Quyen Tran

Experience

1. Quality Assurance Coding Specialist

   UPMC Health Plan

   Oct 2016 — Present · Downtown Pittsburgh, PA, US

   Communicate effectively with Risk Adjustment Staff, nurse reviewers and physicians and ancillary departments as necessary to address issues and concerns. • Compile and report statistical data to internal and external customers. • Completion of special projects including claims and/or coding related audit support. • Determine diagnoses that were treated, monitored and evaluated and procedures done during the episode of care to validate that the appropriate codes were assigned by the HCC Coding Specialist. • Ensure that all codes are documented for the assignment of a valid and accurate Hierarchical Condition Category (HCC). • Monitor the assignment of the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation in the medical record utilizing knowledge of anatomy, physiology, medical terminology and pathology. • Review the coding of diagnoses and verifying the proper ICD-9-CM codes were assigned by the HCC Coding Specialist. • Review the discharge summary, history and physical, physician progress notes, consultation reports, radiology, laboratory, pathology, operative records, emergency room record to accurately assign a diagnosis and / or procedure. • Utilize standard coding guidelines and principles and coding clinics to verify that the appropriate ICD-9-CM and CPT codes were assigned including modifiers for correct DRG/APC assignment and accurate reimbursement.

Education

• University of Pittsburgh

  Bachelor of Science (B.S.)

  2003 — 2008

• Carlow University

  Master of Business Administration (MBA)

  2008 — 2010