Manager Medical

Shawn D. Williams CPC, CPC-H, CCP, CCP-H, FCS, PCS

**** ****** **** ** *** 1302 Atlanta, Ga 30318

Cell: 770-***-****

****************@*****.***

Career Summary

Seasoned professional with 20+ years industry experience seeking a career-

defining opportunity which will utilize my vast knowledge in the areas of

coding, education and training, auditing, consulting and management

Work History:

HARMONY HEALTHCARE

JUNE 2012-PRESENT

E/R facility and professional coding and charging, and assisting with

denials for all outpatient records, assisted also with the diagnostic

coding dept when needed. Coders within the dept also received inservice on

coding issues or questions, along with provider education.

KFORCE HEALTHCARE

APRIL 2012-AUGUST 2012

DRG/APC Validator for all edits and compliance. Ensure accurate and

complete documentation through Professional and Hospital Billing compliance

audits. Provide feedback and audit reports to leadership from E/M, CPT and

ICD9 audits conducted by auditors using all state/federal and 3rd party

payor regulatory standards for outpatient. Using company auditing tools,

conduct retrospective audits of documentation supporting E/M, CPT and ICD9

codes assigned by clinical staff. Auditing e/m and diagnosis association

for Primary Care,Urgent Care, Peds, and other specialties. Research correct

coding practices in relationship to applicable rules, regulations and

coding conventions for billing to determine compliance with Federal, State

and company regulations. Plan, schedule and perform comprehensive chart

audits to identify operational and regulatory issues related to coding,

documentation, and compliance requirements and ensure complete and accurate

data capture in compliance with Federal and State requirements .Provide

technical expertise to regional and local leadership to identify and

resolve coding and chart documentation problems impacting the accuracy and

consistency of coded data.Read and interpret medical data written by

providers. Enter audit results into audit tools to support quality

assurance process and training activities. Conduct quality assurance

reviews.Identify audit trends and risk areas based on audit findings and

data analysis. Assist in developing and implementing policies and

procedures / Compliance Audit Standards to ensure compliance with Federal,

State and other regulatory requirements. Review analytical data and audit

findings to identify coding trends and other risk areas. Recommend

appropriate actions.

medpartners him

Dec

2011- Mar 2012

Conducts review of hospital-based coding/billing to ensure accuracy and

appropriateness, as well as compliance with government regulations.

Responsible for conducting secondary review of Outpatient claims per

hospital compliance policies. Reviews the APC Validation Log to ensure

appropriate review and resolution of edits. Reviews referrals created by

coding staff to ensure appropriateness of secondary review based on receipt

of Vanguard edits. Meets with ancillary departments regarding charge

referrals and works with departments to create a process to reduce the

number of referrals. Trends referrals by department and shares information

with appropriate administrative staff. Acts as a liaison with the regional

CDM Manager and hospital ancillary departments regarding charging, coding,

and documentation issues. Conducts monthly coding audits of high risk

problem cases as directed by Corporate Compliance, and records results of

audits in the 3M Audit expert system. Assist Manager in coordination on

internal and external audit results findings including insurance and RAC.

Ensures audit findings have been re-billed and resolved. Audits

appropriateness of physician queries through review of query reports and

review of the actual physician query. Responsible for review of AE and/or

ARMS reports. Analyzes claims returned by Xactimed to identify patterns and

provide education to coders. Prepares written documentation and periodic

reports as required by the department or hospital. Enhances professional

growth and development through participation in educational programs,

research/review of current literature, and attendance at in-service

meetings and workshops. Stays current with government transmittals and

memorandums, and assures that the appropriate information is passed to

appropriate departments. Provides orientation, training, and in-service to

departmental personnel and hospital personnel as appropriate. Provides

training to all staff in the appropriate use of Audit Expert and the

secondary review process. Acts as a technical resource to staff for

independent projects and assumes role of team leader on group projects.

