• Analyze and interpret complex data set to identify financial opportunity and oversight in coding trends in claim payments and denials. • Research trends in data to reach conclusions and develop code editing rules to support conclusions of data analysis.• Review and interpret; Health care policy, CMS website and guidance, ICD 10 CM coding and CPT Guidelines to support coding concepts and edits. • Lead and mentor a team of certified coders and nurses in developing coding audits and code edits concepts.• Track and report metrics, provide monthly reporting to management. • Serve as a SME to many areas within Humana for coding concepts. • Review disputes and appeals, provide documentation from official coding source to support my findings.

1. Concurrent and retrospective reviews of the documentation in the medical record. Initial DRG assignment. 2. Query the medical staff as necessary via written/verbal communication to obtain accurate and complete documentation that supports the severity of patient illness, risk of mortality, diagnoses treated, and procedures performed. 3. Follow up on queries to maintain goal of 80% response rate.4. Work with Physicians to improve documentation in medical records. 5. Maintain individual goals for new and re-review of 20 to 25 charts reviewed daily and 20% query rate. 6. Coordinates with HIM Coding Professionals to reconsolidate DRGs, monitor retrospective query rates and discuss questions related to Coding and CDI.

Manager -Specialty Coding Review• Establish a team of on and off- shore auditors for outpatient surgical coding audits.• Ensure and report financial goals.• Manage audit inventory volume based on auditor production.• Manage timelines and clocks for prioritization and compliance on record review.• Set up all workflows audit.• Track and report Auditor metrics in production, quality and audit resultsDRG Auditing Lead, Business Consultant/ DRG Auditor/• Lead team of inpatient auditors. Audit both MS-DRG and APR-DRG.• Provide education and feedback to auditors, including new hire evaluation/training and ongoing quality audits on individual coders/auditors.• Provided written determination of DRG disputes and appeals. Clearly explaining outcome along with siting official coding resources for support; using coding guidelines, coding clinics and CMS. • Performed both remote and on-site DRG audits.• Experience in reviewing Medical records from a variety of facilities both electronic and paper medical records.• Make selections for claims to be audited.ICD-10 Implementation, Coding Consultant• Expertise knowledge of ICD 10 CM/PSC coding guidelines.• Educate all coders at Humana to support their transition from ICD-9 to ICD 10.• Prepare and present classroom training on ICD-10 for both in-person and WebEx classes.• Translate ICD-9 to ICD-10 Codes for all areas within Humana.

Coding-Quality Review Analysis• Participates in departmental and hospital programs for quality/compliance in hospital acquired conditions, risk of mortality and severity of illness data/scores and models. • Oversee external audits process of production coders. • Review appeal external audit finding including, CMS RAC audits and payer audits.• Perform internal coding audits to insure correct diagnosis, CPT and DRG assignment. • Acting Coding Manager during Merger project.• Expert User in 3M Computer Assisted Coding program implementation for the facility.• Assist Clinical Documentation Specialist with coding and query process. Inpatient/Outpatient Coder University of Louisville Hospital• Level 1 Trauma center and Teaching facility • Inpatient coding/DRG assignment.• Emergency Room, Facility level assignment, Infusion/Injection coding in addition to facility coding.• Production coder maintaining 98% accuracy or better.

1. Produce monthly reports for information on Physician Profiles.2. Support the staff by doing payroll, order supplies and schedules.3. Assist Medical Record Supervisor with daily functions.4. Code outpatient lab and radiology visits.

1. Assign ICD-9 diagnosis and procedure codes for DRG assignments.2. Claim check reconsideration for coding inaccuracy using ICD-9 diagnosis codes and CPT procedure codes on outpatient codes submitted. 3. Experienced in 3M encoder software.