• Lead and mentor a successful, fluent audit team of multiple lines of business within Medicare Advantage, Medicaid, Tricare, and Commercial Health plans.• Collaborate with IT team to develop algorithms for identification of coding/billing focus.• Oversee the claim selection process.• Maintain ongoing close communication with the CEO to ensure targets are being met and/or exceeded and identifying any needs to achieve goals.• Attend and actively participate in State and National… Show more • Lead and mentor a successful, fluent audit team of multiple lines of business within Medicare Advantage, Medicaid, Tricare, and Commercial Health plans.• Collaborate with IT team to develop algorithms for identification of coding/billing focus.• Oversee the claim selection process.• Maintain ongoing close communication with the CEO to ensure targets are being met and/or exceeded and identifying any needs to achieve goals.• Attend and actively participate in State and National Conferences as well as current and potential Client calls to publicly represent DRG Claims Management.• Oversee new and ongoing Project Development for the company. • Identify and communicate with peers and management any areas needing improvement for efficiency.• Monitor/review QA stats and Change rates. • Monitor staff hours/productivity to meet budget goals.• Identify and develop PIP when necessary with Manager of Auditing.• Create and maintain Operations Procedures.• Hire, onboard and conduct training for employees.• Conduct, field questions/comments and mentor Auditors in Weekly Audit Team/Coding Roundtable meetings and provide education. Show less

In addition to auditing, performing QA, conducting Coding Round tables, I was a client manager performing all duties.

Provide support and operational guidance to hospital HIM departments throughout the company. Assess staffing and department operations for efficiency. Monitor and assist with Unbilled management. Evaluate Clinical Documentation Improvement programs and/or need for such. Lead due diligence reviews and inpatient coding audits as they relate to HIM Operations. Provide coding operations support (staffing, productivity, workflow, etc.) Perform coding audits as well as be a resource for coding… Show more Provide support and operational guidance to hospital HIM departments throughout the company. Assess staffing and department operations for efficiency. Monitor and assist with Unbilled management. Evaluate Clinical Documentation Improvement programs and/or need for such. Lead due diligence reviews and inpatient coding audits as they relate to HIM Operations. Provide coding operations support (staffing, productivity, workflow, etc.) Perform coding audits as well as be a resource for coding questions. Conduct monthly HIM department manager calls to communicate any updates/issues as well as open discussion. Show less

Act as the main contact between VARIS and the client, responding to all requests, maintaining a close relationship with clients with superior communication. Understand ther client's contract in detail, policies, procedures, workflow processed and pricing. Maintain awareness of and ensure compliance with coding guidelines and conventions, state and federal regulation. Establish and revise policies and procedures and monitor peroformance on an on-going basis. Perform detailed DRG and coding… Show more Act as the main contact between VARIS and the client, responding to all requests, maintaining a close relationship with clients with superior communication. Understand ther client's contract in detail, policies, procedures, workflow processed and pricing. Maintain awareness of and ensure compliance with coding guidelines and conventions, state and federal regulation. Establish and revise policies and procedures and monitor peroformance on an on-going basis. Perform detailed DRG and coding analysis of commercial and government payor claims and medical records. Communicate results to hospitals and clients using Official Coding Guidelines, Coding Clinic references, and OIG documentation. Screen claims for coding and payment errors. Show less

Manage and supervise the daily tasks of the entire medical record department including technicians, coders, and transcriptionist. Code inpatient, outpatient, ED, and ambulatory surgery charts daily as needed. Track deliquent records, time and attendance for employees as well as productivity to maintain acceptable standards. Work the Unbilled report. Interact closely with all departments involved to achieve a low DNFB/unbilled total. Enter charge lines and modifiers for departments as necessary… Show more Manage and supervise the daily tasks of the entire medical record department including technicians, coders, and transcriptionist. Code inpatient, outpatient, ED, and ambulatory surgery charts daily as needed. Track deliquent records, time and attendance for employees as well as productivity to maintain acceptable standards. Work the Unbilled report. Interact closely with all departments involved to achieve a low DNFB/unbilled total. Enter charge lines and modifiers for departments as necessary as well as reconcile charges when needed. Worked the HCA Data Exchange Tool (DET) HIM queue as well as the Chargemaster queue. Performed various audits, closed and open medical records, for content and documentation, as well as performed coding audits on inpatient and outpatient records. Produce and enforce policies procedures when necessary to abide by The Joint Commission standards. Show less

Work the unbilled report. Query accordingly. Utilize Meditech, Microsoft Office and 3M coding software. Work the Medicare 72 hour rule accounts per the HCA/DET. Manage the coding productivity. Assign appropriate ICD-9-CM diagnosis and procedure codes to inpatient charts including acute charts comprised of medical, surgical, pediatric, women's services, newborn, intensive care units, and progressive care units, swing (SNF), and rehabilitation. Assign appropriate CPT codes and ICD-9-CM diagnosis… Show more Work the unbilled report. Query accordingly. Utilize Meditech, Microsoft Office and 3M coding software. Work the Medicare 72 hour rule accounts per the HCA/DET. Manage the coding productivity. Assign appropriate ICD-9-CM diagnosis and procedure codes to inpatient charts including acute charts comprised of medical, surgical, pediatric, women's services, newborn, intensive care units, and progressive care units, swing (SNF), and rehabilitation. Assign appropriate CPT codes and ICD-9-CM diagnosis codes to Ambulatory surgery charts of multiple specialities, ER, and outpatient lab and radiology charts. Perform coding, assembly and analysis of Behavioral Health charts. Show less