Patty Caldwell, Mshim, Rhia, Cdip, Chps, Ccs-P, Cpc, Crc Email & Phone Number

Gastonia, Nc, Us

Cary, North Carolina, United States

• Work directly with practices and internal provider relations and EHR specialists to educate and improve the accuracy, completeness, specificity, and appropriateness of diagnosis codes, E&M coding based on services rendered and assign appropriate modifiers.• Work to identify existing or potential problems, gather relevant information, and analyze the information to identify probable causes of problems. Applies knowledge, experience, and common sense and considers alternatives when deciding on the best potential solutions.• Plan, implement, and facilitate presentations and training to large and small internal and external groups on HCC Risk Adjustment and Star rating concepts and critical success factors based on trends and areas of opportunity.• Monitor and analyze key program and population metrics, as well as participate in quality improvement efforts serving as a coding and risk adjustment coding resource for network providers and internal and external partners.• Actively identifying opportunities of improvement and developing and driving annual training initiatives, for both internal and external audiences, related to coding, STAR metrics, and risk adjustment coding management for the populations served. • Assist providers and coding/billing staff in understanding the Medicare Stars quality and CMS - HCC Risk Adjustment driven payment methodology, CPT Category II codes, and the importance of proper chart documentation of procedures and diagnosis coding.• Provides measurable, actionable solutions to providers and internal teams that will result in improved accuracy for documentation and coding practices.• Collaborates with providers, coders, practice staff, and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts.• Interpret, apply, and explain applicable rules and regulations by researching coding requirements for new and existing contracts.

Gastonia

• Responsible for effectively managing and coordinating the coding activities in the Ambulatory Coding Services Department. • Assists with the development and monitoring of structure, policies, procedures, and quality control standards for coding. • Work closely with providers (physicians and advanced care practitioners) of CaroMont Medical Group practices, CMG Central Billing Office, Compliance, Revenue Integrity Departments, Information Systems Informatics and Epic Team Leads regarding process development or system build needed to enhance documentation and coding procedures, and provide education to physicians, coders, and billers when needed regarding coding processes. • Coordinates workflow and work assignments for coding processes and provides education/training for staff based on identified needs through audits or new guidelines published by official coding resources. • Manages team productivity, including implementation and monitoring of coding productivity standards. • Manages team quality, including implementation and adherence to coding quality standards.

Gastonia, North Carolina

• Review identified coding or billing errors from third party vendor from all Gaston Family Heath Services sites and work to correct the errors within 30 days of notice.• Strong analytical skills in order to resolve outstanding insurance claims for all payers.• Review provider documentation to deliver feedback regarding coding appropriately for level of service required and delivered.• Ensuring documentation compliance with all coding mandates and reporting requirements.• Retain a working knowledge of PMCH, MU, HEDIS and other regulatory quality initiatives to support care team members in performing, documenting and appropriately coding to meet desired quality benchmarks.• Evaluate clinical documentation to ensure quality, completeness and consistency as it relates to code selection and reimbursement.Knowledge of documentation requirements, unbundling edits and physician billing issues.• Possess expertise in guiding providers in translating patient information into alphanumeric medical coding.• Supervise, coach, and mentor medical record clerks. • Actively participate in Quality Improvement Initiative.• Oversees, develops and delivers initial and ongoing privacy training to the workforce. • Establishes and administers a process for investigating and acting on privacy and security complaints• Maintains current knowledge of applicable federal and state privacy laws and accreditation standards.• Serves as information privacy resource to the organization regarding release of information and to all departments for all privacy related issues.

Charlotte, North Carolina Area

•Process transactions on customer accounts, ensuring account is set up correctly, problem resolution, and auditing transaction activity•Communicate with customers and third-party contacts (i.e. banks and insurance companies) to ensure timely and accurate processing of account transactions•Perform and document quality assurance reviews on transactions•Analyze and research out-of-state insurance programs for claim and enrollment information to facilitate account transactions•Trend provider activity and claim denials•Prepare claims for mediation review

Chattanooga, Tennessee Area

Responsible for assuring for contractually sound and consistent claims processing for Medical claims. Ability for interpret multiply plan provisions involving medical, flexible spending, dental, and vision benefits. Assisting with third party audits including validating and responding selected claims.

Washington D.C. Metro Area

Preparation of fingerprints records for identification, expedition, and court appears.

Master'S Degree, Health Information/Medical Records Administration/Administrator

Bachelor Of Science (B.S.), Health Information Management /Minor In Computer Information System

Associate Of Arts And Sciences (A.A.S.), Health Information/Medical Records Technology/Technician

Activities and Societies: American Health Information Management Associations

Associate Of Science (A.S.), Health/Health Care Administration/Management, 3.5

Associate Of Arts And Sciences (A.A.S.), Dietetic Technician, 3.0

Associate Of Arts And Sciences (Aas), Business Computer Programming