Healthcare professional with over ten years experience in revenue recovery, health insurance, and hospitals. Inpatient/outpatient coding, DRG validation, denial management, Accountable Care Organization support, medical records, client relations, and publication drafting. Certified Coding Specialist (CCS). Rutgers alum.
Health/Roi
-
Drg ValidatorHealth/Roi Apr 2014 - PresentMetuchen, Nj* Recovered over $2M for NYC hospital systems in FY 2022.* Conducted coder education in-services, focusing on hospital-specific coding trends* Published article for HFMA, detailing financial reimbursement for inpatient ICD-10 coding changes specific to the COVID-19 pandemic* Department trainer for new auditors* Assisted in drafting proposals and responding to RFPs for new clientsCurrently, I review inpatient medical record coding for a number of New York City and New Jersey hospital systems - identifying opportunities for revenue recovery via DRG validation. Extensive experience with both MS and APR DRG groupers. Additional expertise in: client educational services, denial management, RFP responses, NTAP identification, drafting/submitting articles to professional organizations, and submission of questions to Coding Clinic. In 2023 my role expanded to include training of new auditors/validators, with focus on fundamentals of coding conventions and grouper methodologies.
-
Business AnalystQualcare Inc. Oct 2012 - Apr 2013Piscataway, Nj*Compiled clinical & financial Employee Shared Savings Program data into monthly client reports.*Executed specialized cost trend analytics at clients’ requests.*Streamlined and revised Accountable Care Organization (ACO) reporting Standard Operating Procedures (SOPs).I presided over a number of distinct Accountable Care Organizations' data and client needs. In addition to monthly metrics reporting, I spearheaded client outreach and managed provider reporting concerns. Provided analytic support, instituting program changes for enhanced client experience. -
Office AssistantAstera Cancer Care Jun 2007 - Oct 2012East Brunswick, Nj* Systematically compiled and secured confidential patient insurance information.* Assembled and stored information for inactive and deceased patients.* Facilitated patient check-in and insurance intake.Facilitated the day-to-day operation of an Oncology practice. Acquired extensive experience in customer service, medical records, and data entry via patient interfacing, front desk reception, and contact with medical facilities. -
Disease Management InternQualcare Inc. Jan 2012 - May 2012Piscataway, Nj* Bolstered single-client member enrollment by 3%, generating over $9,000 in revenue. * Developed and implemented departmental Standard Operating Procedure (SOP)changes, saving over $16,000 per year.My primary goals focused on improving the efficiency and outreach of the "Keeping In Touch" program. I instituted a number of program changes to optimize departmental efficiency. My enrollment outreach and workflow revision simultaneously boosted single-client enrollment by 3%, while collectively generating $25,000. Proposed changes to reporting metrics, allowing a more transparent display of data. -
InternIndependent Pharmacy Alliance Of America Jun 2011 - Aug 2011Cranbury, Nj* Analyzed state legislation impacting Pharmacy Benefit Managers (PBMs) & independent pharmacies.* Identified key obstacles precluding independent pharmacies’ competition with chain pharmacies and mail-order prescription programs.Researched proposed state legislation for the IPA's Executive Director of Government Affairs. Prioritized bills in both the New Jersey Senate and House based on relevance to IPA's mission goals. Organization facilitated more direct lobbying, relevant to independent pharmacies' needs.
-
VolunteerRobert Wood Johnson University Hospital Sep 2004 - Jun 2007New Brunswick, Nj* Assisted Performance Improvement (PI) department in day-to-day activities.* Processed patient satisfaction surveys, improving in-patient experience.Improved inpatient experiences via data entry of satisfaction surveys. These responses were later utilized by hospital staff to implement appropriate procedural changes to enhance the hospital's care. Provided resources to incoming hospital visitors, ensuring accurate delivery of hospital information.
Tom Risi, Ccs Education Details
-
Public Health
Frequently Asked Questions about Tom Risi, Ccs
What company does Tom Risi, Ccs work for?
Tom Risi, Ccs works for Health/roi
What is Tom Risi, Ccs's role at the current company?
Tom Risi, Ccs's current role is DRG Validator.
What schools did Tom Risi, Ccs attend?
Tom Risi, Ccs attended Rutgers University-New Brunswick, Rutgers University-New Brunswick.
What are some of Tom Risi, Ccs's interests?
Tom Risi, Ccs has interest in Bass Guitar, New York Giants, Music, New York Mets, Creative Writing.
Free Chrome Extension
Find emails, phones & company data instantly
Aero Online
Your AI prospecting assistant
Select data to include:
0 records × $0.02 per record
Download 750 million emails and 100 million phone numbers
Access emails and phone numbers of over 750 million business users. Instantly download verified profiles using 20+ filters, including location, job title, company, function, and industry.
Start your free trial