Tammy Nees, CPC, CPC-H (currently studying for C.P.C.O.) 19820 N 13th Ave #232 Phoenix, AZ 85027(602) 903-0897zengal71@yahoo.com

Partners in Primary Care/Humana - Mesa, AZ November 2014 to currentTitle: HCC Coding Analyst/Provider EducatorRecord and educate through targeted audits any deficiencies/discrepancies in accordance with CMS guidelines. Provider one on one training to eleven Primary Care Providers on documentation for the purpose of collecting MRA HCC relevant conditions. Direct information between regional Medical Director and Humana PiPC market representatives regarding risk scores, STARS ratings and best practice guidelines.

Banner Medical Group - Mesa, AZ June 2014 to November 2014Title: Coding EducatorAnalysis of physician documentation for data accuracy and reporting. Record and track documentation deficiencies/discrepancies in accordance with CMS guidelines. Educate practitioners on relevant findings to achieve compliant minded patient records. Create and present PowerPoint educations that target practice development of best practice habits for coding and documentation. Work in conjunction with Department Head to bridge gap between coding language and clinician language interpretations. Assist with policy and procedure composure for new department within Banner Medical Group. Integrated Medical Services – Phoenix, AZ January 2014 to June 2014 Title: CoderPre visit review of daily charges validating correct E&M level and ICD-9 codes prior to submission. Educate practitioners regarding documentation accuracy and ICD 10 preparedness. Work closely with A/R department on claims denials/ resubmissions with coding corrections as needed. Track tends in denials and update coding department with findings as applicable. *Position will be downsized on 6/30/2014*

Cigna Medical Group (contractor via Kaztronix) – Phoenix, AZ October 2013 to January 2014Title: CoderProspective review of daily charges identifying HCC diagnosis for CMS submission. Retrospective review of prior year documentation for potential HCC missed opportunities. Query providers regarding documentation deficiencies. Research and complete, as applicable, provider requests for deleting non substantiated diagnoses on patient accounts.

Lifeprint/United Healthcare – Phoenix, AZ July 2010 to April 2013Title: Senior Coding AnalystFocused analysis of physician documentation for Medicare Risk Adjustment data accuracy and reporting. Record and track documentation deficiencies/discrepancies in accordance with CMS guidelines. Educate practitioners on relevant findings to achieve compliant minded patient records. Identify trends of recurrent data irregularities for targeted practice development. Work

in conjunction with Medical Director to bridge gap between coding language and clinician language interpretations. Template provider correspondence letters (i.e. clarification of documentation, denials) and tracking methods to assure program compliance in submitted data to CMS. Assist with policy and procedure composure for newly established Optum line of business. *Position will be downsized on 5/30/2013*

Abrazo HealthCare – Phoenix, AZ July 2009 to July 2010Title: Physician Hospitalist CoderAudit physician billing for coding accuracy. Assist in developing education programs for physicians for compliance and accuracy. Educate physicians on a one on one basis with reviews specific to their individual needs/goals to have documentation compliant. Work with claims processors to finalize unpaid claims. Research denials for appeal (e.g. InterQual criteria). Post charge entry and support team members with other claims issues as needed.

TriWest Healthcare Alliance – Phoenix, AZ October 2005 to July 2009 Title: DRG ValidatorRetrospective reviews of inpatient charges to validate DRG payments, utilizing 3M and Coding Clinic guidelines. Weekly collaboration with Medical Director to review and approve coding/payment changes and denials. Provide training for department as new procedures are developed (CFR, CMS, etc.). Collaborate with legal division in reference to provider correspondence (i.e. take backs). Extensive utilization of The Commission, CFR, InterQual, Stark Law and the like, for referring potential issues to Program Integrity Division.

SunHealth Corp. - Sun City West, AZ August 2003 to October 2005Title: BillerBill hospital charges for contracted providers. Research outstanding accounts and correspond with insurance companies. Run monthly receivable reports for finance. Work with provider contracting on provider issues.

JLA (an OSI company) - Phoenix, AZ September 2002 to August 2003Title: Billing SpecialistDistribute Medicaid claims for out of state hospital services. Evaluate and submit authorization paperwork to various states. Investigate unpaid claims for client updates. Request necessary documentation from clients for claim submission. Process incomplete accounts for write off approval.

Blue Shield of California - El Dorado Hills, CA October 2001 to August 2002Title: Triage SpecialistProcess complex claims requiring extensive analysis and verification. Compile and organize supporting documentation for Care Management. Monitor and review aging of periodic reports.

Collect and present monthly production information to the department. Interpret contract information for disposition and payment. Implement retrieval of overpayments.

Shingle Springs Tribal Health - Shngle Sprngs, CA September 2000 to October 2001Title: Assistant Office ManagerDistribute claims to all payers for medical, dental and podiatry services. Follow up unpaid claims and provide necessary documentation for reimbursement. Authorize financial agreements for cash accounts. Full charge of collections for patient balances. Apply payments/credits to appropriate accounts. Balance and process weekly cash deposit. Report month end totals to fiscal department. Troubleshoot computer problems. Update staff on corporate compliance measures. Provide back up to various departments as needed.

Healthcare Financial Staffing – Sacramento, CA September 1997 to September 2000Tile: Contract Employee Temporary employee filling positions such as: Claims Auditor, Insurance Biller, CSR and Data Analyst/ Research Specialist. Subcontracting to insurance companies, hospitals, and physicians i.e.: Mercy Healthcare CHW, Sutter Hospital, Marshall Hospital/IPA, FPA, Blue Cross, MCS, Cigna and UC Davis.

Foundation HealthCare - Rancho Cordova, CA September 1996 to August 1997Title: Claims AuditorInitially processed IPA physician claims, authorized payment for medical, hospital and anesthesia claims, generated explanation of benefits for denied claims, update contractual agreements with participating groups. Promoted to Champus provider division. Physician support interpreting Champus policy/procedures, claim reimbursement and grievance issues. Inform beneficiaries of coverage limitations and changes.

Molina Medical Centers - Sacramento, CA March 1995 to August 1996Title: Insurance BillerDistributed claims for all Northern California clinics to various payers. Managed GMC billing for Medi-Cal services. In charge of collections for cash accounts. Researched unpaid claims and provided documentation for reimbursement. Submitted monthly reports to corporate office. Implemented program to cross train employees for our department. Updated management on compliance issues.

IvaCare Inc. - Placerville, CA October 1992 to March 1995Title: Insurance Biller

Distributed claim for home infusion and DME services. Negotiated reimbursement rates for workers compensation cases. In charge of collections on cash accounts. Researched denied claims and provided documentation for reimbursement. Provided monthly profit reports to franchise director. Evaluate and submit authorization paperwork (i.e.: TARS). Annually prepare year-end budget report for C.E.O. and following years projected expenses.