KAYLA SEXTON
Pine Top,KY
Summary
Certified Professional Coder (CPC) with 10 years of successful experience in coding auditing and medical billing across diverse clinical environments. Recognized for consistent performance excellence and contributions to operational accuracy and compliance. Extensive strengths in Behavioral and Mental Health, Pro Fee Family and Internal Medicine, Pediatrics, Urgent Care, Outpatient and RHC coding, as well as hospital‑based inpatient/outpatient Pro Fee services. Additional background includes Urology, Telemedicine, Critical Care, Endocrinology, and Infectious Disease, supporting a wide range of specialty coding needs.
Collaborative and engaged leader dedicated to fostering an empowering work culture and partnering effectively with multidisciplinary teams. Documented ability to build and maintain strong relationships with physicians, healthcare providers, and insurance companies in fast‑paced, dynamic settings. Highly organized professional with deep knowledge of medical terminology, disease processes, and coding systems, ensuring accurate code assignment and adherence to regulatory guidelines.
Overview
1
1
Certification
20
20
years of professional experience
Work History
Coding Manager
UWVM
01.2024 - Current
- Led cross-functional teams to enhance software development processes and improve project delivery timelines.
- Implemented coding standards and best practices, ensuring high-quality outputs across multiple projects.
- Mentored junior developers, fostering skill growth and promoting collaborative problem-solving approaches.
- Streamlined code review processes, resulting in increased efficiency and reduced error rates in software releases.
- Conducted regular performance assessments, providing feedback to enhance team productivity and individual contributions.
- Developed comprehensive documentation to ensure consistency in coding practices across the team.
- Performed coding quality reviews and tracked, trended and managed coding quality performance.
- Conducted credible research to supply current, relevant, reliable and factual detail.
- Led regular code review sessions to maintain high-quality output and identify areas for further development.
- Conducted thorough audits of coding practices, identifying opportunities for optimization and streamlining processes.
- Reduced coding errors significantly by implementing a rigorous quality assurance process to catch discrepancies before final submission.
- Attended facility meetings and reported on performance.
- Collaborated with cross-functional teams to optimize the coding process, resulting in improved accuracy and quality.
- Participated in hiring and training coding team.
- Ensured compliance with relevant regulations by staying current on updates related to ICD-10-CM/PCS guidelines, CPT codes, HCPCS Level II codes, modifiers usage rules.
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Interacted with physicians and other healthcare staff to for education an compliance
- Generated reports to identify coding trends and discrepancies.
Coder II
UWVM
07.2022 - 01.2024
- Performed accurate coding of patient records according to established guidelines and regulations, utilizing ICD-10-CM, CPT, HCPCS codes.
- Evaluated medical record content for the purpose of determining code selection based on accepted coding principles.
- Participated in quality assurance activities such as chart audits and reviews.
- Reviewed clinical documentation to ensure accuracy and completeness prior to assigning appropriate codes.
- Managed workload efficiently by prioritizing tasks according to urgency and importance.
- Maintained confidentiality of all medical records in accordance with HIPAA regulations.
- Attended continuing education courses in order to stay up-to-date on changes in healthcare industry standards and regulations.
Physician Coder
Himagine Solutions, US
09.2021 - 06.2022
- Maintained accuracy, completeness and security for medical records and health information.
CPC
Frontier Medical Associates, Prestonsburg
05.2017 - 09.2021
- Experienced With Medical Terminology and Authorizations.
- Knowledge of various Insurance companies and their policy on billing and coding.
- Done all aspects of billing as in working denials, rejections from clearinghouse Working payments received from insurance company and from clients.
- Interact with physicians to make sure we are documenting and coding visits to best of our abilities.
- Communicated effectively with staff, patients and insurance companies by email and telephone.
- Reviewed charts and flagged incomplete or inaccurate information.
- Used classification manuals to gain additional knowledge of disease and diagnoses processes.
- Abstracted data to code to best of my ability for several areas in which our facility’s offer EX (Behavioral Health, IP, OP, OBS, Pro fee, Pediatrics, Nursing facility, Lab, Radiology) Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Resourcefully used various coding books, procedure manuals and on-line encoders.
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Used ECW, Medi tech, to assign procedure and diagnostic codes to patient records for billing purposes.
Medical Auditor
RSM CODING, NY, US
03.2020 - 04.2021
- Prepared working papers, reports and supporting documentation for audit findings.
