Job Search Status
Open to workDesired start date: Immediately
Open To Work
Jacquelyn Gorman
Butler
Work Preference
Summary
Dedicated healthcare professional skilled in HCC risk adjustment coding and revenue cycle management. Proven ability to review medical records for compliance, achieve high coding accuracy, and enhance communication with providers, driving improvements in organizational success and patient care quality.
Overview
9
9
years of professional experience
1
1
Certificate
Work History
Coding Specialist II, ICD-10 and HCC Coding
Signify Health
01.2024 - 01.2025
- Reviewed health risk evaluations to accurately and completely assign all supported ICD-10 codes
- Assessed accuracy, completeness, and appropriateness of diagnosis codes, contributing to coding integrity
- Maintained coding accuracy rate of 95% and above
- Demonstrated proficiency with electronic health records (EHR) and coding software systems, ensuring accurate and compliant coding practices.
- Maintained up-to-date knowledge of coding and reimbursement procedures to support Medicare Risk Adjustment initiatives
- Understand the relationship between ICD-10 and HCC (Hierarchical Condition Category) coding
- Demonstrated commitment to integrating coding compliance standards into coding practices
- Find, correct, and report coding problems
- Completed special projects to enhance operational efficiency
- Maintained productivity rate of 65 charts per day or 325 charts per week
- Made recommendations for coding policy/changes.
- Maintained all coding certification status
- Worked remotely to manage coding tasks and communication effectively.
Hierarchical Condition Category (HCC) Coder
Highmark, Inc.
04.2017 - 07.2023
- Prospective Medicare Advantage (MA) HCC Risk Adjustment Coding and Retrospective NLP Production Coding
- Reviewed medical records to accurately identify diagnoses for HCC coding, improving compliance and reimbursement accuracy
- Assigned exact ICD-10 diagnosis codes based on supporting documentation
- Demonstrated proficiency with electronic health records (EHR) and coding software systems, ensuring accurate and compliant coding practices
- Achieved RPM 95% coding accuracy while meeting productivity expectations
- Collaborated with healthcare providers
- Resolved coding discrepancies and issues in collaboration with coding and QA staff
- Assisted with regulatory audits
- Adapted to various coding projects across different specialties
- Recommended process improvements that enhanced coding efficiency and reduced discrepancies
- Stayed informed about coding updates, attended training sessions, and took part in quality improvement activities
- Engaged in provider meetings and education
- Co-presented educational presentation at RPM annual coding conference in 2021
- On the planning committee for the 2022 annual coding conference
- Maintained patient confidentiality and adhered to HIPAA regulations
- Worked remotely from a home office
Billing & Coding Specialist
Dental Systems, Inc.
Butler
10.2015 - 04.2017
- Dental and Orthodontic Revenue Cycle Management
- Accurately assigned ICD-10 and CPT codes to oral surgery procedures
- Verified insurance coverage and secured prior authorizations to facilitate timely patient treatment
- Prepared and sent claims to payers in a prompt and accurate manner
- Demonstrated proficiency with electronic health records (EHR) and coding software systems, ensuring accurate and compliant coding practices.
- Ensured all billing and coding practices were compliant with ICD-10, CPT, CDT, state, and federal regulations
- Monitored accounts receivable and initiated appeals for denied claims to maximize revenue recovery
- Identified and escalated potential compliance issues to management to ensure adherence to regulatory standards
- Communicated effectively with providers, payers, and other healthcare professionals
- Maintained patient confidentiality and data security
- Adhered to HIPAA regulations
- Significantly reduced 90-day and older accounts for my assigned offices
- Rewrote office manual for converting dental to medical claims in Dentrix
Education
Bachelor of Science - Healthcare Administration
Southern New Hampshire University
Manchester, NH10-2022
Certificate - Medical Billing & Coding
Butler County Community College
Butler, PA08-2016
Skills
- HCC Medicare risk adjustment coding
- ICD-9-CM and ICD-10-CM
- Current procedural terminology (CPT-4) and
- Medical record review and CDI documentation improvement
- Coding compliance
- RCM and billing
- A/R and authorizations
- Benefit verifications
- Electronic health records (EHR)
- Microsoft Office 365 suite
- Zoom and virtual collaboration tools
- Analytical and critical thinking
- Problem-solving and decision-making
- Organization and time management
- Team management and supervision
- Communication skills
- Exceptional work ethic
Certification
- Certified Professional Coder (CPC)
- Certified Risk Adjustment Coder (CRC)
Affiliations
- American Academy of Professional Coders (AAPC)
- Healthcare Financial Management Association (HFMA)
Quote
Opinion is the wilderness between knowledge and ignorance.
Plato
Timeline
Coding Specialist II, ICD-10 and HCC Coding
Signify Health
01.2024 - 01.2025
Hierarchical Condition Category (HCC) Coder
Highmark, Inc.
04.2017 - 07.2023
Billing & Coding Specialist
Dental Systems, Inc.
10.2015 - 04.2017
Bachelor of Science - Healthcare Administration
Southern New Hampshire University
Certificate - Medical Billing & Coding
Butler County Community College