Spearhead key client relationships by promoting customized core objectives in Medicare RA marketing strategies. Engaged multiple diverse perspectives focusing on shared purpose to support company performance and success. Developed new Medicare RA marketing strategies, which increased RAF scores by 15% Project Management: Helped improve and maintain high Medicare Advantage RAF nationally, which resulted in generating significant increase in organizational revenue by exceeding net profit goals by 22% in 2012 and 24% in 2013. Executed and led the implementation of effective/strategic health care informatics consultative materials through process improvements and integrations, monitoring and oversight, and the creation of learning solutions through research and analysis of clinical documentation quality documentation and coding audits, compliance, fraud and abuse; combining deep industry experience, valuable knowledge, and broad skill sets in advisory and solutions delivery, which greatly increased provider and administrative staff knowledge base with proven satisfaction. Operations Management: Implement leadership responsibilities to impact core objectives through creation and delivery of effective and informative presentations, training tools, forecasts and models to increase operational efficiency and financial performance in order to optimize strategic objectives both internally and externally. Assist organization efforts in the creation and monitoring of business strategies and process management with the development of creative training and communication deliverables to enhance revenue and profit growth in support of organization objectives. Consult with key business leaders and subject matter experts, and implement extensive research for the development of effective Risk Adjustment PowerPoint presentations, training updates, tables, quick reference guides, charts, templates and manuals that promote adherence to applicable state/federal laws, and program requirements of accreditation agencies and federal, state and private health plans in order to effectively communicate training objectives. David S. Brigner, MA, CPC Norman, OK Extensive research in exploring how key values in an organization's vision can be expressed more fully; developing action plans for implementing new strategies that cut across multiple subunits, and designing resources for performing new types of activities that focus on improved quality and customer/client services; and studying how the appraisal of newly designed resources can be modified to make it more consistent with an organization's strategy utilizing proficiency and creativity in idea generation and problem solving, analyzing events and perceive trends, anticipate changes, and recognize opportunities and potential problems. Thesis study involved research analysis and development of effective business cultural environments utilizing transformational leadership concepts.
Proven leadership abilities to impact and influence the direction of peoples thinking and capabilities Achieved the "Recognition Award" through Optum employee contributions on numerous occasions.
Achieved the "Master Instructor Award" for three consecutive years Authored numerous educational training presentations, notes, tables, learning tools, superbills, and templates to enhance knowledge and proficiency with documentation and coding compliance.
Six Sigma "Yellow Belt" Training.
Activities/Certifications Advisory board member directing educational and training programs for several colleges and private educational institutions.
Construct and maintain course curriculum specializing in Health Information Management, Medical Coding Systems and Health Insurance Claims Processing.
AHIMA-Approved ICD-10-CM Instructor, July 2012 AAPC Approved ICD-10-CM Instructor & Trainer, November 2010 Certified Professional Coder (CPC) through the American Academy of Professional Coders.
Certified Medical Assistant (CMA) through the American Association of Medical Assistants.
Authored and published educational presentations, tools, lesson plans, charts and tables, establishing industry training standards through Optum.
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North Texas Specialty PhysiciansDirector of Training03/2014 to Current
Education (Medicare Risk Adjustment) Dallas-Fort Worth, TX Directed the development, initiation and implementation of internal and external provider and professional group ICD-9-CM and ICD-10-CM documentation and coding training programs geared for the improvement of RAF, including 1:1 provider trainings with customized training strategies.
Developed and helped set in motion an "attestation sheet" process that can generate significant improvement in RAF opportunities in which coders can access documentation and coding issues and query providers for HCC capture based on historical HCCs; retrospective and prospective chart reviews for coding technicalities; and using data mining programs for HCC opportunity capture from claims and sweeps data, diagnostics and lab reports.
Responsible for creating departmental policy, training tools and interactive strategies to enhance the learning experience both externally and internally, focusing on staff training and CDI with high yields on training evaluations.
