Sandra Troade Email & Phone Number

United States

*Responsible for conducting quality assurance audits on all Advantasure coders (including Level 1, Level 2, CDI Reviewers and Pre-Submission Coders) *Answer coding questions for the all coders (Level 1- Pre-Submission Team) *Help interpret and utilize all coding guidelines from Advantasure’ s coding guidelines to ICD 10, Coding Clinic and CMS.Provide coding support and expertise for risk mitigation audits for Advantasure clients including RADV and any government audit.

*Development of Opportunities, Query Identification and Provider Education to improve the Medical Record Documentation. *Communicates, promotes, and partners with physicians for improved clinical documentation to reduce the risk for submitting claims that are insufficient, incorrect, or lack medical necessity.*Understanding the importance of documenting the patient’s acuity of illness by capturing the severity of illness (SOI) and risk of mortality (ROM)- the patient’s overall disease burden. *Accurately capture this information in the medical record. *Becoming familiar with ICD-10-CM codes that impact reimbursement in the CMS-HCC model. *Ensure that updated diagnoses (e.g., obtained through diagnostic studies) are added to the medical record by the PCP • Ensure that information documented in the medical record is translated into specific codable diagnoses.

1401 Nw 136Th Ave Sunrise, Fl 33323

• Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment.• Review medical records, patient medical history and physical exams, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify whether: a. The diagnosis codes are supported by the documentation and ensure with ICD-10-CM Guidelines for Coding and Reporting.b. The diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframec. Review for clinical indicators and query providers prospectively to capture the severity of illness of the patient• Performs on-site or electronic medical record reviews to capture of all relevant HCC diagnosis codes based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.

*Review Medical Record information to identify all appropriate coding based on CMS HCC categories*Provider support, education and training related to revenue optimization, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards*Provide real time support and coordination with Primary Care Providers and Care coordinators for MRA coding, HEDIS and STARS.*Perform compliance audits for designated providers/centers consistent with established audit protocol.* Coordinate with clinical leadership in the development of provider training plans and for active support in the training process.*Monitor Coding changes to ensure that most current information is available

3091 Coral Way, Miami-Fl

HCC AuditorDiverse set of concurrent medical records review skills, clinical knowledge, and knowledge of coding and reimbursement regulations.Educate physicians how documentation affects diagnosis and RAF reimbursement.Ability to interpret medication administration record to look for query opportunities.Work with clinical team to develop provider educational materials on MRA and HEDISPremier conduct coding and abstraction of HCC codes from all types of documentation includes impatient and outpatient charts as per CMS documentation guidelines.

Review medical records to assure proper coding of submitted claims.Ensure all services documented in the patient’s medical records are coded with the appropriate ICD-9-CM codes and procedures codes. Conduct a review of medical records to ensure compliance with coding and documentation guidelines.Provides proper documentation and Medicare Risk Adjustment education to physicians.Submits inaccurate codes to be removed through the appropriate use of the Condition and Code Error Report. Demonstrated Knowledge of ICD-CD-9-CM guidelines for current coding classifications.Ability to perform within acceptable established quality standards.Submit appropriate billing encounters to the appropriate insurance.Follow up to see if a claim was accepted or denials.Investigate rejected claim to see why denied was issued.Review medical record information to identify all appropriate coding based on CMS HCC categories. HEDIS Medical Record Reviewer

Organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered.Review medical record information to identify all appropriate coding based on CMS HCC categories.Responsible in the communication to physicians and medical staff on the importance of medical records charting and coding accuracy.Enter and Bill Pulmonologist study results and procedures into database.ICD9 & CPT Coding and Billing of Pulmonary Function Test’, ABG’s, Spirometries and Pulmonary Stress Tests

Manage patient dental balances and benefits accordinglyEnter all dental specialist claims and balance reports from account payableBill all Dental External Specialist ClaimsRun a weekly and monthly Report for Dental External SpecialistRequest Checks to Finance Department to pay External Dental Specialist claim

Certified Documentation Improvement Expert Outpatient, Medical Insurance Coding Specialist/Coder

Certified Professional Coder Cpc, Medical Insurance Coding Specialist/Coder

Bachelor'S Degree, Health Information Management

Certified Risk Adjustment Crc

Certified Professional Medical Auditor (Cpma), Medical Insurance Coding Specialist/Coder