Healthcare related consulting specific to revenue cycle management, risk adjustment, coding and quality.

· Serves as a subject matter expert on coding as it relates to Risk Adjustment.· Audits diagnosis data retrieved from medical records and/or data extract files.· Provides oversight and ensures complete and accurate coding for Medicare Advantage plan data received.· Collaborates with internal stakeholders to solve complex problems.

· Directed 12 internal coders, 30 external/Offshore coders, 1 lead coder, and 1 manager.· Managed initiatives for accurate and timely Risk Adjustment coding and quality to maximize revenue.· Managed initiatives with internal and external coders to ensure deadlines and objectives were met.· Motivated the coding team to review 100% of Medicare Advantage 2019 and 2020, and ACA 2021 documents with potential opportunity prior to final submission deadline.· Motivated the coding team to review 82% of 448,897 documents with opportunity during the 7 weeks prior to Medicare Advantage 2023 Initial Sweeps deadline.· Collaborated with other teams including Quality, Abstraction, Operations, and Data Submissions during projects to ensure timely completion.· Monitored staff productivity and quality scores to verify values were at departmental standards.· Collaborated with external/Offshore team lead coders to mitigate coding issues and to maximize revenue.

· Presented education and analysis reports to providers/practices related to risk adjustment, coding, and documentation.· Monitored on-going performance of 40+ practices and physicians through retrospective chart audits and presented findings to the providers.· Maximized HCC capture rates for 96% of assigned practices.· Managed relationships with assigned providers and practices within the UPMC Health Plan Network.· Handled the scheduling, tracking, follow-up, and workflow integration of each assigned practice.· Educated and trained Practice/Office Managers on workflows within the office for appropriate capture of HCC diagnosis codes.· Presented HCC education and Lumanent workflows and education to specialist practices within the UPMC Health Plan Network.

· Managed an office of 10+ employees, 4 Physicians, and 1 Nurse Practitioner.· Managed Physician and staff schedules including vacations, on call and meetings as well as training and security access.· Monitored HCC, Gap closures and ratings for the practice to ensure code capture, correct documentation, completed testing, and accurate ratings.· Handled all construction within the office including project management, payment, and approvals.· Contributed to the onboarding processes of Physicians and Non-Physician Practitioners.· Handled all areas of hiring and firing of employees including Performance Improvement Plans.· Conducted employee evaluations and determined merit increases on a yearly basis.· Handled day to day issues amongst staff to include the enforcement of all policies and procedures.· Verified financial aspects including Profit and Loss, Revenue Cycle Management and Denial Management.· Verified billing and coding prior to submission to insurance companies.

· Managed an office of 10+ employees, 4 Physicians, 1 Nurse Practitioner, and 3 Physician Assistants· Designed and implemented the adopted practice management/EHR system.· Technical point of contact during implementation of practice management/EHR system and during all technical systems upgrades for HIPAA compliance including workstation, server, and Active Directory upgrades.· Managed all vendor relations including the negotiation of contracts as well as all aspects of the credentialing process for all providers.· Monitored Meaningful Use, PQRS process, and MD attestation.· Handled website deployment, design and information included on website.· Performed compliance related security risk analysis and drafted security policies and procedures.· Coordinated Physician coverage and managed staff and Physician schedules, vacations, on call and meetings.· Handled all office construction and renovations.· Handled all facets of hiring and firing of employees including but not limited to background checks, drug screenings, credit checks as well as temp agency fee negotiations.· Conducted employee evaluations on a yearly basis and handled day to day issues amongst staff including enforcement of all policies and procedures and disciplinary action within the office.· Accounts Receivable – Managed A/R follow-up, fee schedule negotiations with insurance companies, in-house debt collections, calculations of deductibles/out of pocket, personal balances, personal and insurance refunds, set up payment plans for patients, assisted with applications for medical assistance, posted all payments including personal, insurance and EFT, ensured the accurate posting of all office and hospital charges, conducted monthly chart audits to ensure accurate billing as well as end of month close out/reports.· Coordinated staffing between multiple offices and provided management coverage for an additional office.