Population Health Ambulatory Coding and Documentation Specialist at Penn Medicine Health System (2022-01 – Present)
Instrumental in development of team review processes for Risk Adjustment Data Validation. Ongoing collaborating relationships with Internal leadership, Compliance team, Billing team, Population Health Analysts, EPIC builders and trainers as well as external relationships with IBX, Tandigm, Aledade ACO. Responsible for keeping outpatient CDI team (Coders and Registered Nurses) informed on ICD 10 CM coding updates.
- Running reports out of EPIC to establish review sample and criteria predetermined based on needs for compliance team
- Review provider encounter notes and record findings manually in excel spreadsheet
- Sort the spreadsheet to analyze trends and needs for education
- Develop power point presentations based on the trends across the practice
- Deliver either in a 1:1 focused, small group or large group presentation
- Customize 1:1, as necessary with actual examples of encounter note documentation
- Group sessions would require blinded examples of documentation
- Payer program platforms are visited daily when not focused on reviews
- Attend all payer meetings to stay informed about Value Based Care Contracts and requirements
Clinical Coding and Documentation Specialist/Provider Educator/Risk Adjustment Auditor at Einstein Care Partners ACO (2019-01 – 2022-12)
Team player proactively sharing knowledge and research, participating in weekly coding consensus, developing internal coding guidelines for new MSSP ACO coding team, developing query process, provider training and education materials. Performing pre-claim scrubbing edits for risk adjustment data validation. Training residency program, collaborating with opioid treatment program providers, collaborating with Risk Adjustment Coding project manager, data analysts, care management team, supporting outside network coding teams with upcoming 2021 E/M coding changes. Developed customized upgrade for RCX Rules editing tool.
Maintaining
SharePoint Directory to house coding and provider education materials. Authoring all meeting minutes.
Senior Coder/Coding and Documentation Specialist/Provider Educator/Risk Adjustment Auditor at Holy Redeemer Health System (2017-01 – 2019-12)
- Pre-visit and Post-visit chart reviews and claim analysis
- Formal audit and informal chart review to reveal opportunity for missing risk adjusted ICD 10 codes, missing elements of proper encounter note documentation
- Level of service audits used to educate providers on CPT E/M assignment and proper documentation within the EMR
- GPRO abstraction and education development
- Facilitate monthly coder meetings create policy and procedure discussion and opportunity to share knowledge base
- Developed and implemented program pilot with Director of Care Coordination and Pharmacist to create individualized education/improvement plans for providers and a tracking method for capture gaps in care and measure outcomes
- Provide clinical staff feedback on workflow improvement as related to provider documentation
- Facilitate coding and documentation dialogue with office managers and billing department
- Customize education based on Primary Physician Practice needs, billing, coding, risk adjustment, level of service, etc.
- Ongoing support coding and billing team mates with Coding 101 overview
- Transitioned large provider group from ECW to Athenahealth electronic medical records with regard to coding and documentation
HCC Clinical Coder/Auditor/Physician Educator at Tandigm Health, LLC (2015-01 – 2017-12)
Perform reviews, audits and codes medical documentation for physician practices for the purpose of provider incentive, training, education and compliance using ICD 9, ICD 10, CPT, HCPCS
- Instrumental in developing HCC Coding and Auditing tool to streamline efficiency, accuracy and reporting
- Appropriately educate Primary Care Providers on accurate coding and documentation; training on specificity, ostomies, amputations, Diabetes, Chronic Kidney Disease, End Stage Renal Disease, COPD, Heart Failure, all assessed conditions
- Support office staff with creative need specific work flows to aid in efficiency ending in quality patient care
- Distribute HCC Pearls of wisdom to assist practices in accurate coding and documentation
- Published a Provider Checklist to assist Provider in elements of a proper SOAP note
Quality Care Manager at LMG Family Practice (2009-01 – 2015-12)
Population management for approximately 4000+ patients
- Collected, organized, maintained patient chronic conditions and cancer screening measurement data for several Quality Incentive Programs (Tandigm Enhanced Encounter CVGO form, EPass, Independence Blue Cross chart reviews, Aetna Optum PAF, Cigna Healthspring form, Keystone Mercy chart review, Humana chart review)
- Outreach to patients without encounters, promoted a weekly query with each provider to collect and confirm accurate clinical information for all payers and to share coding and documentation material issued from payers
- Supervised a small staff that was dedicated to Quality and closing gaps. Developed a workflow that would allow all reports to be reviewed by providers and entered into EMR before year end
- Organized and provided data to payers for specific chronic condition initiatives, such as DM, CHF, CKD, COPD, Osteoporosis
- Team lead for Patient Centered Medical Home Recognition Level 3, Meaningful Use Stage I and PQRS reporting
- Interview, hire, and provide ongoing training for Quality Care Department
- Schedule and coordinate payer training for providers and staff
Medical Assistant (2005-01 – 2007-12)
- Roomed patients for providers
- Pre-visit prepping of electronic medical record
- Breath Alcohol Testing
- Drug Screening
- Telephone triage
- EKG
- Spirometry
- Vitals
- Asthma Care
- Diabetic Care
- Diabetic education
- Coordinated patient flow
- Administered injections and vaccinations
- Assisted in small procedures
- Stocked exam rooms
- Stocked supply closet
- Stocked sample closet
- Maintained patient education hand out file
