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Revenue Cycle / Denial Resolutions / Claims Coding Auditor Positions -WFH or Contract

Stockbridge, Atlanta
Best answers
Torie L. Thibodeaux, CPC
2185 Talbot Ridge
Jonesboro, Georgia 30236
Email: torie.thibodeaux@yahoo.com
Cell# (504) 450-1812
Home# (678) 834-5571

Career Objective:

To acquire a position in a Professional HealthCare Capacity, which will allow me the opportunity to utilize my educational, and employment background, as well as opportunities for continued professional growth.


American Academy of Professional Coders Online (AAPC)
Course of Study - Certified Professional Coder (CPC)
Certification Exam Date: July 2010 - Passed - Cert# 01108516
Previously Submitted CEUs:
Approved 2/20/2012 31.50,
Approved 1/6/2014 36.50,
36 Due: 2/29/2016
Recent Studies:
**ICD-10 Distance Learning: Complete Anatomy & Pathophysiology Training
**Advance E/M Chart Auditing

Bryman College – Graduated (December, 1999) GPA 3.0
New Orleans , Louisiana
Course of Study – Medical Assistant

Delgado Community College – August, 1998 and January, 2003
New Orleans , Louisiana ( City Park Campus)
Course of Study – Nursing – Course Incomplete

John F. Kennedy Senior High School – Graduated (May 22, 1998) GPA 3.5
New Orleans , Louisiana
Course of Study – Basic / Nursing Assistant

Membership: AAPC Certification (CPC) – ID# 01108516 Current Thru: Feb 2016 (Member Since: Feb 2008)

Remote Contract Work:
MediConnect Global – 3 month // Remote HCC Coding contract - Ended
Tsystem Rev. Cycle Plus – Facility ED/ER/OBS coding – Contract Part-time Flex - Ended


12/2012 to Present
WellCare of Georgia (CMO)
211 Perimeter Center Parkway Suite 800
Atlanta, Georgia 30346
Provider Solutions Specialist, CPC – Medicaid & Medicare
Duties Include:
Responsible for answering escalated claim adjustment requests, and resolving issues received from providers and facilities. Acts as a subject matter expert and handles more complex provider issues regarding ICD-9 & CPT-4 coding & multiple payment policies.
Responsible for conducting in-depth analysis to identify cost-saving opportunities as it relates to Correct Coding, Compliance and CMS guidelines. Responsible for updating and maintaining requirements regarding billing and coding compliance – regulatory, network development, provider relations, medical directors, health services, claims, configurations, health analytics and IT functions effectively for the Georgia market. Work with market leadership, including providers, regarding all company payment policies and claim edits. Acts as a liaison between internal departments on data gathering and problem solving. Identify root-cause issues to ensure solutions and communicate findings as needed, and present proposed solutions in a clear and concise manner. Assists team members, often guiding them to the appropriate resolution of more complex and difficult cases. Assists with special projects as assigned or directed.

Special Projects:
*CMS – RVU file, PFS, POA, Status Indicators, Lab, DME, HH, Claims Processing Manual, Benefits Manual, CFR, etc.
*NCCI Policy Edits
*DCH – MMIS Portal – Physician Manuals, Fee Schedules, etc.

03/2011 to 07/12/2012
Coventry Health Care of Georgia – Medicare Department
1100 Circle 75 Parkway Suite 1400
Atlanta, Georgia 30339
Coding Quality Auditor – E/M level / HCC Coding, Auditing, HEDIS, STARS, Contracting, etc.
Duties Include:
-Performs audits of Medical Records to ensure all assigned ICD-9 codes are accurate and supported by written clinical documentation.
-Provides education to internal staff and external providers based on audit findings. Provide general education on ICD-9 codes, documentation, and quality measures as appropriate.
-Effectively communicates the audit process and results to the appropriate departments and management.
-Assist senior level staff in providing recommendations for process improvement so that productivity and quality goals can be met or exceeded and operational efficiency and financial accuracy can be achieved.
-Remains current on ICD-9 codes, CMS Documentation requirements, State and Federal regulations, Professional standards, and Accreditation.
-Physician Education Program (PEP) Initiative, HEDIS data collection, and STARS guidelines.
-Performs other duties as required.

