NAKAI KANOYANGWA
Burlington
Summary
Accomplished Certified Medical Coder with extensive 9-year background in Risk Adjustment coding and auditing for Medicare Advantage, Affordable Care Act, and Medicaid Managed Care, committed to applying expertise in ICD-10-CM and HCC Coding to advance coding precision and improve risk adjustment performance, enhancing reimbursement and compliance.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Risk Adjustment Auditor
DATAVANT
05.2022 - Current
- Identify and evaluate clinical documentation gaps by reviewing provider supplied documentation and ICD-10-CM diagnoses codes assigned by vendor.
- Validate clinical documentation can support the risk adjustment codes assigned by vendor, including HCCs, with emphasis on clinical relevance.
- Apply ICD-10-CM guidance, Coding Clinic guidance, and company policies to ensure accurate and compliant coding practices, incorporating clinical judgment to assess documentation sufficiency.
- Effect CMS risk adjustment guidelines oversight and analyze clinical documentation to ensure alignment with regulatory standards and coding compliance.
- Review rebuttals submitted by coders, provide education to the coders if the errors are correct or send the rebuttals through the process if the coders’ initial coding were correct.
- Track trends and report on findings.
- Worked independently on multiple projects and met deadlines.
- Maintain updated knowledge of coding requirements, which includes continuing education and certification renewal.
Senior Risk Adjustment Coder
OPTUM
08.2019 - 05.2022
- Translate clinical documentation into appropriate codes that express the complexity and severity of a patient’s health status.
- Review medical records to identify and code diagnoses using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes.
- Assess, analyze, and capture diagnostic information in a patient's medical record based on client specific guidelines for the project.
- Ensure compliance with acknowledged ICD-10-CM guidance, Coding Clinic updates, CMS reimbursement policies, regulations, and guidelines.
- Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10-CM codes and HCC categories.
- Report trends on documentation deficiencies or coding barriers to management.
Risk Adjustment Coder
CHANGE HEALTHCARE
04.2016 - 01.2021
- Review provider documentation of diagnostic data from medical records to verify that all MA, CDPS, and ACA requirements are met.
- Perform code abstraction of medical records to ensure ICD-10-CM codes are accurately assigned and supported by the clinical documentation to ensure adherence with CMS guidelines.
- Utilize appropriate coding guidelines (i.e. ICD-10-CM, Coding Clincs, CMS, and client specific guidelines) and recommend any changes to diagnoses codes based on chart review.
- Identify coding trends that impact reimbursement or compliance.
- Assist in process improvement for documentation accuracy and clean claim rates.
- Maintain competency in evolving areas of coding guidelines and risk adjustment reimbursement reporting requirements.
Patient Financial Services Representative
UNC PHYSICIANS AND ASSOCIATES
Chapel Hill
09.2001 - 11.2014
- Prevent untimely revenue shortfalls by taking action to resolve financial transactions appropriately and effectively to ensure collection of expected payments, escalate issues when appropriate.
- Complete daily work assignments timely and accurately in accordance with the identified productivity and quality standards set forth by the organization.
- Understand expected payment amounts based on insurance coverage and ensure that (payments, copays, coinsurance, deductibles, adjustments, and deductions) they post accurately to patients’ accounts.
- Analyze and resolve insurance correspondence for unpaid claims.
- Thorough research and resolution of identified payment discrepancies in a timely manner including identifying and correcting posting errors (i.e. money applied to wrong account or not posted correctly to account).
- Post payments by recording cash, checks, and credit card transactions.
- Review overpayment report and process refund checks accordingly.
- Supervise and oversaw large volumes of data with extreme accuracy each day.
- Research customer billing issues and resolve problems to facilitate receipt of overdue monies and promote good customer relationships.
Education
Medical Billing and Coding -
Ashworth College
Norcross, GA01.2014
Bachelor of Science - Business Administration
Ashworth College
Norcross, GA01.2013
Skills
ICD-10-CM Coding
HCC Coding
Medical Terminology
EMR Systems
EMR Formats:
- Athena
- Epic
- Cerner
- SES
- Nextgen
- Allscripts
ACA/HHC Coding
Outpatient and Inpatient Risk Adjustment Coding
Encounter Documents:
- Progress Notes
- Telehealth Visits
- Consultation Notes
- H&P Notes
- Discharge Summaries
- OP Notes
- ER Notes
- Diagnostic Studies
- Pathology Reports
- Colonoscopies
- Physician Assessment Forms
Specialty Types:
- General Practice
- General Surgery
- Urology
- Cardiology
- Dermatology
- Addiction Medicine
- Gynecology
- Ophthalmology
- Physical Therapy
- Interventional Radiology
- Psychiatry
- Psychology
- Audiology
- Hospice and Palliative Care
- Plastic and Reconstructive Surgery
- Physical Medicine and Rehabilitation
- Radiation Oncology
- Neurology
- Rheumatology
- Nuclear Medicine
- Pediatric Medicine
- Infectious Disease
- Chiropractic
- Anesthesiology
- Sleep Medicine
- etc
Certification
- AAPC - Certified Professional Coder (CPC)
- AAPC - Certified Inpatient Coder (CIC)
Timeline
Risk Adjustment Auditor
DATAVANT
05.2022 - Current
Senior Risk Adjustment Coder
OPTUM
08.2019 - 05.2022
Risk Adjustment Coder
CHANGE HEALTHCARE
04.2016 - 01.2021
Patient Financial Services Representative
UNC PHYSICIANS AND ASSOCIATES
09.2001 - 11.2014
Medical Billing and Coding -
Ashworth College
Bachelor of Science - Business Administration
Ashworth College