LiveCareer-Resume

audit implementation manager resume example with 15 years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
Links
  • www.linkedin.com/in/sharon-nichols
Professional Summary

Knowledgeable Medical Coding and Audit Implementation Manager with over 15 years of experience driving critical technology planning, installation, maintenance, and deployment. A comprehensive resource for managing implementations throughout the lifecycle troubleshooting barriers to determine corrective action. Extensive oversight for documentation to streamline setup and preservation processes.

Knowledgeable Compliance Manager with over 26 years documented success in policy development, leading training programs, and managing reporting to achieve compliance. Methodical with exceptional presentation and communication skills. Strong background in staff management procedures positively impacting overall morale and productivity. Experienced working with federal and state reimbursement regulations. Excellent reputation for resolving problems, improving customer satisfaction, and driving overall operational improvements. Consistently saved costs while increasing profits through improving morale, reducing time waste, and increasing productivity by 30-50%.

Experienced, Multi-talented Coder and Auditor with over 24 years of experience coding, abstracting, and auditing in Acute Care, Trauma Level 1-3, Children's, Specialty, Psychiatric, and Teaching hospitals. Excellent reputation for resolving problems, improving customer satisfaction, and consistently reducing DNFB by 50-80% through driving overall operational improvements. Expert in ICD-10-CM, ICD-10-PCS, CPT, HCPCS, and ICD-9-CM following all published guidelines by the cooperating parties.

Skills
  • Medical Records Auditing, audit oversight, preparation, and response for acute care in-house prebill, and retrospective reviews of Inpatient, Outpatient, ER, Ancillary, SNF, Rehab, Psychiatry, Cardiac Cath, Vascular Lab, pain management, and diabetic care including HBO therapy
  • Performance improvement monitoring of productivity and quality standards Medical Records Management and security practices
  • Microsoft Office, Excel, Word, PowerPoint, computer and office equipment skills
  • Data collection, maintenance, and reporting to ensure HIPAA compliance
  • Leadership, coaching and skill development via virtual/remote and physical or telephone meetings covering coding and billing guidelines
  • Medical Records coding, reviewing, benchmarking, and standardizing processes for improved workflow in Clinical (Medical Records) Documentation Improvement for patient care
  • Medical coding and billing using ICD-10-CM, ICD-10-PCS, CPT, HCPCS, and ICD-9-CM following all published coding guidelines, Coding Clinics, and CPT Assistants
Work History
Audit Implementation Manager, 10/2017 - 04/2020
Himagine Solutions Inc. City, STATE,
  • Oversaw implementation life-cycle processes based on organizational needs, regulatory requirements and customer demand.
  • Documented processes to streamline setup, customization and maintenance.
  • Researched and resolved barriers to successful system functionality, improving support and issue resolution.
  • Collaborated with ReviewMate staff to cultivate resources and reference material for technical installation, troubleshooting and maintenance.
  • Collaborated across departments and levels of management to gain consensus on procedural documentation.
  • Monitored and created control reporting to track performance of system and process integrity, vendors, internal workflows and SLAs.
  • Prepared documents for projects in accordance with project manager, team or client/facility specifications.
  • Compared incoming data against quality, integrity and accuracy expectations, identified faults and affected timely remedies.
  • Managed 80 strategic enterprise client implementations
  • Managed over 3000 user profiles
  • Resolved on average of 15 technical support problems daily, improved operations and provided exceptional client support.
National Compliance Manager, 01/2013 - 10/2017
Himagine Solutions Inc. City, STATE,
  • Collaborated with contract team to review client contracts and facilitate personnel compliance training.
  • Formulated detailed recommendations based on audit findings to support annual planning and definition of goals.
  • Structured programs, produced working documentation and implemented best practices for medical coding and review .
  • Consulted with 80 clients on best practices and served as project manager for all process improvements and regulatory initiatives.
  • Delivered subject matter expertise for internal and external customers on compliance best practices and quality control.
  • Managed full life cycle of assigned audits in alignment with departmental procedures, delivering progress as well as closing reports to senior management and clients.
  • Prepared and presented over 500 comprehensive reports to upper management and audit team, covering medical coding and review issues and recommendations.
  • Delivered and tracked program training for 3000 associates and supervisors in order to safeguard continuing business relationships.
  • Liaised with 80 clients to identify and target inefficiencies in areas of risks and business controls, process gaps and workflow discrepancies.
  • Developed and delivered over 20 training programs to inform new and current employees about compliance issues.
  • Maintained current understanding of company standards and applicable legal requirements such as CMS and Commercial Payers.
  • Determined required job seeker qualifications for potential interviews by reviewing and evaluating resume and application information for over 1000 prospects.
  • Oriented 100+ newly hired employees by providing company information, facilitating on-boarding processes and establishing position-related requirements.
  • Partnered with HR team, Sales, and Recruitment to outline and define position requirements in accordance with company needs.
  • Produced and analyzed production or results from job descriptions and advertisements, prescreening protocols, interview questionnaires and post-interview assessments.
  • Developed relationships with 1000 potential job candidates to promote effective communication throughout hiring processes.
  • Improved office efficiency by effectively managing internal communications and correspondence.
  • Assisted senior management with making key decisions by developing and submitting performance and compensation reports with status updates and improvement recommendations.
  • Collected and analyzed information to monitor compliance outcomes and identify and address trends of non-compliant behavior.
  • Maximized team knowledge and productivity by effectively training, monitoring and directing employees in application of best practices and regulatory protocols.
  • Planned, monitored and appraised employee work results by training managers to coach and discipline employees.
National Coding Consultant, 04/2005 - 01/2013
Himagine Solutions Inc. City, STATE,

