SUMMARY:

• 13+ years as a HIM Director/RCM Project Manager with Medical Billing Coding experience.
• Currently working as a Revenue Cycle Optimization Project Manager.
• Experience includes overseeing the full ICD - 10 Implementation, vetting training to all levels of clinicians and performing gap analyses on current workflows.
• Experienced in ensuring provider documentation meets requirements for Medicare and Medicaid and other payer delegated standards and guidelines.
• Knowledgeable in the cross walking of ICD-9 to ICD-10 codes to ensure all mapping scenarios have been identified.

TECHNICAL SKILLS:

• Allscripts
• Cerner
• Epic
• Meditech
• IBEX/Picis

PROFESSIONAL EXPERIENCE:

Confidential

Revenue Cycle Advisor

Responsibilities:

• Delivered guidance and best practice examples for MHS Genesis workflow and process design
• Audited MHS Genesis charge capture workflows against legacy system workflows to ensure standardization and accurate charge capture post implementation
• Performed analysis of the DOD’s current processes to identify gaps in the revenue cycle process and opportunities that could lead to risk in the implementation process
• Completed established imperatives, communicating issues in a timely way, brainstorming and creatively identifying alternative methods
• Worked within the engagement teams and was responsible for identifying business requirements, requirements management, functional design, workflow design, training, and risk mitigation
• Assessed current CDM for multiple service lines, recommended updates for orderable items and CPT codes (assessed billing tier maintenance, price schedules and tested newly built items)
• Provided onsite support to end-users to assist with knowledge gap in the post MHS Genesis implementation environment
• Assisted in coordination of GO Live activities at Bremerton and Madigan

Confidential

RCM Consultant

Responsibilities:

• Revenue Cycle Optimization Project Manager
• Developed and initiated process improvement plans for the patient financial services department
• Increased hospital revenue by over $1.5 million monthly by tracking claim submissions and denials real time and updating billing documentation and overall guidelines based on carrier feedback
• Established daily productivity goals and delegated tasks to PFS staff to increase cash flow while decreasing denials and charge payment lag
• Coached the current PFS director on revenue management, staff management, performance improvement and coding contract management

Confidential

Senior Consultant

Responsibilities:

• Divurgent Project-Los Angeles Department of Health and Human Services: Subject Matter Expert
• Developed and initiated process improvement plans for the line item billing project in Cerner
• Conducted analysis of organization’s revenue cycle process and workflows-presented opportunities for improvement
• Reviewed current state of enterprise charges using CS Pricing Tool and CS Charge viewer
• Evaluated current CDM for multiple project Pillars, recommended updates for orderable items and CPT codes (assessed billing tier maintenance, price schedules and tested newly built items)
• Assisted in coordination of system wide supply chain implementation
• Divurgent Project-Kaleida Health: ICD-10 Implementation/Cerner Go Live Project Manager
• Managed the implementation of EMR, ICD-10 and trained physicians and practice staff on proper use of healthcare software.
• Responsible for managing a team of over 20 Go-Live consultants
• Gathered requirements for complex systems, modules, and/or suggested enhancements
• Ensured team objectives are well clarified and evident to all members of the team
• Represented the team during management report-outs and other forums
• Supervised backlog, either hands-on or by facilitating to the team
• Divurgent Project-Lahey Health: Project Consultant-Team Lead
• Assisted physicians and nurses with updating work list and flow sheet information.
• Provided management support and medication reconciliation. Furnished staff instruction on the use of EpicCare.
• Determined and outlined client needs. Supported nurses on how to properly work with in a specific navigator on how to arrive and discharge a patient, discharge planning and patient education
• Supported nurses and physicians on how to properly update information on flow sheets and work lists
• Conducted training and provided support for providers adding and scheduling tasks on the MAR
• Divurgent Project-Washington Health Care Authority: ICD-10 Clinical Deputy Project Manager
• Managed work efforts and deliverables for the Washington HCA ICD-10 Implementation
• Held responsible for all project assessment focusing on impacts to workflow and identified client needs associated with ICD-10 CM and PCS education, training, code set mapping, system remediation needs and workflow redesign
• Identified potential performance improvement opportunities or best practices
• Made recommendations to clients on how to integrate new process/best practice into current workflow
• Managed day-to-day project administrative tasks such as meetings, issues, escalation and resolution
• Facilitated crosswalk and gap analysis sessions. Clarified descriptions, process flows and evaluated workflows that utilized diagnosis codes
• Suggested any necessary project tool redesign
• Assisted in the development of RFPs for vendor selection
• Managed all coding, compliance, auditing and training activities for multiple practices in the UMMs CBO
• Reviewed and assigned pended claims from the TPA, provider appeals, and member bills
• Maintained HIM dashboard data for required reporting elements as well as internal performance indicators and reports trends and opportunities for improvement
• Served as a resource to manage complex/escalated issues from providers, TPA, and claims staff
• Provided analytical support for conversion to ICD-10, conversion from AP-DRG to APR-DRG or MS-DRG and any other payer reimbursement methodology changes
• Provided analytical support for all contracting efforts, including: payer contracting, bundled payment contracting, pay-for-performance contracting and healthcare exchange complexities
• Delivered ongoing education, training and audits (pre-bill and post bill) on proper coding and billing to all staff, CBO coding team and clinical employees
• Performed coder/biller quality reviews to measure proficiency and determine levels of understanding
• Conducted staff interviews and training and worked collaboratively with finance and IT to mitigate risk during the ICD-10 code set change
• Analyzed coding and billing for several outpatient and inpatient hospital based departments for the CBO
• Ensured the proper usage of codes and modifiers
• Compiled accuracy reports for department coding reviews and submitted recommendations to improve the revenue cycle process
• Held responsible for ICD-10 Project Management, Clinical Documentation Improvement goals and tracking

