Bridget Hall, Coc, Cpc, Crc, Rma Email & Phone Number

United States

Quality Programs Educator provides Risk Adjustment specific education to providers and support staff through a variety of mediums including direct interactive learning sessions individually or in group settings, written guides and protocols, audits etc. They have responsibility for building relationships with the providers,Practice managers, Value based educators and facilitate & provide detailed analysis, reporting, training, education and support to Providers and staff to promote accurate clinical documentation along with HCC opportunities identified via performed analysis. Provides support to the Risk Adjustment and Quality teams as needed.

North Fort Myers, Florida

Quality Assurance Specialist is responsible to assist the department in ongoing HEDIS collection and Quality Improvement Activities. The position reports to the Director of Quality Programs. This position includes ongoing quality improvement activities to assure the organization's quality programs are implemented and meet all requirements for successful HEDIS and quality metric reporting to ACO clients.Assists quality team in performing chart reviews for scheduled visits re contracted quality metrics and GPRO reporting. Support continuum of patient care by identifying patients with gaps in care or in need of quality metrics reporting prior to scheduled identified visits.Provides feedback to manager of areas of opportunity for HEDIS/Quality Measures and other contract-mandated quality metrics specification and pay for performance measurements, and medical record review criteria for GPRO.Supports the reporting of HEDIS/Quality metrics chart review and/or creation of quality scrub encounter/alert.Works independently under the supervision of a Quality Assurance Manager and cohesively with Quality Team.Travel to providers office for data collection (also offsite chart retrieval).Assist clinical teams with proper documentation/requirements for quality requirementsAnalyze quality measures and identify opportunity trends for better data capture Ability to use multiple insurance and quality data bases to support successful Care Gap closure for patients.Assist department with claims work lists related to coding and quality initiatives.Exhibits strength in verbal and written communication and prioritization of assignments.Recognizes the confidentiality of the work assignments and department assignment.Assist with ongoing GPRO data submission.

Punta Gorda, Florida Area

Certified Professional Coder, Office manager, billing manager, registered medical assistant.Review physicians notes for accuracy and assure both procedural and diagnoses for all services were captured.Prepare, organize, submit, track all insurance claims both electronically and on paper and follow up until payment is received and posted accordingly via both manual input and electronic posting of remittance advice.Submit appeals to insurance when needed.Manage collection activities of patients, arranging payment plans when needed, answering billing questions and submitting to appropriate agencies when obligations fail to be met.Prepare, coordinate, and submit quality group measures for various pay for performance and meaningful use programs.Coordinate office activities, repairs of equipment, lunches, representative meetings, order supplies, review resumes, conduct interviews for new positions that open, etc..

Responsibilities included reviewing physicians’ Hospital notes and operative reports for accuracy both internal medicine physicians and specialists that included urology, general surgery, gastroenterology, pulmonary, and vascular surgery.Assigned appropriate medical codes to all diagnoses or servicesEntered and organized the codes into management softwareTranslate codes into insurance companies’ preferred coding systemIf a claim denied due to incorrect coding,conducted medical records research and corresponded with the insurance company and healthcare professionals to resolve the issue including appealsConducted in-house chart audits

Medical Assisting

Education record

Education record