Nichole Russ Email and Phone Number

Responsible for the creation, maintenance, and use of Penstock selection logic for all claim, provider, and review types. Works directly with the Audit Director, Project Director, and the IT edit developers to ensure that Penstock claims selection is effectively meeting client deliverables by identifying and correcting coding, billing, and documentation errors that result in improper payments.

Serves as an Inpatient DRG Auditor. Conducts both concurrent and retrospective audits to ensure the most appropriate ICD-10-CM & ICD-10-PCS codes and MS-DRGs are assigned. • Reviews medical record documentation in detail to validate assigned codes and DRGs. Makes recommendations to revise, delete, and/or add codes as necessary. Evaluates any appeals to recommended changes on a case by case basis. • Recognizes opportunities for potential increased specificity and recommends physician queries as needed. • Provides education to coders, as necessary, using Official Coding Guidelines, Coding Clinics, and other coding references. • Inpatient coding using 3M Encoder. Record review through Horizon Patient Folder, ChartMaxx, Meditech, and StarNavigator among others.

Served as the sole Clinical Documentation Specialist for the ProMedica Flower Hospital. Concurrently reviewed inpatient medical records to ensure the most appropriate codes were captured for DRG/SOI/ROM accuracy. • Reviewed medical record documentation in detail to validate coding and clarified clinical picture. Recognized opportunities for more specificity and documentation clarification. • Worked to ensure correct DRG assignment for inpatient stays on a concurrent basis through direct communication and interaction with resident and attending physicians. • Inpatient coding using 3M 360 CAC/CDIS

Served as the acting team lead for the documentation improvement team. Communicated with management regarding the status of the team as well as projects, educational opportunities, and other pertinent developments. • ICD-10-CM & ICD-10-PCS internal education creator and teacher for physicians. Education was focused on current documentation issues as well as changes that would come with ICD-10. Acted as a main player on the ICD-10 education and development team. • Evaluated all Diagnostic Related Group (DRG) denials/third party coding audits and submitted appeals as necessary.• Reviewed medical record documentation in detail to validate coding and clarified clinical picture. Recognized opportunities for more specificity and documentation clarification. • Worked to ensure correct DRG assignment for inpatient stays on a concurrent basis through direct communication and interaction with resident and attending physicians. • ICD-9 physician education through customized verbal presentations, one on one interaction, and newsletters.• Served as department representative on numerous committees including a readmissions committee, resource utilization committee, and left ventricular assist device committee. Recognized and presented issues with patient flow from beginning to end in these committees. • Inpatient coding using the 3M Encoder. Record review systems included Horizon Patient Folder and StarNavigator.