Confidential

Certified Coding /Billing Manager

Responsibilities:

• Managed multiple projects for Cerner implementation and developed user process flow in response to system and interface changes
• Demonstrated experience working in the Cerner
• Interfaced with county caseworkers, attorneys, and insurance adjusters
• Experienced with multiple Cerner Solutions, such as PowerChart, CareNet, CPOE, FirstNet, iNet, PathNet, PharmNet, SurgiNet and others
• Directed all billing, coding and reimbursement activities of a multi-site emergency physician group practice
• Provided ongoing education on proper coding and billing to practice physicians, coders and reimbursement employees
• Interacted with physicians daily to reinforce documentation quality improvement, record completion, escalation and suspension activities. Attend provider meetings to provide feedback and deliver training
• Investigated medical review policy changes and updates and informed providers and support staff of changes as they occur
• Advised the vendor on product design needs, and conducted troubleshooting for problems throughout the go live and PICIS phase out
• Developed and updated Cerner report specifications to query and report on productivity and charging
• Facilitated regular communications between involved stakeholder groups regarding project status and any issues
• Worked side by side with designated Subject Matter Experts at George Washington University hospital, Confidential, and Cerner to complete date collection, design & build (system review, and validation), and analysis of additional required data set utilizing CERNER implementation strategy, methodology, & tools

Confidential

Billing Supervisor

Responsibilities:

• Managed all billing, coding and reimbursement activities of a 6 physician 3 office orthopedic surgery practice
• Generated monthly revenue of over 1.5 million dollars while assuming responsibility for a staff of 15
• Provided ongoing education on proper coding and billing to practice physicians, coders and reimbursement employees
• Performed coder/biller quality reviews in Allscripts to measure proficiency and determination of understanding
• Conducted staff interviews and training and developed the budget for fiscal year.
• Standardized charge entry and follow-up methods to help increase monthly collections by over 12%
• Managed all aspects of the MFA Billing Intern program and coordinated care for VIPs
• Analyzed coding and billing for several MFA and hospital based departments for the Business Office and ensured the proper usage of codes and modifiers
• Served as a SuperUser during Allscripts implementations and updates
• Compiled accuracy reports for department review and submitted appeals or charge corrections as needed
• Implemented a Clinical Documentation Improvement program

Confidential

Coding Consultant

Responsibilities:

• Accurately coded inpatient encounters for several medical specialties that included; Surgery, Psychiatry, Trauma, Renal and Orthopedics
• Performed inpatient MS-DRG, APR-DRG, POA and ICD-9 coding to ensure appropriate information and charge capture
• Held responsible to fix queries for physicians when code assignments are not straightforward or documentation in the record is inadequate
• Audited records for correct attending documentation and transfer of care between internal departments
• Utilized DOD coding guidelines to request additional documentation as necessary or refused charges for compliance reasons
• Composed nightly reports to show encounters coded or not coded due to documentation or other problems

Confidential

Coding Account Manager

Responsibilities:

• Held responsible for reviewing all charges and codes for 5 national practices, prior to submission to insurance carriers
• Assisted each client with compliance issues and provided correct coding information
• Investigated medical review policy changes and updates and inform clients of changes as they occur
• Educated hospitals and physician offices about proper documentation and components required to necessitate payment
• Understood and translated coding denials to practices and account managers and submitted the appeal when the denial was incorrect
• Provided outpatient, E&M, inpatient, MS-DRG, APR-DRG, POA, CPT and ICD-9 coding

Confidential

Accounts Receivable Specialist

Responsibilities:

• Analyzed and reviewed daily billing correspondence
• Researched and reconciled account overpayments and underpayments using EOB’s and remittance statements and collected all patient balances due
• Evaluated quality of coding and developed methods to reduce coding and billing errors
• Held responsible for abstracting and processing all Medicare and third party payor claims

Confidential

Senior Medical Abstract and Coding

Responsibilities:

• Led the efforts of the coding department and ensured proper coding and diagnosis of inpatient/outpatient procedures for the compliance department and patient billing
• Held responsible for coding all free text ICD-9 and CPT codes entered the MDE system
• Supervised chart reviews and audits to ensure thorough documentation and compliance with 3rd party and governmental requirements
• Provided physician review and education on policy changes and ways to optimize reimbursement
• Acted as a resource about the rules of utilization of LMRP’s, CPT, ICD-9, E & M, HCPCS codes and modifiers to ensure accurate coding and subsequent payment
• Reduced claim denials by over 85% and oversaw the Focused Medical Review for 9 departments