Relevant Expertise

Sandy is an experienced consultant and a certified professional coder CPC, with over 13 years in the healthcare industry providing direct physician and staff education in documentation and reimbursement issues. She has a strong background in clinical, regulatory and fiscal physician issues and a solid understanding of Diagnosis Related Groups DRGs , International Classification of Diseases ICD-9 and ICD-10 CM/PCS coding principles, Current Procedural Terminology CPT and HCPCS , and is an AHIMA-approved ICD-10 CM/PCS Trainer. Sandy also has extensive experience with CMS guidelines, audits, and appeals, clinical documentation improvement, compliance, remediation plans, and project management. She has worked on and managed projects in hospital, academic, and outpatient environments. Sandy has assisted with electronic health record EHR implementations to ensure accurate and compliant medical record documentation and her EHR and practice management systems experience includes: Allscripts, Centricity, Cerner, Epic, Gateway Electronic Medical Management Systems GEMMS , Ingenious Med, McKesson, MEDITECH, and NextGen. She is proficient in Microsoft Word, Excel, PowerPoint, Visio, and Microsoft Project.

Accomplishments

• Identified millions in revenue opportunity through improved charge capture for a 2-hospital, 1200 bed client.
• Challenged large insurance company head-to-head through the Medical Director, reducing one physician's estimated restitution from 78K to 12K by challenging transparency issues in their contract regarding procedure bundling .
• Assisted multiple clients in appealing CMS Comprehensive Error Rate Testing CERT and Recovery Audit Contractor RAC audits, and probe reviews with success in over-turning costly paybacks.

Work Summary

Confidential

Consultant

• Evaluated and improved charge capture process through revenue cycle analysis in the hospital setting.
• Identified revenue enhancements through improved charge capture, and correct documentation/coding of procedures to include cardiac catheter lab, orthopedics, renal transplant, and labor and delivery services.
• Improved revenue capture through CDM charge description master revision.
• Identified missed revenue in anesthesia services, and supply billing.
• Identified opportunities to optimize physician productivity to enhance revenue.

Confidential

Managing Consultant

• Conducted ICD-10 readiness assessments, identifying opportunities for CDI activities and training, and diagnosis mapping initiatives.
• Provided specialty groups with ICD-10 conversion mapping by individually comparing and mapping most commonly utilized ICD-9 codes with their appropriate ICD-10 counterpart, carefully examining results to remove inherent mapping flaws, to clarify unspecified codes and combination codes, and to ensure that consistency in data was maintained.
• Produced results based on education and training, and monitoring and profiling of physician productivity.
• Streamlined clients' operations for improved performance, including more efficient processes from accepting and triaging new patients, to utilization of mid-level providers, Registered Nurse RN and Medical Assistant MA staff, as well as denials management on the back-end.
• Generated analyses of group coding trends, using data to improve correct coding practices.
• Developed customized coding tools, EHR templates, and charge tickets in the hospital setting to assist physicians and staff in thoroughly capturing charges and proper clinical documentation.
• Organized multiple second and third level payer audit appeals with success at over-turning auditor decisions.
• Conducted informed, well-organized presentations to both primary and multi-specialty physicians, hospital administration, practice managers, and other office staff.
• Provided HCC hierarchical category coding training to physicians and coders of a large Midwest multispecialty healthcare system.

Confidential

Senior Consultant

• Exceeded all financial goals/objectives in revenue opportunity/enhancement with every client - 9 clients/projects in 5 years working with 5 of them for 3 years.
• Identified revenue enhancements through correct and appropriate coding of evaluation and management services, charge capture, and correct documentation/coding of professional services and procedures to include cardiac catheter and EP procedures, nuclear imaging, general and vascular surgery, chemotherapy/radiation, and neurologic and psychiatric services.
• Worked with privately owned clients through integration with hospital systems, as well as one's conversion to provider-based billing status.
• Created and implemented compliance programs for clients, several attached directly to physician compensation.
• Assisted clients in EMR vendor selection, and/or implementation, and optimization - a continuous process regarding Meaningful Use EMR experience to include Allscripts, Centricity, Cerner, Epic, GEMMS, Ingenious Med, McKesson, MEDITECH, and NextGen .

Confidential

• Coding and Audit Manager, Physician Network Management
• Coded, documented, and audited functions for 170 multi-specialty physicians and mid-level providers.
• Served first as coding analyst and quickly advanced to manager and implemented a physician compliance plan.
• Served as member on committees regarding HIPAA, JCAHO, OIG, and CMS issues.
• Improved the Relative Value Unit RVU rate per physician, under-coding significantly decreased.
• Maintained multiple physician network charge-masters.
• Coding Analyst
• Multi-specialty, primary care, outpatient surgery and emergency department coding and audit activities.

Instructor

• Created and implemented curriculum for the coding program at the community college.
• Implemented a clinical rounds segment to the curriculum through the cooperation of a local medical center which allowed students to experience different areas and aspects of healthcare in outpatient, Emergency Room ER , and lab.
• Prepared students, most with no healthcare background or experience, in passing their coding certification exams - 80 pass rate.