Amber Walker, Mha, Cpc, Crc Email & Phone Number

Ridgeland, Ms, Us

• Configure and optimize TriZetto Facets/HealthEdge platforms.• Assist in the design, development, testing, and implementation of data solutions.• Use iterative software, data design techniques, data modeling principles, and testing best practices.• Analyze and translate business needs into technical specifications and long-term solutions.• Reverse engineer existing system of record and conduct bottom-up analysis of existing systems and data models.• Coordinate with development teams to create conceptual data models and data flows.• Develop best practices for data modeling to ensure data integrity, consistency, and quality.• Develop data strategies and solution approaches, conceptual, logical, and physical data models.• Generate documentation to support operational processes, lessons learned, diagrams, systems administrationguidelines, system setup, integration test plans, and results.• Participate in Agile ceremonies (Scrum or Kanban).• Actively communicate with users and team to troubleshoot and resolve technical issues related to the platforms.

Perform code abstraction of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentationIdentify diagnosis and chart level impairments and documentation improvement opportunities for provider educationAssist coding leadership by making recommendations for process improvements to further enhance coding goals and outcomesMaintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulationsConsistently maintain a minimum 95% accuracy on coding quality auditsMeet minimum productivity requirements as outlined by the project termsHandle other related duties as required or assignedPrepared candidate profiles and organized client interviews, streamlining the hiring process.Maintained strong client relationships, positioning Scion as a reliable staffing resource.Leveraged JazzHR, Manatal, and ATS to track candidates, document interactions, and schedule appointments efficiently.

Reviews national coding guidelines for updating and maintaining our internal coding application tool (Coding Rules Engine), resolves claim processing inquiries received through coding pends, and supports implementation of new, revised and deleted procedure and diagnosis codes maintained by ADA (Dental), CMS (ICD10 and HCPCS) and AMA (CPT4) national organizations. Also assist with research for developing and updating coding policies, and provide coding and implementation recommendations for medical policies.

Performs various duties to accurately interpret and bill physician charges for physician services. Enters into the Billing System appropriate CPT and ICD-10 codes and bills charges.

Review orders in various queues and files for potential fraud. Analyze order information, research prior customer history and make determination to approve or decline orders based on information learned. Review for fraud patterns so as to maintain reasonable fraud detection and mitigation.

Take inbound calls from current customers. De-escalate calls with customers, diplomatically handle irate customers effectively to assist them and retain their business.Upsell other services. Handle questions that may include some technical help to get their service working properly.

Master'S Degree, Health/Health Care Administration/Management

Certificate Of Completion, Risk Adjustment Coding

Bachelor Of Applied Science - Basc, Health/Health Care Administration/Management

Certification

Associate Of Arts - Aa, General Studies