Caitline` Summers
Kirksville
Summary
Seasoned medical coding auditor, who is proficient in CPT, ICD-10-CM, and HCPCS code sets. Has experience in stetting up and performing audits based on coding guidelines. Has a great deal of experience in educating providers on how to improve their documentation to ensure compliance and while maximizing revenue. Adept analyst, auditor, and problem solver committed to excellence in all aspects of healthcare.
Overview
9
9
years of professional experience
Work History
Compliance Director
Complex Care Center
01.2024 - Current
- Enhanced compliance program effectiveness by developing and implementing comprehensive policies and procedures.
- Developed targeted training programs to increase employee awareness and understanding of compliance requirements.
- Collaborated with senior leadership to set strategic direction for the organization''s compliance function, aligning objectives with business goals.
- Managed the billing and coding department
- Managed the prior authorization department
- Provider credentialing
Medical Coding Auditor
Valera Health
01.2023 - 03.2024
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
- Maintained confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
- Ensured compliance with regulatory requirements by performing regular audits and staying up-to-date on industry standards.
- Streamlined audit processes, improving efficiency and reducing time spent on each audit engagement.
- Planned and executed follow-up audits at appropriate intervals.
- Mentored junior auditors, sharing knowledge and best practices to foster their professional growth within the team.
- Coordinated, managed and implemented auditing projects and prepared for evaluation.
- Analyzed data and findings to prepare reports detailing financial information.
Medical Coding Auditor
Farragut Square Group
11.2021 - 01.2023
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
- Maintained confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
- Streamlined audit processes, improving efficiency and reducing time spent on each audit engagement.
- Planned and executed follow-up audits at appropriate intervals.
- Conducted risk assessments to determine areas requiring increased focus during subsequent audits.
- Interpreted state and federal laws, accepted auditing principles and procedures and program standards to audited materials and data to detect non-compliance and facilitate recommendations.
- Interviewed auditees to gather data needed to conduct audits.
- Analyzed data and findings to prepare reports detailing financial information.
- Maintained up-to-date knowledge of industry regulations and standards, ensuring audit practices remained compliant.
- Developed and maintained productive relationships with clients, facilitating smooth audit processes and engagements.
Medical Coding Auditor
Crossroads Treatment Center
08.2021 - 12.2021
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
- Maintained confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
- Ensured compliance with regulatory requirements by performing regular audits and staying up-to-date on industry standards.
- Streamlined audit processes, improving efficiency and reducing time spent on each audit engagement.
- Mentored junior auditors, sharing knowledge and best practices to foster their professional growth within the team.
- Performed observations and evaluated supporting documents to supplement audit findings.
- Conducted risk assessments to determine areas requiring increased focus during subsequent audits.
- Trained new employees on accounting principles and company procedures.
Documentation and Coding Auditor
Tri-Cities Community Health
08.2019 - 08.2021
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
- Maintained confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
- Ensured compliance with regulatory requirements by performing regular audits and staying up-to-date on industry standards.
- Streamlined audit processes, improving efficiency and reducing time spent on each audit engagement.
- Mentored junior auditors, sharing knowledge and best practices to foster their professional growth within the team.
- Performed observations and evaluated supporting documents to supplement audit findings.
- Initiated corrective actions to address audit findings, improving internal control systems.
Lead Medical Biller
Ideal Option
01.2016 - 08.2019
- Enhanced revenue collection with consistent follow-ups on outstanding accounts and negotiating payment plans when necessary.
- Improved billing accuracy by diligently reviewing and updating patient information in the system.
- Managed electronic health record systems, ensuring data integrity and accessibility for authorized personnel.
- Collaborated with healthcare providers to obtain necessary documentation for accurate billing submissions.
- Provided ongoing support to junior staff members through mentorship and sharing best practices in medical billing operations.
- Led a team of billers, providing guidance and training to ensure timely completion of tasks.
- Developed comprehensive training materials for new hires, facilitating their smooth transition into the medical billing team.
- Assisted patients in understanding their medical bills, addressing concerns and clarifying any confusion regarding charges or insurance coverage.
Education
Certified Professional Biller -
AAPC
Salt Lake City, UTCertified Professional Coder -
AAPC
Salt Lake City, UTCertified Professional Compliance Officer -
AAPC
Salt Lake City, UTCertified Professional Medical Auditor -
AAPC
Salt Lake City, UTAssociate of Science - Health Information Management
Charter College
Anchorage, AK01-2013
Skills
- Audit management
- Compliance monitoring
- Ethical leadership
- Legal research
- Auditing processes
- Investigations skills
- Documentation review
- Internal audits
- Federal and state regulations
- Compliance reviews
- Provider credentialing
- Trend monitoring
- Compliance procedures
- Policy design
- Teamwork
- Problem-solving
- Attention to detail
- Problem-solving abilities
Timeline
Compliance Director
Complex Care Center
01.2024 - Current
Medical Coding Auditor
Valera Health
01.2023 - 03.2024
Medical Coding Auditor
Farragut Square Group
11.2021 - 01.2023
Medical Coding Auditor
Crossroads Treatment Center
08.2021 - 12.2021
Documentation and Coding Auditor
Tri-Cities Community Health
08.2019 - 08.2021
Lead Medical Biller
Ideal Option
01.2016 - 08.2019
Certified Professional Biller -
AAPC
Certified Professional Coder -
AAPC
Certified Professional Compliance Officer -
AAPC
Certified Professional Medical Auditor -
AAPC
Associate of Science - Health Information Management
Charter College
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