Didi Lawter
Inman
Summary
Dynamic and detail oriented professional experienced in healthcare coding, financial analysis and quality performance management. Proven expertise in overseeing revenue cycle processes, ensuring compliance with regulatory standards. Skilled in data analysis and interpretation leveraging financial insights to drive strategic decision making and enhance organizational performance. Committed to enhancing quality of care through accurate coding practices and data driven initiatives that support both operational efficiency and patient outcomes.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Senior Manager, Risk Adjustment
Astrana Health
10.2024 - Current
- Oversee the risk adjustment coding and data validation programs.
- Monitor daily queue volumes, prepare executive reports, oversee the coding of risk adjustment audits.
- Develop & support risk adjustment infrastructure and maintain ROI by managing various inputs/outputs.
- Used database to research, gather, analyze and present data.
- Improved team productivity with implementation of collaborative project management tools.
- Spearheaded the design of innovative dashboards and reports to convey complex information effectively to non-technical stakeholders.
Manager, Risk Adjustment Coding Operations
Centene Corporation | Collaborative Health System
08.2023 - 10.2024
- Oversee the risk adjustment coding and data validation programs.
- Monitor daily queue volumes, prepare executive reports, oversee the coding of risk adjustment audits.
- Develop & support risk adjustment infrastructure and maintain ROI by managing various inputs/outputs.
- Improved team productivity with implementation of collaborative project management tools.
- Spearheaded the design of innovative dashboards and reports to convey complex information effectively to non-technical stakeholders.
Revenue Cycle Coding Manager
Prisma Health
10.2020 - 08.2023
- Managed the audit process of professional billing areas within Palmetto Health USC Medical Group or Prisma Health University Medical Group to ensure charge capture and medical record documentation efficiency.
- Developed quality improvement programs to include assessment of physicians clinical practice guideline adherence and PQRI reporting, if applicable.
- Planned, controlled, monitored, trained and implements efficient work processes.
- Implemented process improvements, ensuring accurate charge capture and coding compliance.
- Responsible for reviewing medical records extracting relevant information and accurately converting this information into standardized codes using ICD-10, CPT, and HCPCS coding conventions.
Provider Engagement & Performance Specialist
Spartanburg Regional
09.2017 - 10.2020
- Responsible for continuous quality improvement by assisting in the development and delivery of education to physicians regarding governmental quality programs, and Risk Adjustment coding.
- Implemented and carried out quality initiatives aimed at robust provider engagement, overall provider performance, and positive operational and financial outcomes.
- Collaborated with physician champions who positively influence quality and coding performance, developing strategies for maximizing data accuracy.
- Enhanced performance quality by conducting thorough data analysis and identifying improvement opportunities.
- Served on RHP Provider Engagement & Performance Committee and SRHS HR Grievance Committee.
Coding Compliance Auditor & Educator
Spartanburg Regional
05.2016 - 09.2017
- Responsible for reviewing medical records extracting relevant information and accurately converting this information into standardized codes using ICD-9, CPT, and HCPCS coding conventions.
- Analyzed clinical documentation to ensure clear, thorough documentation to support the diagnoses, procedures, and level of care provided for inpatient and outpatient services.
- Assisted in the development of education and training programs regarding ICD-10, CPT and HCPCS coding.
- Managed the development of action plans for coding practices as necessary and required by the healthcare system's policies and procedures.
- Collaborated with cross-functional teams to ensure timely implementation of corrective actions, mitigating potential compliance issues.
Denials Management Professional
Spartanburg Regional Medical Center
09.2014 - 05.2016
- Responsible for reviewing medical records extracting relevant information and accurately converting this information into standardized codes using ICD-9, CPT, and HCPCS coding conventions.
- Processing claims, appeals preparation and reconsiderations to Medicare, Medicaid and all third-party payers.
- Posted and adjusted payments from insurance companies.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience.
Medical Billing Specialist
Carolinas Center for Advanced Management of Pain
04.2013 - 09.2014
- Responsible for reviewing medical records extracting relevant information and accurately converting this information into standardized codes using ICD-9, CPT, and HCPCS coding conventions.
- Processed billing for pain management services provided ensuring accurate and timely submission of claims to insurance companies and other payers
- Posted payments and collections accurately in the billing system, reconciling accounts and identifying any discrepancies or issues for resolution
- Provided excellent customer service to patients, insurance companies, and other stakeholders, addressing billing inquiries, resolving payment issues, and assisting with billing-related concerns
Medical Billing Specialist
Resource Medical Group
05.2007 - 01.2013
- Verified insurance coverage and eligibility services, obtaining necessary authorizations and documentation for claims submission.
