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Skills

  • Internal Audit Leadership
  • Supervision
  • Regulatory compliance
  • Team building
  • Communications
  • Compliance with CMS risk adjustment policies
  • First Aid/CPR
  • Problem resolution
  • NDCMedisoft
  • Claim denial root-cause analysis

Work Experiences

  • Looked for industry trends on social media and through online sources.
  • Ensured that medical records and health information were accurate, complete, and secure.
  • Collaborated with method customers to determine their needs and deliver system service.
  • Achieved a 38% decrease in incomplete claims.
  • Built streamlined communication processes.
  • Achieved an 80% reduction in deficiencies.
  • Used classification manuals to learn more about disease and diagnosis processes.
  • Achieved exceptional audit results.
  • Oversaw the delivery of framework project by program team, which resulted in framework.
  • Went over the charts and highlighted any information that was missing or incorrect.

Summaries

  • Accomplished Risk Adjustment Coder proficient in medical record abstraction and physician documentation collaboration, with a documented 45% improvement in RAF score capture through strategic coding initiatives.
  • Achieved cost savings of 45% in penalty avoidance.
  • Bilingual achiever with experience scanning and indexing medical records to the correct chart.
  • Achieved 43% improvement in RAF score capture.
  • Accomplished and efficient in applying risk adjustment factors, consistently exceeding coding benchmarks for chronic conditions and improving monthly submissions for risk adjustment by 57% in 2022.
  • Achieved a 33% compliance rate across multiple coding categories.
  • Within Miscellaneous, senior Risk Adjustment Coder and outstanding performer in strategic planning and data analysis.
  • Medical Records Specialist with 15 years of experience in document evaluation and quality control.
  • Achieved a 79% improvement in coding efficiencies.
  • Achieved a 47% improvement in documentation quality.

Accomplishments

  • Improved patient case coding review process and reduced backlog by 84% through the implementation of ServiceNow automation tools.
  • Validated and coded complex chronic conditions like process, driving a reduction in audit corrections by 26% over the past several months.
  • Produced quarterly metric reporting for leadership, focusing on areas of improvement for coder performance, leading to a 79% increase in HCC accuracy.
  • Delivered bi-annual training for coding teams focused on critical diagnoses, improving overall RAF score by 58% within one year.
  • Resolved product issue through consumer testing.
  • Collaborated with physicians to enhance documentation specificity, increasing accurate HCC capture by 42% and reducing pending claims by $8.
  • Developed and implemented query resolution protocols, reducing code-related query response times by 42% and enhancing documentation clarity.
  • Optimized the clinical documentation process workflow, reducing claim preparation time by one year and increasing completed charts by 60%.
  • Proactively identified coding trends through retrospective analysis, resulting in a 29% increase in accurately capturing chronic conditions.
  • Designed easy-to-follow educational materials for medical providers to enhance documentation precision, boosting RAF scores by 58% in under two years.

Affiliations

  • American Society of Safety Professionals
  • Epic Systems User Group – Participating member in best practices workshops for streamlining electronic medical record coding
  • Corporate Coding Compliance Collaborative – Led risk adjustment coder groups to improve audit readiness and data accuracy
  • Senior Health Coders Network – Collaborating with peers on Medicare coding practices and reducing compliance risks
  • American Association of Clinical Coders and Auditors (AACCA) – Contributor to audits and analysis of group claims, enhancing coding integrity
  • Toastmasters
  • International Council of Nurses
  • Association for Healthcare Documentation Integrity (AHDI) – Member of the coding and documentation compliance committee
  • Council for Affordable Quality Healthcare (CAQH) – Participant in initiatives focused on coding standards to improve billing accuracy
  • Healthcare Financial Management Association (HFMA) – Regular attendance at financial workflow and audit-related webinars

Certifications

  • SHRM Certified Professional (SHRM-CP)
  • Certified Healthcare Financial Professional (CHFP) - HFMA
  • Project Management Professional (PMP)
  • Certified Coding Specialist (CCS) - AHIMA
  • CompTIA Security+
  • Certified HCC Coder (CHCC) – Meridian
  • Certified in Healthcare Privacy and Security (CHPS) – AHIMA
  • Certified Emergency Medical Coder (CEMC) – AAPC
  • Cisco Certified Network Associate (CCNA)
  • Certified Public Accountant

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