OptumHealthDirector of Training02/2007 to 02/2014
Education (Medicare Risk Adjustment) Dallas & San Antonio TX Provider and professional group ICD-9-CM and ICD-10-CM coding trainer/advisor and project manager responsible for initiating and leading Medicare Risk Adjustment CDI training facilitation programs and activities that improve documentation & coding as a result of HCC, HEDIS/Stars quality reviews/audits compliance performances.
Develop, design, update and revise existing provider-based MRA and ICD-10 training programs, curricula, best practices and training tools in conjunction with specific subject matter experts to ensure all materials meet business quality and accuracy standards through implementation of research, project planning and needs analysis; and ensuring overall deliverables on schedule and within scope coupled with ongoing evaluation and monitoring.
Provide consulting and training both externally and internally to include partnering with the cross-functional teams to execute the necessary training and implementation of applicable programs, training tools, policies and procedures related to training and development actions including, but not limited to: technical skills, standard operating procedures, leadership development training, new hire orientation and corporate-sponsored training initiatives.
Also develop a qualified network of site trainers across regional markets and functional areas.
Medical Edge Healthcare GroupDallas, TXProvider Outreach Compliance Consultant05/2004 to 11/2006
Medical records quality review, compliance consulting and auditing by appropriately screening documentation and billing records for correct coding and compliance initiatives for outpatient, inpatient and nursing home providers and mid-levels.
Analyze problem areas concerning audit results, provided on-site consultation for constructive advice, and training to maintain compliance standards for a 350 multi-specialty physician management organization.
Reviewed information contained in charge master reports and standard claims processing files to determine provider billing patterns, and to detect fraudulent or abusive billing practices or vulnerabilities utilizing CMS/TrailBlazer guidelines.
Analyzed potential risk determinations by utilizing a variety of resources such as Medicare provider manuals and Medicare regulations to identify potential compliance problems.
Other duties included analyzing billing data, creation and implementation of documentation audit plans, and report creation.
Compiled data and maintained various statistical reports for due diligence analysis, Medicare review, and compliance record keeping.
Constructed E/M progress note templates for multi-specialty providers to generate accurate documentation and coding compliance improving compliance efforts by 89%.
Brookhaven CollegeFarmers Branch, TXInstructor01/1999 to 04/2004
Constructed and maintained medical business management course curriculum and taught classes in Medical Terminology, Anatomy and Physiology, Medical Insurance Claims Processing, Coding and Compliance Issues, Medical Law and Ethics, and Billing Software.
Brigner, MA, CPC.
Masters of Liberal Arts Degree5 2009University of Oklahoma
Bachelor Degree:Administrative Leadership business leadership, marketing, nonprofit business management and communications5 1987Baylor UniversityGPA: Active member of the Gold Key Business Honor Society and the National Scholars Honor Society.Administrative Leadership business leadership, marketing, nonprofit business management and communications Active member of the Gold Key Business Honor Society and the National Scholars Honor Society.
Bachelor of Liberal Arts DegreeAdministrative Leadership, Norman, OK
Bachelor of Science:BiologyLife Sciences, Waco, TXBiology Specialized training in medical terminology, anatomy and physiology, applied medical science, disease processes, surgical technology, laboratory procedures, medical law and ethics, genetics, organic and Inorganic chemistry, psychology, advanced mathematics and other core curricula involving literature and composition, communications and computing skills.
RAF, auditing, Billing, business management, CMS, consultation, consulting, data mining, documentation, due diligence, functional, ICD-9, Insurance, leadership development, Law, MA, materials, mathematics, Medical Terminology, access, needs analysis, network, nursing, policies, processes, Coding, progress, project planning, psychology, quality, record keeping, research, San, staff training, trainer, training programs, composition
Masters of Liberal Arts Degree 5 2009 Bachelor Degree : Administrative Leadership business leadership, marketing, nonprofit business management and communications 5 1987 Bachelor of Liberal Arts Degree Bachelor of Science : Biology
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