Nathan Monroe Email & Phone Number

Sarasota, FL, US

Emeryville, CA, US

Emeryville, CA, US

Lisle, Illinois, US

Indianapolis, Indiana, US

• Oversaw and directed the activity of Compliance Consultant Sr. associates
• Completely redesigned the provider coding audit program including program scope and associated objectives
• Completely redesigned the provider clinical documentation education program including the development of new provider facing review summary documents
• Contributed to key policies, procedures, and departmental operating procedures
• Developed a comprehensive provider facing clinical documentation and coding guide published on Anthem’s provider webpages
• Innovated and developed new tracking and reporting tools to facilitate operational efficiency and program oversight

Maryland Heights, Missouri, US

• Met with clients, defined the scope of each engagement, ensured necessary resources were available or obtained, reported out key project metrics to client leadership, and ensured overall project success
• Oversaw and directed the activity of the coding consulting team
• Served as lead risk adjustment and outpatient clinical documentation improvement subject matter expert
• Composed and implemented key policy, procedure, and departmental operating procedure documents in tandem with the enterprise compliance team
• Piloted and provided feedback on new auditing platforms with the intent of streamlining workflow processes

Saint Louis, MO, US

• Oversaw and directed the activity of coding consultants, customer service representatives, and project managers
• Lead Prospective, Concurrent, and Retrospective Risk Adjustment Processes for three unique lines of business: Medicare, Medicaid, and ACA health planso Chart Chasing, Risk Adjustment Suspecting and Outreach, Risk.
• Serve as a subject matter expert on all things Coding, CDI, and Compliance

Louisville, Kentucky, US

• Conduct focused coding audits on providers identified by an outlier analysis or as the result of an allegation received by the plan.
• Audited multiple calendar years with an emphasis on trending aberrant documentation, coding, and billing patterns year over year.
• Compiled audit findings into an executive summary and subsequently presented the summary to the internal investigations team

Louisville, Kentucky, US

• Conducted over 100 face-to-face provider education sessionso Ran audit engagement with each provider group from start to finish
• Developed Coding Improvement Plans to be distributed to providers and their staff. o Improvement plans catered to each provider’s individual audit results.
• Established rapport quickly with multiple points of contact. o Communicated extensively with providers, office managers, and other coding and CDI professionals.
• Traveled nationally to accommodate on-site education.

Atlanta, GA, US

• Served as the primary coder and auditor for four branches of Kindred at Home.
• Abstracted all ICD diagnosis codes as needed for Start of Care, Resumption of Care, and Recertifications.
• Performed limited OASIS review to ensure code assignment was congruent with clinical documentation found within the OASIS assessment.
• Collaborated regularly with branch managers to ensure timely filing, accuracy, and completeness of all home health episodes of care.
• Queried clinicians as needed for ambiguous, conflicting, or otherwise unclear clinical documentation.

Associate'S Degree, Registered Nursing/Registered Nurse

Master Of Science - Ms, Health/Health Care Administration/Management

Bachelor'S Of Science, Health Information/Medical Records Administration/Administrator

Bachelor'S Degree, Biology, General