· 26 years’ experience Reviewing medical documentation, coding office and hospital procedures for CPT and ICD-10, and keying charges in the Billing system.

· Edit and correct claims as needed for accurate billing. Work with denial team as needed on coding related denials.

· Keep up to date on correct coding procedures. Obtain CEUs to maintain coding certification. Let Management know about documentation problems and request physicians to do addendums when needed to improve documentation.

· Add missing payments to spreadsheet for tracking purposes. Assist with coding audits. Correct insurance info so claims can be billed correctly, plus other duties as assigned

· Manage assigned charge review and coding-related claim edit work queues to ensure timely and accurate charge capture. Accurately deciphers charge error reasons and plans follow-up steps.

· Identifies all billable services through review of all applicable data sources, including but not limited to: electronic health record, inpatient admit, discharge and transfer (ADT) reports, operative logs, nursing home visit documentation, procedure reports generated from non-the electronic health record systems, etc.

· Reviews medical record documentation in the electronic health record and/or on paper. Identifies, enters and posts CPT-4 and ICD-10 codes to the electronic health record. Identifies need for medical records from outside the organization and follows established procedures to obtain. Ensures all coded services meet appropriate Medicare, National Correct Coding Initiative (NCCI) or payer-specific guidelines.

· Consults with physicians/ providers as needed to clarify any documentation in the record that is inadequate, ambiguous, or unclear for coding purposes. Provides education around documentation improvement for maximum patient care.

· Assists physicians/providers with questions regarding coding and documentation guidelines. Provides ongoing feedback based on observations from coding physician/provider documentation. Identifies opportunities for education and communicates trends to lead

· Reviews and resolves charge sessions that fail charge review edits, claim edits, and follow up denials. Works to improve billing based on findings/resolution of errors.

· Trains and mentors coding staff to effectively perform their job responsibilities following current coding policies and procedures. Assists coders with medical terminology, disease processes and complex surgical techniques.

· Manages assigned charge review, claim edit, and coding follow up work ques.

· Maintained accuracy, completeness and security for medical records and health information.

· Managed system conversion from hybrid paper-digital records to electronic health record in STAR, EPIC, and Eclipsys maintaining minimal downtime during updates.

· Research and compile statistical data to support cost control and care improvement initiatives.

· Interact and communicate easily with department personnel and public.

· Identified new methods to optimize medical records management.

· Utilized multiple encoder, EHR, and billing software systems to manage and confirm patient data, such as insurance, demographic and medical history information.

· Used classification manuals to gain additional knowledge of disease and diagnoses processes.

· Trained 60 direct reports on department procedures and policies to maximize department effectiveness.

· Communicated effectively with staff, patients and insurance companies by email and telephone.

· Drove operational improvements which resulted in savings and improved profit margins.

· Resolved conflicts and negotiated mutually beneficial agreements between parties.

· Developed team communications and information for Health Information Management and Clinical Documentation Improvement/Quality Management department meetings.

· Managed quality assurance program, including on-site evaluations, internal audits and customer surveys.

· Maintained excellent attendance record, consistently arriving to work on time.

· Resolved coding production backlog problems, improved operations and provided exceptional client support.

· Increased customer satisfaction by resolving time management, workflows and backlog issues.

Education
Bachelor of Science: Business Management, Expected in 05/2010
-
University of Phoenix - Tempe, AZ,
GPA:
Status -
Associate of Applied Science Degree: Health Information Technology, Expected in 1994
-
National Park Community College - Hot Springs National Park, AR,
GPA:
Status -
Affiliations

American Health Information Management Association (AHIMA)

Arkansas Health Information Management Association (ARHIMA)

Certifications

Registered Health Information Technologist (RHIT) 36484

Certified Coding Specialist (CCS) C11204

Certified Healthcare Technology Specialist-Trainer (CHTS_TR) CHTS5708

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • University of Phoenix
  • National Park Community College

Job Titles Held:

  • Audit Implementation Manager
  • National Compliance Manager
  • National Coding Consultant

Degrees

  • Bachelor of Science
  • Associate of Applied Science Degree

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: