Nicole Dixon, Ccs, Rhit Email & Phone Number

Atlanta, Georgia, United States

Serve as a subject matter expert on claims editing, CMS, AHA, and ICD-10 guidelines.Provide detailed rationale to clients on whether to uphold or overturn edits based on guidelines set forth by CMS and other industry standard sources.Assist in identifying and securing $1M in lost revenue via analysis of editing products and their performance. Ensure that editing products are working properly to reduce inappropriate payments on claims with improper coding and increase revenue optimization. Perform weekly and monthly analysis of our editing products to identify trends and opportunities for revenue growth for our clients. Answer ad hoc requests for trend analysis

• Assigned to Optum NorthBay account to review all tasks associated with claim edits on inpatient and outpatient accounts with outstanding balances. • Worked and reduced over $100M in accounts receivable revenue. • Resolve all codes with conflicting, missing, or unsupported documentation by auditing the complete medical record via ECAC, Cerner and Powerchart, and adding any omitted data. • Research and respond to insurance coding requests related to CCI, NCCI, medical necessity LCD/NCD by consulting with revenue cycle applications, such as Revenue Cycle Pro.• Review medical records for overlapping accounts, missing charges and/or modifiers, and any unsupported codes assigned by maintaining thorough knowledge of coding guidelines. • Add missing charges, missing demographics, POA indicators, reconcile mismatched DRGs, and provide further instructions to billing department to resolve all claim rejections.

Tampa/St. Petersburg, Florida Area

- Accurately review, abstract, and assign medical codes to clinical notes for more than the required 28 medical records daily.- Analyze medical record documentation to identify codes associated with diagnosis and Evaluation and Management services. - Assign, edit, validate, and sequence IDC-10-CM, CPT codes, and modifiers. - Initiate and edit physician queries to ensure they remain in compliance with company policies. Track and reconcile coding discrepancies related to denials and rejections. - Educate healthcare providers to ensure specific documentation requirements are met for proper recordkeeping, accurate coding, and maximize claim reimbursement.- Assigned codes to the highest specificity, ensuring diagnostic codes and documentation accurately reflect and support patient encounters and the highest level of reimbursements.- Worked with the billing department to review National Correct Coding Initiative (NCCI) edits; assisted in resolving identified Medicare and private insurance claim denials.- Proficient in coding accounts for various encounters, including hospice, palliative care, clinics, and home health.- Lauded by management for maintaining above 95% accuracy, as per company standards.- Consistently meets or exceeds productivity standards. - Compiled medical coding reports to provide leadership statistics of healthcare encounters.- Perform thorough provider reconciliation after month-end to identify any missed opportunities for coding, errors in the transfer from CAC to EHR software causing missed bills, and any other coding errors made by staff.