coding validation specialist manager resume example with 20+ years of experience
JessicaClaire
, , 100 Montgomery St. 10th Floor(555) 432-1000, resumesample@example.com
Professional Summary
Accomplished HIM Professional capable of building and leading productive remote working teams. Recognized within the organization as a subject matter expert (SME) with both ICD-10-CM/PCS classification and DRG methodologies. Competent HIM professional with strong mentoring and leadership skills with a focus on individual and team quality performance indicators. Extensive experience that includes managing 68 direct reports, team development, project management and data analytics. Exceptional customer relationship skills that includes interaction with stakeholders, clients and providers to resolve complex medical coding decisions.
Skills
Industry standard knowledge
Process Analysis
Attention to Detail
Problem-Solving
Organization and Time Management
Regulatory Research
Self-Motivated
Excellent Communication
Planning and Coordination
Training and Development
DRG methodologies
ICD-10CM/PCS SME
Work History
01/2007 to CurrentCoding Validation Specialist ManagerFuture Today Institute | New York, NY,
Manage daily operations of five assistant managers and sixty thee coding and clinical validation specialists (CVS)-all remote
Responsible for overseeing hiring, training , quality assurance and professional growth of employees
Recruit and train talented coding professionals for CVS positions
Continuously monitor quality, production for team and plan performance
Conduct performance evaluations and develop performance improvement plans as needed
Oversee appeal process including written responses and escalated issues that require a conference call and/or onsite response
Prepare written reports and conduct exit interviews with clients and staff
Ensure compliance with coding guidelines, official published coding references, state and federal regulations as well as client specific policy and procedures
Led development of template rationales to improve compliance, consistency and productivity
Oversee selections of claims using data analytics; identifying claims that have highest potential for overpayment identification
Organize team projects that are data driven; scrutinizing frequent DRG changes to identify trends or patterns
Coordinate and develop staff education sessions both online and for annual onsite meetings
Coordinated and developed company-wide ICD-10-CM/PCS training and implementation
Developed clinical education program targeting CVS knowledge of disease pathophysiology which led to development of learning library
Implement knowledge management strategies to improve performance and quality
Project manager for company projects as directed to meet company goals and objectives
Recognized as key player within organization for leadership, team building, data analytics , development of new lines of business and project management
Explain highly complex information in terms easily understood by non-technical personnel.
Monitor for fraud and abuse by verifying coded data accurately reflects services provided.
Expert witness testimony for ALJ hearing
01/2007 to 01/2008Coding Validation SpecialistVARIS, LLC | City, STATE,
Member of first remote team employed by VARIS
Ensure compliance with coding guidelines, official publications, state and federal regulations was well as client specific policies and procedures
Utilize coding and clinical knowledge for MS-DRG, CMS-DRG, and APR-DRG determination
Prepared written responses for change rationale and appeal responses
Recognized for substantial DRG recoveries within first six months of employment- over $1,000,000,000.
Monitored for fraud and abuse by verifying coded data accurately reflected services provided.
Reviewed inpatient records and interpreted documentation to identify diagnoses and procedures.
Promoted within one year to CVS Manager position
01/2005 to 01/2007DRG ValidatorNurse Audit | City, STATE,
Conducted onsite DRG validation audit completing 30 audits per day
Participated in exit interviews with hospital staff
Required travel throughout New England providers included trauma centers and community hospitals
Prepared written rationales for identified DRG changes and responded to appeals
Top performer for DRG validation
01/1995 to 01/2007AssociatesMedical Record, MRA | City, STATE,
Reviewed patient charts to better understand health histories, diagnoses and treatments.
Reviewed medical records to select appropriate coding sequences and assignment
Used 3m, Winstat and Trucode to input information into computerized patient record system.
Developed strong rapport with customers and created positive impression of business
Education
Expected in 2016 to to Masters | Health Informatics University of Illinois, Chicago, ILGPA:
Expected in 2011 to to ICD-10CM/PCS Trainer | AHIMA Academy, Chicago, IL, GPA:
Expected in 1993 to to Post Graduate Certificate | HIM Northeastern University, Boston, MAGPA:
Expected in 1991 to to BS | Elementary Education/Political ScienceUMASS, Boston Boston, MAGPA:
Affiliations
American Health Information Management Association (AHIMA)
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.