I create and deliver comprehensive educational presentations focusing on risk adjustment documentation and coding, where the content adheres to CMS guidelines, regulatory agencies, and industry best practice for overall accuracy and compliance. I identify coding errors or deficiencies in provider documentation and make recommendations for targeted provider education. My responsibilities also include conducting charts audits for proper coding and compliance with both company standards and documentation guidelines. I am committed to maintain high standards of accuracy and compliance by staying up to date with continuous learning and professional development.

I assessed the quality of clinical documentation by conducting daily chart reviews to identify incomplete or inconsistent provider documentation. I would meet with providers to review findings and educate on ways to improve their documentation practices to ensure HCC coding and documentation compliance with CMS guidelines. I also collaborated with the coding team and managers to improve our various resources which included queries, presentations, and performance tracking. I served as a subject matter expert and mentor to my team members and assisted in the creation of educational materials for both coders and providers.

By leveraging my subject matter expertise in HCC coding, clinical documentation, education, and auditing, I established and led the development of a comprehensive risk adjustment program within the organization. I developed effective processes, protocols, and training programs for providers and coders to enhance our performance in our value-based contracts. These initiatives utilized various educational tools, including live or recorded PowerPoint presentations, diagnosis code tip sheets, HCC documentation tip sheets, and specialty specific educational meetings. As a result, this led to millions of dollars in additional monies in our risk-based contacts. I collaborated with the analytics team to review and interpret risk adjustment metrics which focused on the capture and recapture of HCC diagnosis codes and provider performance. We identified HCC coding opportunities and developed strategic plans for future outreach for targeted educational training. I also played a key role in our implementation of EPIC into Tufts Medicine Integrated Network, focusing on HCC coding and documentation protocols and compliance to ensure efficiency and accuracy.

Oversaw internal retrospective, concurrent and prospective medical chart audits for a multi-specialty medical provider group of over three hundred providers, including any special audit requests from providers, management, third-party payers, CERT, and RAC. I prepared training and educational materials on accurate coding and documentation consistent with CMS guidelines and state and federal regulatory agencies for providers and coding staff in relation to E/M, CPT, HCPS, modifiers, and ICD-10 coding.

Managed billing department, as well as performing data entry for charges and payment posting. Supervised daily activities of the entire billing cycle, from front-end demographic data to managing the appeals process.

Provided direct patient care, including administering routine immunizations and medications. I maintained and updated detailed immunization data to ensure accuracy of the medical record. I also collaborated with pediatricians and other healthcare staff to ensure comprehensive care. Used the Cerner electronic health record application for documentation