- Completed audit papers by thoroughly documenting audit tests and findings.
- Maintained patient confidence by keeping patient records information confidential.
- Maintained patient records in compliance with security regulations.
- Reviewed charts and flagged incomplete or inaccurate information.
- Processed medical records requests from outside providers according to facility, state and federal law.
- Maintained historical reference by abstracting and coding clinical data such as diseases, operations, procedures and therapies with standard classification systems.
Medical Biller/Collector/Authorizations
Potter Medical Clinic, Lackey
02.2016 - 05.2017
- Have worked successful with several insurance companies included but not limited to Medicare, Medicaid and Compensation in prior authorization of various medical test that included echo, MRI, CT.
- Have great knowledge of medical terminology and coding of diagnosis to help me properly authorize these examinations.
- Have also billed office visits and related procedures done within office setting to these companies.
- Have completed numerous appeals and rebilling cycles for items that had went left unpaid from insurance company.
- Handled all of prior authorization that was needed for medication within office.
- Answered phone calls from patients and insurance companies on daily basis.
Office Assistant
Bluegrass Heritage Group, Whitesburg
10.2012 - 09.2015
- Answered phones, made and scheduled appointments.
- Kept office stocked with all essential items.
- I ran errands, dropped off paperwork.
- I faxed, emailed helped with filing out of all required documents for apply of insurance.
- I cleaned and kept clean office.
- I talked to customers about different areas of coverage we provided.
- I updated our website on weekly basis.
- I assisted customers on various plans that are offered within company.
Lab Technician
Pikeville Medical Center, Pikeville
07.2010 - 02.2012
- Injuries and medical conditions by providing clinical testing and specimen analysis.
- Prepare chemical solutions, reagents and specimens for microscopic examination; perform laboratory tests; analyze and report findings; and investigate atypical results and discrepancies to determine causation.
Assistant Manager/Photographer
Olan Mills, KY, US
08.2008 - 08.2010
- Some of my job duties included bringing customers into the store, talking with customers on the phone an in person on a daily basis.
- I photographed small and large groups of people on a daily basis.
- I ran numerous computers and helped customers select merchandise based on their needs and wants.
- I handled money and deposited it every night.
- Informed customers about current sales and promotions in a friendly and engaging manner.
- Managed wide variety of customer related problems and administrative tasks to resolve customer issues quickly and efficiently.
Assistant Manager
PCA, KY, US
03.2006 - 07.2008
- Trained new employees on company customer service policies and service level standards.
- I traveled to all the stores within the district an trained these new employees.
- I worked with customers an resolving an issues the customer may have at each of these locations.
- Recommended and helped customers select merchandise based on their needs.
- Confirmed that appropriate changes were made to resolve customers’ problems.
Education
MBA - Business Administration And Management
Midway University
Midway, KY06-2022
BBA -
Midway University
Midway, KY01-2021
Associate of Applied Science -
Hazard Community And Technical College
Hazard, KY01-2010
Skills
- Medical Billing (6 years)
- Medical Terminology (6 years)
- Document management
- Attention to detail
- Problem-solving abilities
- Excellent communication
- Team collaboration
- Medical Billing
- Medical Terminology
- Healthcare Common Procedures Coding System (HCPCS)
- Attention to Detail
- ICD-10 Coding
- Verbal and written communication
Certification
- CPC - Certified Professional Coder since 2017
- Behavioral Health Training - 2019
- Rural Health Clinic Training - 2018
Timeline
Coding Manager
UWVM
01.2024 - Current
Coder II
UWVM
07.2022 - 01.2024
Physician Coder
Himagine Solutions, US
09.2021 - 06.2022
Medical Auditor
RSM CODING, NY, US
03.2020 - 04.2021
CPC
Frontier Medical Associates, Prestonsburg
05.2017 - 09.2021
Medical Biller/Collector/Authorizations
Potter Medical Clinic, Lackey
02.2016 - 05.2017
Office Assistant
Bluegrass Heritage Group, Whitesburg
10.2012 - 09.2015
Lab Technician
Pikeville Medical Center, Pikeville
07.2010 - 02.2012
Assistant Manager/Photographer
Olan Mills, KY, US
08.2008 - 08.2010
Assistant Manager
PCA, KY, US
03.2006 - 07.2008
MBA - Business Administration And Management
Midway University
BBA -
Midway University
Associate of Applied Science -
Hazard Community And Technical College