Worked with multidisciplinary teams to ensure treatment plans and progress notes were accurately recorded and compliant with healthcare quality standards.
Supported case management by ensuring accurate collection of records for ongoing risk adjustment and HEDIS reporting.
Education
Bachelor's Degree in Psychology
University of Phoenix, Phoenix, AZ Graduated: 2020
Licenses & Certifications
First Aid Certification
Crisis Prevention and Intervention Training
Trauma-Informed Care Training
Motivational Interviewing Certification
Skills & Qualifications
HEDIS & Risk Adjustment Experience: Knowledge of HEDIS record collection and risk adjustment coding, including ICD-10 and CPT codes.
Medical Coding & Billing: 3+ years of experience in billing and coding, with expertise in ICD-10, CPT, and workers’ compensation claims.
Data Management: Proficient in handling patient data, ensuring accurate record collection and coding for risk adjustment and quality reporting.
Healthcare Knowledge: In-depth understanding of healthcare cost, quality, and compliance standards, particularly in case management and risk adjustment.
Customer-Facing Experience: Over 5 years of client-facing experience in managing healthcare relationships, educating clients on billing, coding, and risk adjustment processes.
Technical Skills: Proficient in Microsoft Office 365 (Excel, PowerPoint) for data analysis and presentation creation.
Communication Skills: Strong written and verbal communication skills, capable of delivering presentations to senior leadership and clients.
Process Improvement: Expertise in identifying inefficiencies and developing strategies to streamline healthcare operations.
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