Dawn Wallace
Middle River
Summary
Passionate medical professional purposed in providing an excellent foundation for patient care and provider support. Highly organized, detail-oriented medical professional established in coordinating patient support services such as patient screening, registrations, and specialty communications for effective personalized care Active listener, team player, quality focused with ability to multitask Recognized for excellent customer service serving with compassion and empathy Specialized in Inpatient, Observation, Same Day Admit and Discharge Services, and identified social determinants of health that impact a person’s health outcomes Perceived anatomy, physiology, clinical disease processes, and medical terminology needed to identify diagnosis and procedures Developed strong provider and peer relationships through collaborative efforts and mentorship Understood and adhered to CMS, Medicaid, and Commercial payer policies. Assembled presentations, curriculum, and ongoing training initiatives for provider and patient educations Epic, Microsoft Office, Word, Power Point, and Excel Skilled in providing efficient and compassionate patient service, with a background in patient access associate roles. Experienced in managing patient registration, verifying insurance coverage, and scheduling appointments. Strengths include ability to handle high-stress situations, excellent interpersonal skills, and proficient use of medical software. Brought significant improvements to patient satisfaction and streamlined processes in previous positions.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Coding Compliance Auditor & Educator
UMMS St Joseph Medical Center
01.2022 - 01.2024
- Conducted compliance audits to ensure regulatory adherence in healthcare operations.
- Reviewed policies and procedures for compliance with state and federal regulations.
- Collaborated with departments to implement corrective action plans for compliance issues.
- Evaluated documentation practices to maintain accurate records and reporting standards.
- Provided training sessions on compliance regulations for staff members across departments.
- Analyzed audit findings to identify trends and areas for improvement in processes.
- Assisted in the development of internal controls to mitigate compliance risks effectively.
- Drafted comprehensive reports detailing audit results and recommendations for management review.
- Developed audit plans for evaluating compliance with regulatory requirements.
- Provided training on new policies and procedures related to compliance initiatives.
- Maintained up-to-date knowledge on relevant laws, regulations, guidelines, and standards.
- Prepared audit reports summarizing results of evaluations for management review.
- Assisted in the development of policies and procedures designed to comply with federal regulations.
- Participated in special projects as assigned by leadership team involving compliance issues.
- Identified areas of non-compliance and recommended corrective action plans.
- Presented audit results to management teams, delivering information in non-technical terms for easy understanding.
Medical Coder
UMMS St Joseph Medical Center
01.2017 - 01.2022
- Reviewed medical records for accuracy and compliance with coding guidelines.
- Assigned appropriate codes to diagnoses and procedures using ICD-10 and CPT systems.
- Collaborated with healthcare providers to clarify documentation and coding queries.
- Utilized electronic health record systems for efficient data entry and retrieval.
- Educated staff on coding updates and changes in healthcare regulations.
- Resolved discrepancies in coding through effective communication with billing departments.
- Maintained up-to-date knowledge of coding practices and industry developments.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Maintained high accuracy rate on daily production of completed reviews.
- Maintained up-to-date knowledge of coding changes, updates, and new rules.
- Verified proper coding, sequencing of diagnoses, and accuracy of procedures.
- Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
- Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
- Verified accuracy of procedure codes to ensure proper reimbursement levels.
- Communicated with healthcare personnel, including practitioners to promote accuracy.
- Quickly responded to staff and client inquiries regarding CPT codes.
- Collaborated with other departments such as billing, clinical documentation improvement, quality assurance to ensure accurate coding practices are being followed.
- Researched discrepancies between documentation and billing information in order to resolve any issues prior to submission.
- Educated healthcare staff on coding standards and changes in coding guidelines.
- Participated in coding team meetings to discuss challenges and best practices.
- Coordinated with billing department to clarify billing issues related to coding.
- Entered coded data into electronic health record (EHR) systems.
- Utilized ICD-10, CPT, and HCPCS coding systems to process claims and billing.
- Maintained confidentiality of patient information according to HIPAA regulations.
Patient Access Associate- Team Leader
Medstar Franklin Square Hospital
01.2005 - 01.2017
- Greeted patients and verified insurance information for timely registration.
- Assisted patients with financial inquiries and payment processing options.
- Managed medical records and ensured compliance with privacy regulations.
- Collaborated with clinical staff to streamline patient access processes.
- Verified demographics and insurance information to register patients in computer system.
- Utilized electronic health record systems to update patient information accurately.
- Educated patients on necessary documentation for services received.
- Applied HIPAA privacy and security regulations while handling patient information.
- Obtained necessary signatures for privacy laws and consent for treatment.
- Assembled registration paperwork and placed identification bands on patient.
- Applied knowledge of payer requirements and utilized on-line eligibility systems to verify patient coverage and policy limitations.
- Resolved any issues that arose during registration process in a timely manner.
- Answered telephone calls promptly, routing them to appropriate personnel as necessary.
- Attended departmental meetings regularly to stay updated on policy changes.
Education
American Academy of Professional Coders- AAPC
Salt Lake City, UTSkills
- Attention to detail
- Effective communication
- Proficiency in Teletracking, HDX EVS, SMS Cerner Amnion, IDX, Epic, and 3M
- HIPAA compliance
- Patient registration and insurance verification
- Electronic health records management
- Healthcare customer service
- Team collaboration
- Medical coding expertise
- Compliance auditing
Affiliations
- American Academy of Professional Coders- AAPC
- AAPC Charm City Baltimore East Chapter- Vice President
- National Alliance Medical Auditing Specialist- NAMAS
Certification
- Certified Professional Coder- CPC
- Certified Inpatient Coder- CIC
- Certified Professional Medical Auditor- CPMA
- Certified Professional Pediatric Coder- CPEDC
- Certified Risk Adjustment Coder- CRC
Accomplishments
- Introduced a process improvement that resulted in increased patient satisfaction.
- Hosted networking events that increased membership and promoted community awareness.
References
Upon Request
Timeline
Coding Compliance Auditor & Educator
UMMS St Joseph Medical Center
01.2022 - 01.2024
Medical Coder
UMMS St Joseph Medical Center
01.2017 - 01.2022
Patient Access Associate- Team Leader
Medstar Franklin Square Hospital
01.2005 - 01.2017
American Academy of Professional Coders- AAPC