Train and mentor a team of eleven Coding and Documentation Auditors, while fostering a culture of continuous improvement and professional development.Analyze revenue data to identify trends, variances, and opportunities for improvement. Prepare regular reports on revenue cycle performance and present findings to management.Stay up-to-date with relevant laws, regulations, and industry standards related to revenue cycle operations. Liaise with multi-disciplinary teams to identify opportunities, streamline coding and documentation processes and improve efficiency. Implement workflow changes and technology solutions as needed to enhance productivity and reduce costs.

Review clinical documentation to determine reimbursement levels, assess quality of care, study patterns and compare healthcare data between physicians, to ensure regulatory and payer reporting requirements are met. Key Accomplishments:Daily Operations: Identify and resolve clinical documentation and charge capture data discrepancies to improve quality. Audit and educate multidisciplinary team members, including physicians, as it pertains to frequently changing mandated rules, regulations, and guidelines.Revenue Recovery: Revenue opportunity identified for non-operative fracture care performed and documented by Geriatric Practitioners but not billed. Met with key stakeholders to understand current state model. Researched credentials, scope of practice, billing and coding guidelines for the provider types and place of service to ensure compliant billing practices. Created non-manipulative fracture care coding and documentation education, presented it to performing practitioners and implemented new workflow to capture services at the highest level of specificity.Project Management: Facilitator (meeting management) for Mental Health and Addiction practitioner onboarding consolidation project. Identified internal and external stakeholders, created timeline for review and consolidation of internal and external coding and documentation education for new providers and Licensed Mental Health Practitioners. Leveraged the universal content and partnered with IT/Informatics to create Learning Modules within Epic to be used as an education onboarding tool.Provider Support: Performed bell curve analysis on levels of service for Emergency Department Providers to identify bottlenecks. Identified opportunities to improve documentation accuracy and implement best practices to ensure compliance with industry standards to obtain appropriate reimbursement.

Served as an experienced coding leader, and solutions manager driving development, implementation, training, and support. Leading a team of internal staff and external vendors in delivering viable business solutions.Key Accomplishments:Vendor Partnership & Management: Served as Client Solutions Manager to create and maintain positive working relationships with internal and external customers. Monitored and mitigated client concerns with effective collaboration. Provided coding and billing consultation services regarding specific topics of interest. Process Improvement: Developed Client Inquiry and Tracking Process. Created centralized repository to store, track and trend client inquiries. Evaluated potential applications (Monday.com, Microsoft 365 Office Suite, Totango) Used MS Teams to develop flows within MS Power Automate tool to route communications across departments to streamline data collection and metric reporting on inquiry activity. Performed integrated testing, developed training materials, and sought buy-in for roll out. Project was successfully closed prior to deadline after implementing across teams (Implementations, Coding Operations, Quality, Education and Client Solutions teams).Project Management: Task Management Project. Timeline 4 weeks. Created organization wide process for Task Management. Met with all key stakeholders to understand current state and the expectations. I researched MS Task by Planner and built the solution according to project requirements. I led one-on-one training sessions with stakeholders. Scheduled a kick-off meeting to share the Power Point presentation and demonstrate the tool in real-time. Addressed feedback received from end-users, mitigated barriers. Project successfully completed within scheduled time frame.