- Ensured timely submission of claims to various insurance carriers, resulting in prompt payment for services rendered.
- Posted payments and collections accurately in the billing system, reconciling accounts and following up on any outstanding balances or denials.
- Provided customer service to patients, and insurance companies, addressing billing inquiries, resolving payment issues, and assisting with insurance claims.
- Collaborated with internal teams, including sales, operations, and customer service, to ensure seamless coordination of billing and reimbursement processes for DME services.
Administrative Assistant
Southeastern Paper Group
05.2007 - 01.2013
- Processed billing for durable medical equipment (DME) ensuring accurate and timely submission of claims to insurance companies, Medicare, and other payers
- Posted payments and collections accurately in the billing system, reconciling accounts and following up on any outstanding balances or denials
- Provided customer service to patients, and insurance companies, addressing billing inquiries, resolving payment issues, and assisting with insurance claims
Patient Care Representative II
Spartanburg Regional
05.2007 - 11.2007
- Greeted and checked in patients, collected necessary information, and verified insurance coverage
- Answered patient inquiries, provided information on services rendered, and assisted with appointment reminders
- Handled billing inquiries, processed payments, and assisted with insurance verifications
Billing & Collections Specialist
Chemung Dental Health
01.2007 - 03.2007
- Prepared and submitted insurance claims for dental procedures, ensuring accuracy and compliance with insurance guidelines
- Followed up on outstanding insurance claims, resubmitted claims as needed, and tracked claim status
- Followed up on overdue patient accounts, delivered reminders, and set up payment plans as needed
- Handled patient inquiries regarding billing, insurance coverage, and payment options
- Maintained financial records related to billing and collections, tracked revenue, and generated reports
Physician Billing Clerk
Arnot Health
04.2005 - 01.2007
- Ensured timely submission of claims by accurately preparing and submitting medical bills to insurance companies within specified deadlines.
- Prepared and submitted appeal letters for denied claims, providing additional documentation to support the claims, when appropriate.
- Streamlined the billing process by implementing efficient medical coding practices, resulting in reduced errors and improved revenue collection.
- Assisted patients with inquiries regarding bills, providing clear explanations of charges and answering questions related to insurance coverage or payment options.
Insurance Specialist
Guthrie Clinic
05.2004 - 04.2005
- Processed eligibility and benefits verification and authorization requests.
- Submission of medical claims to insurance companies or third-party payers for reimbursement.
- Prepared and submitted appeals for denied claims to insurance companies.
- Followed up on denials, late payments, extensions and other special circumstances.
- Enhanced customer satisfaction by addressing insurance-related inquiries and resolving issues promptly.
Education
Bachelor of Arts - Health Informatics
University of South Carolina
Spartanburg09-2025
Skills
- Operations Management
- Data Analytics
- Data-driven decision-making
- Strategic Planning
- Cross-Functional Collaboration
Certification
- AAPC Certified Professional Coder 01237145 since 2012
- AAPC Certified Risk Adjustment Coder 01237145 since 2017
Timeline
Senior Manager, Risk Adjustment
Astrana Health
10.2024 - Current
Manager, Risk Adjustment Coding Operations
Centene Corporation | Collaborative Health System
08.2023 - 10.2024
Revenue Cycle Coding Manager
Prisma Health
10.2020 - 08.2023
Provider Engagement & Performance Specialist
Spartanburg Regional
09.2017 - 10.2020
Coding Compliance Auditor & Educator
Spartanburg Regional
05.2016 - 09.2017
Denials Management Professional
Spartanburg Regional Medical Center
09.2014 - 05.2016
Medical Billing Specialist
Carolinas Center for Advanced Management of Pain
04.2013 - 09.2014
Medical Billing Specialist
Resource Medical Group
05.2007 - 01.2013
Administrative Assistant
Southeastern Paper Group
05.2007 - 01.2013
Patient Care Representative II
Spartanburg Regional
05.2007 - 11.2007
Billing & Collections Specialist
Chemung Dental Health
01.2007 - 03.2007
Physician Billing Clerk
Arnot Health
04.2005 - 01.2007
Insurance Specialist
Guthrie Clinic
05.2004 - 04.2005
Bachelor of Arts - Health Informatics
University of South Carolina
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