Conduct comprehensive chart reviews to facilitate the accurate and appropriate identification of patient medical conditions that result in improvement in overall quality, completeness and accuracy of clinical documentation, and disease registry assignments.Combine clinical expertise and coding knowledge of Hierarchical Condition Categories (HCCs) to recognize accurate and appropriate diagnosis considerations meeting HCC criteria for suspect condition identification as well as new and recapture opportunities.Interpret health information in the medical record and present relevant supporting clinical indicators regarding diagnostic specificity in context of compliance considerations.Identify themes through chart review that prompt provider education and contribute to training efforts.Communicate appropriately with physician or care team through Epic resources. Explore opportunities for process improvement and quality assurance while promoting integrity within the electronic health record (EHR) documentation.

Provide clinical documentation integrity (CDI) services aimed at enhancing quality assurance efforts in the new era of value-based care by optimizing capture of risk adjusted HCC diagnosis through the evaluation of practice processes, detailed chart review, and enhanced provider engagement and education.* Per Diem Contract 3/2018 – 3/2019: ENJOIN CDI, Population Health CDI: Risk Adjustment Clinical Analyst

Identified and explored opportunities within documentation and in medical and nursing practices directed at improving patient safety, and reducing mortality rates and number of care complications.Conducted clinical case reviews at encounter level for granular breakdown and performed high-level reviews of data for trends and aggregated analysis to benchmark performance and outcomes.Assisted with oversight of inpatient quality measures, which included specific CMS/AHRQ Patient Safety Indicators (PSIs).Participated in organizational pursuit for national leader recognition by overseeing several Clinical Collaboration Council Consensus Workgroups. The objective was to improve the health system’s 30-day mortality rates and decrease identified complications of care through clinical standardization and reduced care variation by employing evidence-based medicine best practices.Collaborated closely with Director of Clinical Collaboration Council (CCC) to improve process of care and outcome metrics.Oriented and mentored the system’s first Sepsis Coordinator with the Sepsis 3 definition adoption and program roll-out.

Contracted through AMN Healthcare: Conducted outpatient clinical documentation integrity (CDI) services by using my clinical knowledge, understanding of national coding guidelines, and standards of compliance to improve overall quality and completeness of clinical documentation within the patient electronic medical record using a multidisciplinary team process.Applied clinical knowledge to evaluate how the medical record will translate into coded data, including reviewing provider and other clinical documentation, chronic disease processes, medications and their indications, diagnostic information, and treatment plans.Worked collaboratively with ambulatory physicians and advanced practice providers to ensure that the clinical information within the medical record is accurate, complete, and compliant. This included accurate documentation to support the capture of Hierarchical Condition Categories (HCC), ICD-10-CM specificity and medical necessity of ambulatory visits. Educated members of the patient care team both formally and informally regarding documentation guidelines, coding requirements and service specific requirements.

(Described under University of California, Davis)

Conducted Medicare Annual Wellness Visits (AWVs) for Medicare beneficiaries at health screening events throughout Southwest Florida. Provided individualized patient risk assessment and prevention plan, as well as end-of-life advanced care planning.

Conducted outpatient clinical documentation integrity (CDI) reviews of ambulatory patient visits for several clients to support the accurate capture of Hierarchical Condition Categories (HCC) diagnoses with attention to ICD-10-CM specificity and the submission of compliant provider queries.

Performed health risk assessments (HRAs) on a mobile unit for Medicare, Medicare Advantage, and various commercial health plan beneficiaries throughout Florida. Conducted clinical documentation reviews and ICD-10/CPT code assignment for the HRAs performed.

Provided ongoing provider education related to the clinical documentation of the annual health risk assessments (HRA) conducted by our providers, nurse practitioners, who represented various health plans in the prospective, multistate “Healthy House Calls” Program. Performed documentation audits to safeguard quality assurance and improve documentation. Acted as clinical liaison to providers by addressing their clinical inquiries, documentation issues, and clarifying queries.Reviewed comprehensive health risk assessments and past medical records for documentation related to disease or symptoms and diagnostic descriptions for a given encounter, and accurately assigned ICD-9-CM and ICD-10-CM codes to the highest specificity ensuring that diagnostic codes and documentation correctly reflected and supported the visit. Identified diagnoses related to CMS HCC, Rx HCC, and HEDIS measures; queried providers related to documentation deficiencies and maintained a ninety-five percent accuracy rate.

Responsible for assisting the healthcare team in providing urologic care for men and women of all ages in a busy urology practice in Southwest Florida.

Responsible for providing perinatal care to a diverse population of obstetric patients in a large maternal-fetal-medicine practice in SW Florida specializing in managing high-risk pregnancies complicated by pre-existing medical diagnoses, pregnancy-related conditions, multiple gestations, fetal anomalies & other fetal concerns.

Responsible for providing perinatal care to a diverse population of obstetric patients in a large maternal-fetal-medicine practice in South Florida specializing in genetics and high-risk pregnancy management.

Nursing faculty member at private university responsible for instructing associate-degree nursing students in the obstetrical and pediatric nursing curriculum and clinical experiences.

Staff RN and Charge Nurse for perinatal unit, responsible for nursing care of high-risk and surgical obstetric patients at level three hospital & Regional Perinatal Intensive Care Center (RPICC), with an annual average of 3,500 deliveries.· Managed high-risk antepartum patients, postpartum patients, and low-risk newborns.· Managed intrapartum nursing care of low and high-risk obstetric patients. Assessed maternal/fetal status and labor progress. Assisted care providers with intrapartum procedures and deliveries.· Functioned as triage nurse responsible for prioritizing cases, initiating testing and treatment, and collaborating treatment plan with health care team. Provided patient education and discharge teaching.· Performed pre-operative, circulating, and recovery room nursing duties during the peri-operative periods for obstetrical surgeries. Served as scrub nurse responsible for assisting surgeons during elective, indicated, and emergent operative cases.

Staff RN responsible for all phases of obstetric nursing care at level three teaching hospital specializing in high-risk obstetrics, with an annual average of 4,000 deliveries.

Staff RN responsible for all phases of obstetric nursing care at level three teaching hospital specializing in high-risk obstetrics, with an annual average of 2,400 deliveries.