Director of OperationsJzanus Consulting, Inc － West Hempstead, New York
Health Information Practice.
10/1991 to 09/2003
ManagerErnst & Young, LLP － Melville, New York
Managed multi-million dollar revenue cycle engagements, which increased physician and hospital reimbursement through revisions to the chargemaster, coding and billing practices.
Served as an engagement Director with the responsibility for planning and directing the assessment of revenue cycle engagements.
Performed operational reviews of Health Information Management departments to ensure optimal efficiency.
Assessed and performed APC (Ambulatory Payment Classification) Operational Readiness Assessments for hospitals/medical centers.
Provided management and implementation assistance to successfully transition hospitals/medical centers to the Outpatient Prospective Payment System.
Managed Fraud & Abuse compliance audits related to the Office of Inspector General investigations.
Served as a Project Manager assisting outside counsel in performing legal review of billing compliance issues.
Quantified the financial impact of coding changes to be used by internal counsel during discussions with the OIG.
Performed coding assessments for academic practice plans to ensure HCFA documentation compliance.
Evaluated the quality of clinical coding as it relates to inpatient and outpatient compliance and reimbursement.
Performed Clinical Documentation Management validations resulting in improved documentation, coding and billing practices.
Conducted chargemaster reviews to assess CPT coding accuracy and compliance.
Developed and updated superbills for multi-specialty physician group practices.
Provided education to Health Information Management, Finance, and Patient Accounting professionals on APC and CPT/HCPCS coding and reimbursement issues.
Performed medical record documentation reviews to ensure compliance through the appropriate assignment of CPT and UB-92 codes.
Managed and performed CDM consolidations for multi-hospital systems.
Conducted concurrent and retrospective DRG reviews.
Educated nursing and ancillary staff on Concurrent DRG Management Program (CDMP).
Managed resolution of DRG discrepancies arising between hospitals and third party payors resulting in a significant reduction in DRG reassignment rates.
Arlene Fauth Developed and presented inservice education sessions on ICD-9-CM coding and DRG methodology to hospital personnel.
Quantified and prepared monthly DRG financial reports for CFO estimating the financial impact of DRG changes.
Developed and implemented Health Information Management policies and procedures to assure compliance with Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards.
Assisted in the preparation of Health Information Management Department for survey by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
01/1986 to 10/1991
Assistant Director of Health Information ManagementMary Immaculate Hospital － New York
Responsible for the overall management of the Health Information Management department.
Conducted quality assurance and JCAHO compliance studies.
Monitored and reported to Finance any outstanding Discharged Not Final Billed (DNFB) accounts, as they relate to incomplete medical records.
Implemented corrective action as necessary.
Co-chaired Medical Record Committee meetings.
Participated in Health Information Management computer vendor selections and Request For Proposal (RFP) selection.
Effectively communicated with executive hospital staff, nursing and HIM management staff to promote effective working relationships.
Educated medical staff, nursing personnel and coding staff on ICD-9-CM and CPT coding.
Conducted concurrent and retrospective DRG validations Responded to all changes in initial DRG reassignments by Peer Review Organizations, Insurance Companies and other third party payors.
Bachelor of Science Degree: Medical Record AdministrationC.W. Post/Long Island University － Greenvale, New YorkGPA: Dean's List, Magna Cum LaudeMedical Record Administration Dean's List, Magna Cum Laude
Member of the American Health Information Management Association (AHIMA)
Member of the New York Health Information Management Association (NYHIMA)
Member of the Long Island Health Information Management Association (LIHIMA)
Member of the Healthcare Financial Management Association (HFMA)