Marcus Smith
Hospital & Health Care Professional
- Role
- Coding Quality Analyst at Optum
- Location
- Dallas-Fort Worth, TX, US
- LinkedIn followers
- 500 followers
About Marcus Smith
Highly self-motivated professional with demonstrated health care experience coupled with…
Experience
Coding Quality Analyst
Sep 2022 — Present
Performs clinical review of CPT, HCPCS, and modifiers assigned to codes on claims.Determines appropriate level of service utilizing Evaluation and Management coding principles.Provides detailed clinical narratives on case outcomes.Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance.Identifies aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommends providers to be flagged for review.Maintains and manages daily case review assignments, with accountability to quality, utilization, and productivity standards.Participates in team and department meetings.Engages in a collaborative work environment when applicable but is also able to work independently.Serves as a clinical resource to other areas within the clinical investigative team.Work with applicable business partners to obtain additional information relevant to the clinical review.
Education
Jackson State University
Business Administration and Management, General
2002
Virginia College-Jackson
Associate’s Degree
2004 — 2006
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