Tiffany Vaughn, CPC
Louisville
Summary
Experienced in medical coding and auditing, with a focus on conducting initial validation audits and ensuring compliance with coding standards. Proficient in reviewing clinical data to assign ICD, CPT, and HCPCS codes, while maintaining accuracy in patient and insurance information. Knowledgeable in applying coding rules established by the American Medical Association and Centers for Medicare and Medicaid Services. Committed to ongoing education and certification renewal to stay current with evolving coding requirements.
Overview
14
14
years of professional experience
Work History
Medical Records coder/auditor
Cognisight via W3R Consulting
06.2022 - 09.2024
- Initial Validation Audits, Coding and auditing medical records, reporting HCCs and RxHCCs approved by Medicare for clients.
- Conducted code reviews to ensure adherence to coding standards and best practices.
- Reviewed clinical data from medical records to assign ICD, CPT, and HCPCS codes.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
- Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
- Maintained updated knowledge of coding requirements, which included continuing education and certification renewal.
Medical Records coder/auditor
AdvantMed
Santa Ana
02.2021 - 04.2022
- Coding and auditing medical records, reporting HCCs and RxHCCs approved by Medicare for clients.
- Conducted code reviews to ensure adherence to coding standards and best practices.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
- Reviewed patient records and assigned accurate codes for diagnoses and procedures.
Medical Records coder/auditor
AdvantMed (formally RecordFlow)
Santa Ana
09.2015 - 04.2016
- Coding and auditing medical records, reporting HCCs and RxHCCs approved by Medicare for clients, HEDIS measures reviewer, ACO measures.
- Conducted code reviews to ensure adherence to coding standards and best practices.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Reviewed clinical data from medical records to assign ICD, CPT, and HCPCS codes.
- Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
- Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
Medical Records coder/auditor
AdvantMed (formally RecordFlow)
Santa Ana
10.2014 - 04.2015
- Coding and auditing medical records, reporting HCCs and RxHCCs approved by Medicare for clients, HEDIS measures reviewer, ACO measures.
ADMIN/Gym Management
BEFIT, LLC
Killeen
02.2014 - 11.2014
- Front desk customer service, marketing, collections, order needs for gym, inventory, scheduling, sales reports.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Managed inventory and supplies to ensure materials were available when needed.
- Recognized by management for providing exceptional customer service.
- Updated and maintained databases with current information.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
Medical Coder
Matrix Healthcare
Scottsdale
08.2013 - 02.2014
- Coding risk assessments and abstracting CMSHCCs and RxHCCs remotely.
- Verified accuracy of procedure codes to ensure proper reimbursement levels.
- Provided support for coding queries raised by coders or staff members regarding specific cases or coding issues.
- Maintained up-to-date knowledge of coding changes, updates, and new rules.
- Maintained confidentiality of patient information according to HIPAA regulations.
- Validated accuracy of diagnosis codes as well as modifiers used on claims before final submission to payer and insurance companies.
Medical Records Auditor
Humana- Medicare Risk Adjustment
Louisville
04.2011 - 02.2013
- Auditing medical records, reporting HCCs approved by Medicare found in medical records, HEDIS measures.
- Reviewed patient medical records to ensure accuracy and completeness of documentation.
- Performed internal reviews to assess the effectiveness of current processes related to patient medical records management.
- Conducted audits of patient medical records for compliance with regulatory requirements.
- Assessed coding accuracy for diagnoses, procedures, services, and other elements according to established guidelines.
Coder/Biller/Administrator Assistant
Pain Medicine and Rehabilitation Center
Jeffersonville
05.2010 - 04.2011
- Coding, charge entry, account balances, posting, follow-up on denied claims, resubmit claims, chart auditing, filing, read remittances, customer service, procedure price lists, create weekly A/R reports, supervised the duties of 5 employees (2 front office, 3 back office), front desk duties, worked hand and hand with administrator of business practice to help collect data needed to renegotiate contracts, patient relations.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Entered charge rationale in patient account notes.
- Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
- Responded to coding questions from callers and other internal departments.
- Conducted code reviews to ensure adherence to coding standards and best practices.
- Reviewed clinical data from medical records to assign ICD, CPT, and HCPCS codes.
Education
MBA - Concentration of Healthcare Management
Sullivan University
Louisville, KY06.2025
Bachelor of Science - Business Administration- Concentration in Healthcare Management
Sullivan University
Louisville, KY09.2018
Associate Degree - Medical Coding
ATA College
Louisville, KY03.2010
Skills
- CMS-1500
- ICD-10-CM coding
- CPT coding
- HCPCS coding
- Medical Records Auditing
- Medicare
- Medicaid
- HIPAA training
- Insurance verification
- Word processing
- Excel
- PowerPoint
- 3M Coding software
- E/M Coding worksheets
- Fast learner
- Adaptable
- Supervision
- Multi-tasking
- Fast pace environment
- Healthcare regulations
- Auditing principles
- Patient account management
- Customer service
- Data management
- Effective communication
Timeline
Medical Records coder/auditor
Cognisight via W3R Consulting
06.2022 - 09.2024
Medical Records coder/auditor
AdvantMed
02.2021 - 04.2022
Medical Records coder/auditor
AdvantMed (formally RecordFlow)
09.2015 - 04.2016
Medical Records coder/auditor
AdvantMed (formally RecordFlow)
10.2014 - 04.2015
ADMIN/Gym Management
BEFIT, LLC
02.2014 - 11.2014
Medical Coder
Matrix Healthcare
08.2013 - 02.2014
Medical Records Auditor
Humana- Medicare Risk Adjustment
04.2011 - 02.2013
Coder/Biller/Administrator Assistant
Pain Medicine and Rehabilitation Center
05.2010 - 04.2011
MBA - Concentration of Healthcare Management
Sullivan University
Bachelor of Science - Business Administration- Concentration in Healthcare Management
Sullivan University
Associate Degree - Medical Coding
ATA College