Detroit Metropolitan Area
*Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement. *Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers. *Collaborate with team leaders to ensure thorough review of DRG denials. *Conduct audits in alignment with organizational quality and timeliness standards. *Use proprietary auditing systems proficiently to make consistent determinations and generate audit letters. *Recommend improvements to the audit system to enhance efficiency. *Ensure compliance with HIPAA regulations for protected health information.
• Works with the Coding Liaison Manager and Director of Coding Quality Management in 1:1 or small group sessions to establish open lines of communication regarding potential coding quality concerns. • Assists with coding review inquiries in prebill or postbill (retrospective) status related to ICD-10-CM, ICD-10-PCS, CPT, DRG/APR-DRG or APC codes following internal coding policies, AHA and AMA coding references, local, state, and federal coding guidelines. Quality reviews also include missed query opportunities. • Completes requests from customers and collaborative partners to determine if coding quality issues exist. Review results are shared with Local and Regional Coding Site Managers, Coding Advisory Team and Education and Training Team as needed when coding issues are identified. • Educates the CDI team and Physician Advisor on coding changes, DRGs, Official Coding Guidelines and documentation requirements • Works with Quality & Risk teams to review coding related to HAC’s, PSI’s and Mortalities
• Perform internal coding audits and communicate feedback to coders to correct errors and improve coding skills • Coordinate with Compliance and Audit Manager to perform education, action plans or other measures necessary to assist those who are falling below the minimum 95% standard • Ensure optimal reimbursement of all cases in compliance with CMS policies and processes and Official Coding Guidelines • Provide one-on-one training and education for remote coding staff as part of onboarding
• Abstract and review hospital inpatient medical record documentation to assign, sequence, edit and/or validate the appropriate ICD-10-CM, and/or ICD-10-PCS codes. Coding Specialties include pediatrics (complex), cardiology, GI/GU, orthopedics, OB/GYN and neurology • Coordinate with clinical documentation improvement and quality teams to ensure validation of MS-DRG, APR-DRG’s, potential preventable complications and hospital-acquired conditions • Creation of physician query when documentation in medical record is ambiguous or unclear for coding purposes
• Responsible for pro-fee coding of CPT and ICD-10 codes remotely for inpatient/outpatient evaluation and management services to prepare for reimbursement.
• Lead and directed 6+ employees in all aspects of coding, reimbursement, and compliance • Abstract and review outpatient medical record documentation to assign, sequence, edit and/or validate the appropriate E & M leveling code, CPT procedure code and ICD-10-CM diagnoses assignment of multi-specialty pro-fee outpatient services including urgent care, OB/GYN, ancillary and Same Day Surgery • Serve as a coding resource to the business office team including ICD-10 implementation
• Lead and directed 35+ employees in all aspects of coding, reimbursement, and compliance for over 200 multi-specialty physician groups. • Supervision of staff including charge entry, coding, and accounts receivables • Coding and billing of pro-fee services including same day surgery and E & M leveling • Prepared and presented billing information to employees and practices
Responsible for leading and directing 20+ employees in all aspects of coding, reimbursement and compliance for 25 multi-specialty physician groups. Duties and responsibilities include: Coding/billing all professional/technical components for inpatient, outpatient and E/M for multi-specialty groups; trained new associates and interns in coding and charge entry procedures and policies; processed rejections/denials and inquiries from insurance companies; monitored and audited charge entry/coding for accuracy for in house billing and physician practices and organized and distributed incoming coding and charge entry work load