Key Accomplishments:Daily Operations: Assists the System Compliance Director and Chief Compliance Officer in the development and execution of the overarching compliance program mission, strategy, and oversight. Analyzes new or previously initiated aspects of Fairview’s business to ensure that compliance infrastructure is understood and that compliance concerns are addressed. Including: identification, communication, and collaboration with cross-functional teams to develop, implement, and monitor corrective action plans.Project Management: Target Probe and Educate (TPE) Audit Workflow. Served as Compliance Strategist assigned to mitigate a missed deadline to round one audit findings. Personally led education session with key stakeholders regarding unfavorable audit results from The National Government Services (Local Medicare Administrator Contractor). Accountable for capturing meeting notes and recommendations to prepare for second round of audit. Dispersed and followed up on actionable items to completion, ensuring compliance per Medicare recommendations. Documented the process for lessons learned register for future TPE audits received. Implemented and monitored new standard workflow to ensure compliance. Process Improvement: Behavioral Health Inpatient Level of Care in the Emergency Department. Timeline 6 months. Need was identified to bill for Inpatient level of care for Behavioral Health patient type, in the Emergency Room setting. Scheduled and led meetings and stakeholder engagement to drive compliant billing practices. Accountable for weekly meeting notes and action item assignment, escalating stalled items through the appropriate chain of command. Worked closely with Legal Counsel and Clinical Operations to ensure the expected level of care could be provided and evidenced within the documentation. Project completion was dependent on available clinical resources to provide patient care

Key Accomplishments:Daily Operations: Collaborates with Informatics team to create and review new templates as part of clinical workflow; verifies that documentation meets regulatory requirements and assists with implementation process. Evaluates trends and continuous improvement opportunities; identifies training needs and creates targeted educational programs and resources for physicians and staff.Revenue Recovery: Hyperbaric Oxygen Denials Project. Served as subject matter expert representing Revenue Integrity. Conducted root cause analysis for denial trend uncovering an issue with missing ICD-10 diagnosis codes in payor claims scrubber. Crafted and submitted rebuttal to payor resulting in 106 claim denials being overturned, recapturing approximately $300K in revenue.Provider Support: Introduction to Medical Coding and Documentation, Emergency Department Residents. Partnered with the ED Medical Director and IT/informatics to create onboarding resident education modules within the Epic. The intent was to offer training materials to Emergency Department residents on coding and documentation guidelines for Evaluation and Management Services, following AMA, CMS and policies internal to HCMC.Process Improvement: Partnered in creating and presenting organization-wide education materials for 2021 Outpatient Evaluation and Management changes from CMS and CPT; recorded education modules for online completion by all MDs and APPs.Project Management: COVID Telehealth Toolkit. Partnered with all applicable stakeholders, including, billing, compliance, contracting, coding, and HIM teams; to create and implement new billing and coding policies and procedures for telehealth and telemedicine services in an emergent timeline with ongoing iterations with almost daily changing guidelines. Key stakeholder in the design of a “telehealth toolkit” to be used as education organization wide.

Assigned appropriate ICD-10 and CPT codes for ambulatory encounters across multiple departments including Radiology, General Pediatrics, Emergency Department, Hematology/Oncology, Pain, Cardiology, Outpatient Lab, Concussion, ENT, Genetics, Orthopedics, Gynecology, Inpatient Hospitalist, Eating Disorder, and Endocrine.• Achieved 95% or greater on internal and external audits of coding assignments.

Oversaw daily coding operations for Primary Care and Emergency Department. Managed coding team providing education, direction, and assignments to drive productivity and accuracy. Processed institutional and professional claim edits and payor denials in conjunction with business office.• Passed internal and external coding audits with a score of at least 95%.• Served as subject matter specialist and trainer for Centricity Business revenue cycle implementation; participated on project team collaborating on design, planning, integrated testing, and implementation.• Developed and executed coding education to HIM department on Centricity Business system.• Acquired extensive knowledge of ICD-10-CM Diagnosis and CPT Coding for Radiology, General Pediatrics, Emergency Department, Hematology/Oncology, Pain, Outpatient Lab, Concussion, ENT, Genetics, Orthopedics, Gynecology, Inpatient Hospitalist, Eating Disorder, Endocrine, Integrative Medicine, Neurology, Neurosurgery, Skin, Infectious Disease, Asthma, Psychiatry, Psychology, Diabetes, Feeding Clinic, EKG Reads, Feeding Clinic, Pulmonology, Neonatal, and Non-Invasive Cardiology.