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Skills

  • Diagnostic coding accuracy
  • Customer service
  • Records review
  • Internal Audit Leadership
  • DRG assignment
  • Chart review and analysis
  • Medical billing code accuracy
  • Claim denial root-cause analysis
  • QMSoftware Receivables Management
  • Creating coding policies and guidelines

Work Experiences

  • Analyzed conflicting documentation.
  • Oversaw the delivery of framework project by program team, which resulted in framework.
  • Achieved a 83% compliance rate.
  • Achieved exceptional audit results by improving documentation retrieval processes and preemptively resolving coding errors, achieving audit pass rates of 78% over one year.
  • Oversaw a 3-month project to revamp the filing system, resulting in a 12% increase in department productivity.
  • Discovered new ways to improve the management of medical records.
  • Transported Jira to several months customer locations.
  • Achieved this in 2018.
  • Achieved a 71% decrease in query turnaround time.
  • Achieved audit pass rates of 30% over 18 months.

Summaries

  • Achieved a 79% improvement in coding efficiencies.
  • Accurately reviewed and coded medical records.
  • Accomplished Risk Adjustment Coder.
  • Achieved an 62% reduction in claim rejections.
  • Excited and dedicated to accuracy, with excellent decision-making abilities.
  • Adhered to the latest CMS risk adjustment policies.
  • Collaborated with physicians to enhance coding efficiency.
  • Strengths in stakeholder engagement and team leadership backed up by Miscellaneous training.
  • Aligned documentation with industry best practices.
  • Accomplished in applying risk adjustment factors.

Accomplishments

  • Collaborated with physicians to enhance documentation specificity, increasing accurate HCC capture by 42% and reducing pending claims by $8.
  • Monitored and enhanced clinical documentation integrity, raising code accuracy rates by 59% and facilitating better provider-payer communication.
  • Oversaw coder performance reviews, implementing a targeted feedback system that improved coder error rates by 55% within the past year.
  • Proactively identified coding trends through retrospective analysis, resulting in a 29% increase in accurately capturing chronic conditions.
  • Produced quarterly metric reporting for leadership, focusing on areas of improvement for coder performance, leading to a 79% increase in HCC accuracy.
  • Reduced query volume by 60% through hands-on physician education sessions, improving coder efficiency across high-impact diagnostic categories.
  • Mentored junior coders to develop strong code validation skills, resulting in improved team performance and increased claim acceptance rate by 45%.
  • Utilized ITIL knowledge to assist in coding for patients with system, boosting compliance with CMS directive by 76%.
  • Led initiative to identify and amend coding discrepancies, recovering $7 in overdue claims during a one year quality assurance audit.
  • Led the successful deployment of a dual-language (English and Japanese) coding team, improving turnover rates on international claims by 49%.

Affiliations

  • American Association of Clinical Coders and Auditors (AACCA) – Contributor to audits and analysis of group claims, enhancing coding integrity
  • National Alliance of Medical Auditing Specialists (NAMAS) – Participation in specialized risk adjustment audit training
  • International Association of Administrative Professionals
  • Healthcare Financial Management Association (HFMA) – Regular attendance at financial workflow and audit-related webinars
  • American Marketing Association
  • Association for Computing Machinery
  • ACDIS (Association of Clinical Documentation Integrity Specialists) – Engaged in workshops focused on coding best practice and compliance
  • Certified Coding Specialist (CCS) credential holder via AHIMA – Demonstrating mastery in coding healthcare diagnoses and procedures
  • Association of Information Technology Professionals
  • Medical Group Management Association (MGMA) – Participation in coding and compliance leadership development programs

Certifications

  • Licensed Practical Nurse (LPN) - category
  • Google Certified Professional Cloud Architect
  • Health Care Compliance (HCCA) Certification
  • Certified E/M Coder (CEMC) – AAPC
  • Certified Risk Adjustment Coder (CRC) - method
  • Certified Professional Medical Auditor (CPMA) - AAPC
  • Certified Clinical Documentation Specialist (CCDS) - framework
  • Salesforce
  • CompTIA Security+
  • SHRM Certified Professional (SHRM-CP)

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