10/2010 to 02/2011
3440 Preston Ridge Road
Alpharetta, Georgia 30005
Medical Coder (Abstractor) E/M, WC, Urgent Care, Ortho, PT, etc.
Duties Included:
-Log all daily coded batches, which will ensure all censuses have been submitted to regional corporate
-Create charge batches with the appropriate center, date and division
-Code all primary care and physical therapy charge tickets for their designated centers
-Select levels of Evaluation and Management services in accordance with the Official Medical Fee Schedule
-Code all surgical procedures in accordance with the Official Medical Fee Schedule
-Capture all x-rays taken and bill the correct number of views taken in accordance with the Official Medical Fee Schedule
-Capture all supplies and ancillary charges documented
-Bill all PR2 reports as well as other reports in accordance with the Official Medical Fee Schedule
-Ensure all billable services have been captured in accordance with the Official Medical Fee Schedule
-Ensure patient diagnosis is updated in accordance with standard ICD-9 Diagnostic Coding
-Ensure any outstanding or recurring issues regarding their assigned centers are communicated to their supervisor
-Ensure all assigned coding is completed in the appropriate time frame to ensure a seven working day month-end close etc.
-Ability to read and interpret physician handwritten S.O.A.P. notes
-Working knowledge of ICD-9, CPT/OMFS Coding and medical terminology
-Other duties as assigned.

05/2008 to 07/2010
1 Galleria Boulevard
Metairie, Louisiana 70001
Clinical Intake Specialist

Duties Included:
Assisting Nurses with Pre-authorizations, Data Entry, Waiver Request, Disease Management Referrals, Office Referrals, taking incoming calls from providers, DME providers, members, etc. inquiring about preauthorizations. Building and approving authorization cases, assisting providers in selecting correct ICD-9 and CPT codes for Home Health, Durable Medical Equipment, Emergency Room (ER), Ambulatory Surgical Centers , Inpatient and Outpatient preauthorization request. Researching Humana systems for any information that is needed to resolve claim/auth issues. Act as primary point of contact, communicate with vendors/members, and other Humana staff to resolve escalated case management, claims, customer service and/or reporting issues. Answer questions about Benefits, eligibility, and claims, actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience. Excellent at organizing and managing multiple priorities and projects by using appropriate tools. Strong telephone, Customer service skills, excellent written and verbal communication skills, other duties as assigned etc.

10/2005 to 08/2006
HCA Patient Account Services
10030 North MacArthur Boulevard Suite# 100
Irving, Texas 75063
Collections Analyst / Refunds Analyst

Duties Included:
Processing Patient and Insurance Overpayments, Accounts Receivable, Researching and Resolving Denied Insurance Claims, Following Policies and Procedures on Medicare and Medicaid accounts, Reviewing EOB's and UB92 to process claims, Insuring proper documentation on all accounts, Resolving accounts in a timely manner, Processing Returned Checks in a 48 hour time period, calling insurance companies for verification, calling patients and Insurance companies to collect payments on past due accounts, Analyzing Patient accounts to refund patients for overpayments etc.

04/2002 to 08/29/2005
Tulane University Hospital & Clinic (HCA Facility)
1415 Tulane Avenue
New Orleans, Louisiana 70118
Endoscopy Department Secretary (PSC) / Urological Technical Specialist / Medical Assistant

Duties Included:
Hospital & Clinic, Schedule and confirm appointments, Schedule and Coded various special testing appointments and Surgical Procedures for patients, Maintain filing system, Open, Sort, and route incoming mail, Answer inquiries and provide information to patients, Ensure compliance with HIPPA regulations, Insurance Verification, Routing phone calls, taking messages, greeting visitors, Ensuring that the Medical Record is in the appropriate and approved sequence, Responsible for coordinating all documents for surgical and anesthesia patient procedures, Performed all Clerical Duties and Responsibilities….Medical Assistant / Urological Technical Specialist: Vital Signs, Procedure Room duties, Sterile Technique, Assisting and preparing Cystoscopies, Urodynamic Studies, Prostate Biopsies, Urinalysis, and other invasive procedures, etc.

12/1999 to 03/2001
Clinical Research Center (CRC)
143 South Liberty Street
New Orleans, Louisiana 70118
Clinical Research Coordinator / Medical Assistant

Duties Included:
Inpatient Research Center, Administrative Office Procedures, Medical Terminology, Vital Signs, Injections, Venipuncture, EKG's, Urinalysis, Bookkeeping, Filing, Screening patients for Research studies, Answering multiple phone lines, Scheduling meetings, Scheduling follow-up appointments, Type 35wpm, other duties as assigned.

Summary of Qualifications:
Responsible, dedicated, reliable individual. Highly inquisitive, creative and resourceful. Exceptional organizational skills.
Excellent interpersonal skills, team player and ability to work with all levels of an organization. Effective verbal and written communication skills.
Able to handle several priorities at once. Skilled in handling the public with professionalism, courtesy, and respect.
Skilled in listening to customer needs and developing effective solutions. Professional in appearance and presentation. Willingness to go the "extra mile".

References are available upon request

Computer Skills:
Citirix remote server, 3M encoder, Pro for Payers Encoder, AAPC encoder, CodeMap, Meditech, IDX, Microsoft Word, Excel, Powerpoint, and Outlook, LSAMS, Collections Systems, Host / Patient Accounting Systems, eTran, Lotus Notes, IM, MetaVance, CCA, CCP2, Physician Finder, PAL, Access, HSS, Mentor, Milliman etc
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