Heather Pope
Farmington,MO
Summary
Dynamic Coding Analyst I at Centene Corporation with expertise in HCPCS coding and a strong commitment to compliance. Proven track record in enhancing operational efficiency through data analysis and process improvement. Exceptional team collaboration and customer service skills, driving successful outcomes in coding accuracy and provider education initiatives.
Organized and dependable candidate successful at managing multiple priorities. Willingness to take on added responsibilities to meet team goals.
Overview
7
7
years of professional experience
Work History
Coding Analyst I
Centene Corporation
11.2021 - Current
- Review and Analyze Medical Records: Thoroughly examine patient records (e.g., electronic health records, discharge summaries, operative reports) to identify and assign appropriate codes for diagnoses (ICD-10) and procedures (CPT, HCPCS). Ensure coding accuracy and completeness, adhering to official coding guidelines and regulations.
- Compliance and Auditing: Conduct reviews of coding practices to identify areas for improvement and ensure compliance with coding standards and regulations .Identify and address potential coding errors or discrepancies. I
- Provider Education and Support: Provide guidance and support to healthcare providers on coding and documentation practices.
Address coding-related questions and concerns from providers and staff. - Data Analysis and Reporting: Analyze coding data to identify trends and patterns. Prepare reports on coding performance and compliance.
- Appeal and Denial Management: Review and respond to coding-related denials or appeals from payers. Develop and implement strategies to reduce denials.
- Collaboration: Work collaboratively with other healthcare professionals, including physicians, nurses, and billing staff. Participate in meetings and quality improvement initiatives.
Claims Analyst
Centene Corporation
01.2019 - 11.2021
- Claim Review and Analysis: Review insurance claims for accuracy, completeness, and compliance with company policies and regulatory requirements. Determine eligibility and coverage under insurance policies.
Identify and investigate potential issues, discrepancies, or irregularities in claims. Collect and analyze data related to claims to identify trends and patterns. - Investigation and Resolution: Investigate claims, gather information, and conduct research to determine the validity of claims. Communicate with policyholders, providers, and other stakeholders to resolve issues and answer questions. Negotiate settlements and make recommendations for claim resolution. Process payments and ensure timely and accurate reimbursement.
- Documentation and Record Keeping: Maintain accurate and detailed records of all claims processed. Document findings, investigations, and resolutions. Prepare reports and summaries as needed.
- Compliance and Process Improvement: Stay up-to-date on industry trends, regulatory changes, and company policies. Identify areas for process improvement and make recommendations for enhancing efficiency and accuracy. Collaborate with other departments to resolve complex claims issues.
- Other Duties: May handle patient queries and concerns regarding billing and payment. Review accounts for possible write-offs. Research and appeal denied claims. Analyze complex insurance payments and resolve billing issues.
Insurance Producer
State Farm
10.2017 - 01.2019
- Sales and Client Acquisition: Develop and implement marketing strategies to generate leads and build a client base.
Contact potential clients to discuss their insurance needs and offer tailored solutions. Present and sell various insurance products, including life, health, property, and auto insurance. Negotiate and process insurance policies. - Client Relationship Management: Build and maintain strong relationships with clients. Provide excellent customer service and address client inquiries and complaints promptly. Conduct regular reviews of client policies and suggest adjustments as needed. Assist clients with the insurance claims process.
- Professional Development: Stay informed about the latest insurance products, regulations, and industry trends. Maintain a valid insurance license and meet ongoing education requirements. Continuously improve sales skills and knowledge.
- Other Duties: Maintain accurate records of all sales and client interactions. Monitor client accounts to ensure all policies are up to date. May be involved in field underwriting during the application process.
Education
High School Diploma -
Central High School
Park Hills05-2011
Skills
- Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
- Identify and analyze user requirements, procedures, and problems to improve existing processes
- Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation
- Identify ways to enhance performance management and operational reports related to new business implementation processes
- Develop and incorporate organizational best practices into business applications
- Lead problem solving and coordination efforts between various business units
- Assist with formulating and updating departmental policies and procedures
- Team collaboration
- Customer service
- HCPCS coding
- HIPAA compliance
- Claims processing
- Training and mentoring
- Error reporting
Timeline
Coding Analyst I
Centene Corporation
11.2021 - Current
Claims Analyst
Centene Corporation
01.2019 - 11.2021
Insurance Producer
State Farm
10.2017 - 01.2019
High School Diploma -
Central High School
Similar Profiles
Christiana BootyChristiana Booty
Lead Claims Analyst at Centene CorporationLead Claims Analyst at Centene Corporation
Stephanie DaviesStephanie Davies
Supervisor at Centene CorporationSupervisor at Centene Corporation
Amber D. WikeAmber D. Wike
Care Engagement Specialist at Centene CorporationCare Engagement Specialist at Centene Corporation