Laura Prichett
Hixson
Summary
Certified Professional Coder with over 7 years of experience in customer service, adept at fostering strong relationships with providers and patients through exceptional communication skills. Expertise in CPT and ICD-9/10 coding, complemented by a thorough understanding of industry standards and compliance requirements. Highly organized and detail-oriented, committed to delivering accurate results within tight deadlines. Recognized for a coachable and collaborative approach, consistently achieving high-quality outcomes in dynamic environments.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Coding Policy Review Analyst
Zelis
11.2021 - Current
- Performed in-depth clinical coding analysis to ensure accuracy and compliance with payer and regulatory standards.
- Applied industry coding guidelines (e.g., AMA, CMS, NCCI) to claim processes, maintaining adherence to best practices.
- Maintained and updated clinical guidelines and assisted in creating job aids to promote consistency and efficiency in coding workflows.
- Identified edit performance issues and recommended process improvements to optimize claim accuracy and reduce errors.
- Communicated regularly with leadership and team members to provide updates, share insights, and align on coding policy initiatives.
Patient Centered Medical Health (PCMH) Program Coordinator
Erlanger Health Systems
02.2019 - 11.2021
- Created and maintained Excel spreadsheets to track quality measures for 22 clinics, ensuring accurate reporting and compliance.
- Reviewed patient charts for specific tests and procedures across multiple insurance carriers to close gaps in health maintenance records.
- Conducted provider assessment documentation reviews, completed necessary updates, and submitted reports for compliance.
- Coordinated team activities for 14 members, including scheduling off-site, remote, and on-site work at Erlanger, by creating and distributing updated calendars.
- Acted as primary communication liaison between the supervisor and team members, ensuring timely dissemination of critical information.
PCMH Referral Auditor
Erlanger Health Systems
02.2019 - 11.2021
- Generated and analyzed monthly performance reports for 9 clinics to monitor referral processing and compliance.
- Reviewed approximately 1,200 referrals per month to ensure completeness and accuracy of patient records.
- Verified documentation in patient charts and closed referrals upon confirmation of required records.
- Initiated electronic record requests for incomplete referrals and tracked provider responses to maintain workflow efficiency.
- Scanned and uploaded received records into patient charts, ensuring timely and accurate updates.
- Created and delivered monthly quality reports to supervisors, highlighting trends and opportunities for process improvement.
Certified Medical Assistant
Mountain Management
05.1998 - 01.2003
- Provided direct patient care, including obtaining vital signs and performing phlebotomy.
- Administered injections, EKGs, and breathing treatments in accordance with clinical protocols.
- Assisted physicians with in-office procedures, ensuring patient safety and comfort.
- Scheduled specialist appointments and diagnostic tests, coordinating precertification for insurance approval.
- Managed prescription requests and patient phone calls, ensuring timely and accurate communication.
- Delivered patient education on chronic conditions such as diabetes, hypertension, and hyperlipidemia, as well as medication management and lifestyle modifications.
Student
Allied Health Careers
01.1998 - 06.1998
- Completed 160-hour clinical externship providing direct patient care and administrative support.
- Performed phlebotomy, administered injections, conducted EKGs, and recorded all vital signs.
- Managed patient phone calls and prescription refill requests, ensuring timely communication and accuracy.
- Scheduled diagnostic tests and specialist appointments, coordinating precertifications as needed.
- Delivered patient education on chronic conditions including diabetes, hypertension, and hypercholesterolemia, as well as medication management.
Medicare Customer Service Representative
Blue Cross Blue Shield TN
09.1996 - 05.1998
- Processed healthcare claims accurately and efficiently, ensuring compliance with payer guidelines and regulatory requirements.
- Served as a Customer Service Representative, answering provider and beneficiary inquiries regarding claim status and coverage.
- Explained claim outcomes, including reasons for payment or denial, in clear and professional language.
- Managed Medicare Customer Service Correspondence, drafting and sending detailed letters to beneficiaries addressing coverage questions and claim status.
- Demonstrated strong communication and problem-solving skills to resolve complex claim and coverage issues.
Education
Certified Coding Class -
Humana/AAPC
03.2020
Associates Degree - Nursing
Chattanooga State Technical Community College
05.2004
Certified Medical Assistant - undefined
Academy of Allied Health Careers
06.1998
Accounting Major with business classes, statistics, business law, accounting
Chattanooga State Technical Community College
05.1998
High School - undefined
Sale Creek High School
05.1995
Skills
- Active listening
- Active listening
- Active listening
- Active listening
- Active listening
- Active listening
- Active listening
- Active listening
Certification
- Certified Professional Coder, Zelis - November 2021-Present
- Certified Medical Assistant, Mountain Management-May 1998-January 2003
- Associates Degree in Nursing, Chattanooga State Technical Community College- August 2000-May 2004
Timeline
Coding Policy Review Analyst
Zelis
11.2021 - Current
Patient Centered Medical Health (PCMH) Program Coordinator
Erlanger Health Systems
02.2019 - 11.2021
PCMH Referral Auditor
Erlanger Health Systems
02.2019 - 11.2021
Certified Medical Assistant
Mountain Management
05.1998 - 01.2003
Student
Allied Health Careers
01.1998 - 06.1998
Medicare Customer Service Representative
Blue Cross Blue Shield TN
09.1996 - 05.1998
Associates Degree - Nursing
Chattanooga State Technical Community College
Certified Medical Assistant - undefined
Academy of Allied Health Careers
Accounting Major with business classes, statistics, business law, accounting
Chattanooga State Technical Community College
High School - undefined
Sale Creek High School
Certified Coding Class -
Humana/AAPC