Emily D. Email & Phone Number

• Responsible for overall direction and professional development of a newly created team.• Delivered targeted coding and billing training for team, optimized performance through increased knowledge of policy translation, coding, and enforcement for lab claims editing and decisioning. • Cross-functional collaboration with Scientific Affairs, Coding, Policy Configuration, and Enforcement to translate health plan’s priorities into actionable strategies and tactics.• Client-facing meetings spanning multiple time zones to deliver value and operational excellence for their book of business.• Performed value proposition analyses for coding and enforcement variances based on policy adoption decisions. • Key contributor to compliance board reports and client quarterly business reviews.• Managed multiple projects and compliance deadlines for twenty-one clients.• Leveraged native capabilities within JIRA application to streamline daily tasks and adherence to best practice.

• Revenue cycle liaison for Value Analysis committees, created cost benefit analyses for new products and services.• Served as subject matter expert for OPPS, IPPS, and EAPG coding and reimbursement for new drugs, supplies, and services. • Led cross-functional projects, programs, and committees to achieve reimbursement objectives supporting hospital-based services.• Specialty pharmacy…• Engaged with clinical trial sponsors to solve coding and coverage issues to maximize payor reimbursement for investigational devices.• Directed compliance requirements and deadlines for MRF and price transparency enforcement.• Collaborated with HIM, pharmacy, and finance to optimize coding, charge capture and reimbursement for NTAP.• Updated trauma activation charging to align with resource utilization.• Improved claim edits and denials for device-dependent procedures by updating order sets.• Served as an educational resource for less experienced colleagues. • Reported to Chief Revenue Officer.

• Led activities related to provider enrollment, registration, coding, charge capture, and billing that impacted inpatient and outpatient behavioral health and neurology revenue. • Served as service line resource for clinical leaders and staff. Provided coding education and regulatory requirements for new procedures, drugs, and supplies. • Achieved strong partnerships and shared goals with service line Vice President and Associate Vice President.• Presented strategic planning, financial performance, and KPIs via council and operational meetings. • Resolved accounts in assigned Charge Router, Charge Review, Claim Edit, and Follow-Up work queues.• Participated in Joint Operating Committee payor meetings.• Provided CDM updates to align with annual and quarterly CPT and HCPCS updates.

• Served as revenue cycle leader for enterprise-wide expansion for behavioral health, telehealth, and clinical trial services.• Promoted through various roles and responsibilities. Managed different teams including Coding Quality, Outpatient Coding, Coding Edits and Denials, Surgery Charge Audit, Observation, Charge Capture, and Charge Management.• Increased employee morale and satisfaction from lowest to highest Press Ganey score within 12 months of taking leadership role. Received recognition from Revenue Cycle Vice President.• Provided overall direction and operational activities in maintaining an enterprise-level CDM and Fee Schedule Master files which supported operating revenue totaling $7 billion. • Change owner for all CDM and fee schedule requests, charge capture tools and systems, and revenue routing for fifteen hospitals and multi-specialty physician groups.• Created Revenue Cycle Steering Committee to improve KPIs and reduce denials related to CDM. • Standardized charge capture and charging guidelines resulting in uniformity and consistency for system and patient’s billing experience.• Reduced coding edit backlog and unbilled below benchmark levels.• Provided regulatory and coding guidance for cross-functional projects impacting the CDM, including hospital and physician integrations.• Key contributor to system readiness for Recovery Audit Contractor program and ICD-10 conversion.

Bachelor'S Degree

Certification