Codes facility ambulance and outpatient records.Performs monthly HIPAA audits to monitor privacy standards.

 Served as HIM Project Manager for implementation of Powerchart EMR (Cerner Millenium) and Profile HIM applications for 5 affiliate hospitals.  Managed transcription department and served as system administrator for transcription applications.  Worked directly with transcription vendor operations manager and IT department to resolve quality, turn-around-time, and distribution issues.  Served as IT liaison to HIM department EMR users for system issues, and provides technical guidance to identify system deficiencies, investigated opportunities, and recommend corrective action or needed enhancements. Participated in the planning, design, training and implementation of computerized provider order entry (CPOE), electronic physician documentation, and electronic medication reconciliation projects.  Documented and coordinated all change management, Start/Stop/Continue, and training material during system conversions and upgrades.  Responsible for creating and updating department policies and procedures, physician orientation training material

Manages claims coding rule initiatives utilizing iHealth and Optum’s CES payment policy management systems.Monitors CMS transmittals to ensure payment policies adhere to CMS guidelines and researches state laws and AMA guidance. Evaluates clinical coverage guidelines in order to recommend health plan policy edits. Evaluates change proposals related to medical expense initiatives from a regulatory, financial, and operational perspective. Documents supporting authority for coding and payment policy edits and presents change proposals to committee.

  Serve as coding expert for Medicare Advantage health plan. Manage relationship with DRG audit vendor, to include responding to second-level DRG appeals, requesting offset of identified overpayments, managing invoices, refunds, and check requests.  Audit medical records referred by Special Investigation Unit (SIU) for potential fraud, waste, and abuse, and provide detailed report of findings back to SIU.  Utilize knowledge of Medicare payment methodologies to ensure claims processing system applies appropriate payment to institutional and professional claims.  Resolve daily claim holds for unlisted CPT codes, claims pending review of supporting documentation, category III CPT codes, pricing modifiers, and carrier-priced codes. Monitor CMS transmittals and submit change requests to claims processing vendor to ensure system is properly configured to adhere to CMS guidelines. Utilize knowledge of MUEs, CCI, LCDs, and modifiers to enhance cost containment initiatives

 Supervised twenty employees in the departments of coding, insurance, credentialing, accounts receivable, medical records, registration, and scheduling. Reviewed patient medical record documentation to accurately code diagnoses, procedures, and services. Performed monthly internal coding audits per compliance guidelines. Provided quarterly coding, documentation, and compliance training to all physicians, and mid-level providers.  Negotiated contracts and fee schedules for new insurance products, and renegotiated existing contracts to ensure maximum reimbursement and adherence to contract language.  Developed a surgery tracking system that accounted for more than $200,000 in additional revenue over 3 years. Worked all coding related and second-level appeals, which accounted for additional revenue of $50,000 over 3 years.  Responsible for NextGen practice management system implementation, training, troubleshooting, upgrading, security, and support. Obtained credentials as NextGen Certified Professional for both EPM and EMR software.  EMR core group member. Assisted EMR system administrator with training and support, documentation requirements, and security rights.  Assisted with credentialing providers for medical licenses, hospital privileges and insurance products