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.
· 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.
American Health Information Management Association (AHIMA)
Arkansas Health Information Management Association (ARHIMA)
Registered Health Information Technologist (RHIT) 36484
Certified Coding Specialist (CCS) C11204
Certified Healthcare Technology Specialist-Trainer (CHTS_TR) CHTS5708
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