Carol Self Email & Phone Number

United States

Seattle, Washington, United States

Seattle, Washington, United States

Seattle, Washington, United States

Seattle, Washington, United States

Seattle, Washington, United States

Leawood, Kansas

Coding and Compliance Strategist / AMA CPT Editorial Panel Physician Liaison / AMA E/M Workgroup Physician Liaison / Vaccine Coding Caucus Physician LiaisonSUPPORT 138,000 MEMBER FAMILY PHYSICIANSCODING AND COMPLIANCE STRATEGIST - “ASK THE EXPERT” - respond in a timely and comprehensive manner using a multitude of communication options including the physician inquirer along with any interested parties (coders, billers, practice managers, business office managers, etc). Subject matter of inquiries include CPT, ICD 10, HCPCS, documentation guidelines, denial management, revenue cycle management, payer relations, LCD/NCD interpretations, commercial payer policy interpretation. Creation of reference materials including social media explainers, marketing products, and website content. Most currently, interpretation of CMS HHS Waivers related to COVID 19 and PHE. AMERICAN MEDICAL ASSOCIATION CPT EDITORIAL ADVISOR LIAISON / E/M WORKGROUP / VACCINE CODING CAUCUS – support CPT Editorial Staff Physician Advisors by reviewing AMA Code Change Applications for documentation, coding and billing inaccuracies, work with AMA staff in collaboration with other national societies to create and edit CPT code language, hold a seat in support of the E/M Workgroup, hold a seat in support of the Vaccine Coding Caucus.

Kansas City, Missouri

In the wake of coding outsource – transition coding staff to clinician educators which includes department trending and audits, individual clinician documentation audits, external coding vendor trending and audits, creation of PowerPoint presentations to CMH standard, creation of measurements of productivity and assignment of specialties, collaborate with coders and clinicians on complicated coding scenarios including cutting edge medicine, work with both coding and patient accounts on high volume / high value denials and appeals along with patient complaints and survey focused issues. Track production and other measureables and report to Assistant Director and Director. Increase staffing levels from 26 coder / educators and 1 supervisor to 30 coder / educators and 3 supervisors which includes candidate review, interviews, and payroll equitability.

Kansas City, Missouri, United States

TOTAL OF 40+ ADULT, ADOLESCENT, PEDIATRIC AND NEONATAL SPECIALTIES DUTIES: Project ManagementInitiation of coding denials audit team, educate staff on federal, state, and commercial policies and guidelines, review external coding vendor guidelines for amendment, collaborate with EPIC system programmers and trainers in creation of system edits and workflow adjustments, monthly review federal, state and commercial payer websites for HIM updates, monthly all staff presentation subject matter coding, billing, and compliance, create coding and billing matrix for clinical staff, collaborate with credentialing on NPPES accuracy, RAC audits, support UHC on HEDIS data collection, joint effort with facility representatives in audit of clinic MSP patient consent documents, create ADA Diabetes and Nutrition Matrix and assist with the assimilation of the Diabetes Program from the hospital, liaison from Central Billing Office to Hospital Compliance Department, ICD 10 sequencing education, collaborate with BCBS KC on Renal Mass Ablation Policy, create process document for depression screening.

Kansas City, Missouri Area

Prior to November 2014 I functioned as a PRN Consultant in educating residents in coding and billingNovember 24, 2014 I became a senior management staff member with focus on Coding and Physician EducationBuilt the coding department from 4 FTE’s to 15 FTEs including job descriptions, duties, candidate review, interviews, measurement of productivity and assignment of specialties. Created training programs geared towards each specialty for coders and staff physicians. Created an ICD 10 “History of…” education PowerPoint for Staff Physicians, Residents, and other clinicians. Work on a day to day basis with each coding staff member on routine documentation issues and complicated coding scenarios. Work with both coding and patient accounts on high volume or high dollar denials and appeals. Identify external training sources for physicians and coders to attend and manage CEUs. Track production and other measureables and report to CFO, UPA Board, Operations Board, Management Committee, etc.

Kansas City, Missouri Area

TOTAL OF 8+ ADULT, ADOLESCENT, PEDIATRIC AND NEONATAL SPECIALTIES June 23, 2008 to January 2015 (overlap in employment while training staff)DUTIES June 23, 2008 through September 15, 2011: Coding and charge entry of all specialties listed above for inpatient, outpatient and office services. Work all appealable denials and facilitate policy changes within the insurance industry to benefit providers. Management of reference materials. Create reports that directly communicate productivity and accountability. Collection activity - review all potential collection accounts for payment posting accuracy, maximize insurance benefits for our patients and approve collection activity.MANAGED CARE COORDINATOR / CONTRACTING AND CREDENTIALING SPECIALISTDUTIES September 16, 2011 to January 2015: Liaison between contracted carriers, clinicians, and management staff in facilitating reimbursement of cutting-edge medicine. Maintenance of Intranet Website by reviewing carrier newsletters, publication. In addition, notify individual departments coding and billing staff of upcoming changes to carrier policies. Work as a team in contract negotiations and management credentialing and re-credentialing of contracted providers. Advocate mass claims denial issues (including audit of claims for coding and billing accuracy, review of remits, review of carrier policies, and transmission of my findings to the appropriate carrier department). Refunds - audit mass claims refund requests and appeal to maintain custody of payments. Work one on one with out of network carriers to negotiation reimbursement rates. Maintain all carrier fee schedules and provide data to departments on request. Manage web user access.

Associates, Elementary Education And Teaching

Associate Of Arts (A.A.), Business Administration And Management, General

Emt, Emergency Care Attendant (Emt Ambulance)

Elementary Education, Elementary Education And Teaching

High School Diploma, Elementary Education And Teaching