V. LEANNE ROTTER
Holts Summit
Summary
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
31
31
years of professional experience
1
1
Certification
Work History
Reimbursement Consultant
University of Missouri School of Medicine - Pediatric - Family Community Medicine
10.2022 - Current
- Generated detailed reports summarizing financial performance metrics associated with reimbursements received.
- Fostered strong relationships with external providers in order to promote accurate claim submission processes.
- Drafted correspondence with payers regarding denied claims, appeals, and other issues.
- Developed an understanding of Medicare and Medicaid reimbursement policies and procedures.
- Identified potential billing errors or discrepancies within medical records documentation.
- Conducted audits to ensure accuracy of claims submitted by providers for payment.
- Researched industry best practices related to coding and billing processes.
- Recommended process improvements based on research findings concerning current reimbursement trends.
- Reviewed patient charts prior to claim submission in order to verify accuracy of diagnosis codes used.
- Performed analysis on provider contracts in order to maximize reimbursement opportunities.
- Led training sessions on proper coding techniques for staff members responsible for entering claims information into systems.
- Ensured company compliance with federal and state laws, including reporting requirements.
- Compiled department-specific reports to help senior managers identify trends and improve progress.
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Performed Missouri and federal regulations compliance audits related to documentation and reporting.
- Guided office staff on how to effectively complete prior authorization forms and appeals documentation to achieve positive results.
- Built proactive, client-specific edits into system to prevent future denials.
- Employed clinical and billing codes expertise to correct billing inconsistencies.
- Helped minimize escalations by reaching out to clients in advance of expected problems.
- Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
- Delivered timely information to insurance representatives to resolve common and complex issues.
- Delinquency reports for missing and/or incomplete documentation with communication to clinicians.
- Resolved and clarified codes and diagnoses with conflicting, missing and unclear information by consulting with clinicians and others and by participating in coding team's regular meetings.
- Protected security of medical records to ensure that confidentiality was maintained.
- Review documentation for completeness, accuracy and compliance with hospital policies and regulations.
- Ability to manage multiple tasks while remaining adaptable and flexible.
- Provided efficient and courteous service to clinicians, coders, and leadership always.
- Provide documentation and coding education to clinicians and coders.
- Data analytic gathering for completion of audits on coding and clinician documentation.
- Serve as a confidential point of contact for employees seeking clarification on issues.
- Identify compliance issues that required follow-up or investigation.
- Prevented delays and claim denials by correcting information prior to submission.
- Other duties assigned by Director.
Certified Medical Coding Specialist
University of Missouri School of Medicine - Orthopaedic Surgery
10.2021 - 10.2022
- Resolved and clarified codes and diagnoses with conflicting, missing and unclear information by consulting with doctors and others and by participating in coding team's regular meetings.
- Protected security of medical records to ensure that confidentiality was maintained.
- Reviewed records for completeness, accuracy and compliance with regulations.
- Demonstrated ability to manage multiple tasks while remaining adaptable and flexible.
- Provided efficient and courteous service to providers, coders and leadership at all times.
- Provide education to providers and coders.
- Coding both Inpatient and Outpatient records.
- Edit resolution.
- Reject resolution.
- Quality Assurance on department coders.
- Other duties assigned by Supervisor.
Compliance Analyst
MU Health Care
08.2007 - 06.2021
- Prepared reports of activities, evaluations, recommendations and decisions.
- Identified compliance issues that required follow-up and investigation.
- Provided assistance to internal and external auditors in compliance reviews.
- Verified documentation, implementation and communication of firm and regulatory policies and procedures.
- Provided efficient and courteous service to customers at all times.
- Defined problems, collected data, established facts and validated conclusions.
- Regulatory audits on all billable clinicians both inpatient and outpatient, all coders within the system to ensure appropriate coding and documentation.
- Identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
- Provide employee training on compliance-related topics, policies and procedures.
- Reports to the relevant leaders and helping to proactively address problems and restored compliance.
- Served as a confidential point of contact for employees seeking clarification on issues.
- Identified compliance issues that required follow-up or investigation.
Reimbursement Consultant
University of Missouri School of Medicine Professional Coding and Revenue
08.2009 - 07.2013
- Ensured company compliance with federal and state laws, including reporting requirements.
- Provided employee training on compliance topics, policies and procedures to ensure proper coding and documentation for the best revenue.
- Supervised 6 employees to ensure precise coding and/or related rejections completion.
- Data Analytic gathering for completion of audits on coding as well as provider documentation.
- Education to coders and providers regarding rules/regulations changes.
Sr. Reimbursement/Coding Specialist
St. Mary's Physician Billing
06.1995 - 08.2007
- Supervision 5 employees to ensure precisely completed appropriate claims paperwork, documentation and system entry.
- Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
- Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
- Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.
- Researched questions and concerns from providers and provided detailed responses in timely manner.
- Conscientiously reviewed medical record information to identify appropriate coding based on CMS.
- Initiated, performed and documented quarterly coding audits for providers.
- Interaction with providers regarding billing and documentation policies, procedures and regulations.
Education
Lincoln University
Jefferson City, MO01.2004
Cosmetology - undefined
Merrill University of Cosmetology
Jefferson City, MO07.1994
Skills
- CPT Code Modifiers
- Coding Diagnoses
- Certified Professional Coder
- Patient Data Coding
- Procedural Coding
- EMR Systems
- Charting and Clinical Documentation
- Cognos Data
- Power BI Data
- Patient confidentiality
- Clinical documentation
- Documentation review
- Medical billing
- Software applications
- HCPCS coding
- Medicare regulations
- Medicaid regulations
- Provider education
- Anatomy and physiology
- ICD-10 coding
- Microsoft office
- Data recording
- Policy analysis
- Teamwork and collaboration
- Multitasking
- Problem-solving
- Attention to detail
- Time management
- Organizational skills
- Excellent communication
- Adaptability and flexibility
- Reliability
- Self motivation
- Professionalism
- Task prioritization
- Analytical thinking
Certification
CPC
Timeline
Reimbursement Consultant
University of Missouri School of Medicine - Pediatric - Family Community Medicine
10.2022 - Current
Certified Medical Coding Specialist
University of Missouri School of Medicine - Orthopaedic Surgery
10.2021 - 10.2022
Reimbursement Consultant
University of Missouri School of Medicine Professional Coding and Revenue
08.2009 - 07.2013
Compliance Analyst
MU Health Care
08.2007 - 06.2021
Sr. Reimbursement/Coding Specialist
St. Mary's Physician Billing
06.1995 - 08.2007
Cosmetology - undefined
Merrill University of Cosmetology
Lincoln University