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Simone Townsend

@simonetownsend

Medical Documentation Investigator / Auditor at Deloitte auditing ABA and behavioral health coding for documentation, accuracy, and payer compliance.

United States

Message

At Deloitte, I conduct medical record and coding audits for Applied Behavior Analysis (ABA) and behavioral health services, assessing documentation support, coding accuracy, and payer-guideline compliance.

I review ICD-10-CM, CPT, and HCPCS assignments against clinical documentation and coding requirements, then document findings and communicate actionable feedback.

At Zotec Partners, I researched and developed state-specific reimbursement policies and translated policy and claims-edit logic into operational rules for claims adjudication and system implementation.

My work at PathGroup, Community Health Network, and Eskenazi Health included coding and fee-schedule reviews, claims operations, and denial resolution. I’m a Certified Professional Coder (CPC), and I’ve also trained colleagues and presented operational trends and fraud-related findings.

Experience

Work history, roles, and key accomplishments

Current

Medical Documentation Investigator / Auditor

Current

Deloitte

Jul 2026 - Present (3 months)

Conducts medical record and coding audits for ABA and behavioral health services, assessing documentation support and coding accuracy. Reviews ICD-10-CM, CPT, and HCPCS code assignments to identify discrepancies and recommend corrective action.

Medical Coding Audit Behavioral Health Coding ICD 10 CM CPT HCPCS Medical Record Review Payer Guidelines Compliance

Provider Enrollment Specialist

Zotec Partners

Dec 2024 - Jun 2026 (1 year 6 months)

Researched and developed state-specific reimbursement policies, evaluating CMS guidance and payer policies. Translated complex policies into operational rules for claims adjudication and investigated claims-system edits and appeals.

Reimbursement Policy CMS Guidelines Familiarity Payer Policy Claims Adjudication Claim Edits Appeals Stakeholder Management

Professional Medical Coder

PathGroup

Oct 2022 - Oct 2024 (2 years)

Evaluated CPT and HCPCS code changes and fee-schedule updates, assessing coverage and reimbursement implications. Reviewed medical record documentation and applied E/M, CPT, HCPCS, and ICD-10-CM coding guidelines.

CPT HCPCS ICD 10 CM E M Coding Medical Record Review Fee Schedule Review Reimbursement

Healthcare Claims & Reimbursement Operations

Community Health Network

Mar 2018 - Aug 2022 (4 years 5 months)

Performed pre-adjudication claims reviews to verify coding and reimbursement standards. Prepared provider communications on coding updates and trained customer service colleagues on system functionality.

Claims Adjudication Reimbursement Provider communication Training System Functionality

Claims & Denial Resolution

Eskenazi Health

Oct 2014 - Mar 2018 (3 years 5 months)

Submitted and followed up on outstanding claims to facilitate timely processing and reimbursement. Investigated and resolved claim denials by researching discrepancies and taking corrective action.

Claims Submission Denial Management Claims Resolution Research