Supervises and/or conducts complex and sensitive special projects, reviews,

investigations, studies, or research projects. Enforces and assists in the

development of interdepartmental flow and processes. Develops policies,

procedures and processes to facilitate accuracy in the revenue cycle.

On-assignment HIM

May 2011-

Jan 2012

Review patients records and codifying results for reimbursement or

payment purposes, abstracting, coding charging and sequencing for all

emergency room records, Diagnostic and Ancillary Records also sequencing of

all medical and surgical procedures, diagnosis and treatment modalities,

for urgent care clinics and all specialties within a hospital. Review

provider documentation to determine principal diagnosis, co-morbid and

complications, secondary conditions and surgical procedures . Maintain

strict confidentiality with all patient data, provide feedback to

management concerning possible problem areas or areas that need to be

improved. Make recommendations to implement improved processes, and perform

other duties as assigned. Analyze and Educate staff on ICD-10 CMS/PCS-Gems

file mapping, backward and forward mapping of icd-10cm and pcs, and

development of the best practice for non-mapping codes.

DeKalb Medical Center- Outpatient Coder PT

March -2011-May 2011 Duties were to code all work types from er to

rehab pt/ot interventional radiology, ancillary services to decrease dnfb.

On assignment-Travel Coder-Tuba city Hospital Oct.

2010-March 2011

Duties included coding all facility and profees for the emergency room and

capture all charges for the hospital and specialty clinics audited

providers for all levels of service and all charges billed for the entire

hospital of tuba city.

Trustaff- Travel Coder-Guam Memorial

May 2010-Sept. 2010

Duties included educated physicians and staff on outpatient hospital

charges primary focus was the emergency room, radiology, and or.

Responsibilities INCLUDED CHARGE capture and missing charges for all depts.

using cms guidelines, meeting were held each week along with education and

the financial hospital team to see the progression and reimbursement growth

Risk Adjustment Management LLC

Jan. 2008- Apr. 2010

Consultant for a private company performing chart auditing on-site at a

variety of clients including hospitals, physician specialty groups and

private practices. The auditing covers a broad spectrum of specialties for

both inpatient and outpatient records. Duties include physician and

documentation specialist education. Also have worked on Medicare risk

adjustment managed care projects.

Medpartners HIM-Auditor/QA/Physician Education Aug.

2007- Jan. 2008

Performed on-site auditing of all remote coders for Kaiser Permanente in

Denver, Colorado and gave feedback on coding accuracy. Primary duty was to

ensure all coders performed at a 95% accuracy rate. Other responsibilities

included physician education regarding proper documentation for their

charts and coding. Also performed Medicare risk adjustment including the

identification, collection, assessment and documentation of ICD-9 coding

information.

American Medical Institute - Dean of Coding March 2003-

May 2007

Part-time position- Provided all instructors with the tools and training

necessary to teach industry professionals how to obtain their CCS, CPC and

CPC-H certifications. Also managed the department, hired all new employees

and provided orientation. Provided students with an in-depth knowledge of

coding principles, practices, standards and guidelines. Received and

reviewed weekly and monthly student retention reports, reviewed monthly

instructor observations for creativity and growth in teaching, initiated

and conducted all program meetings. Also directed Instructors and assisted

them with teaching principles to help ensure classroom control and

establishment of optimal learning environments

Medical Career Education - April 2002 - Aug.

2007

Provided training for all new primary care physicians, LCSW's, and

Psychiatrists regarding all E/M documentation, mental health and chemical

dependency. Training included coding to the highest level and supporting it

with proper documentation. Also provided a monthly audit report to help the

providers see the relationship between proper documentation and their

reimbursement levels. Handled all coding updates within the physician

education department along with fraud and abuse issues which were discussed

at the weekly and monthly management meetings.

Medical Claims Consultant (Part-time) Oct.

2003 - Aug. 2007

Performed coding and abstracting for Mental Health and Psychiatry and

Primary Care services. Also performed chart audits and utilized the

findings to provide staff education.

HITech Institute - Program Director for Coding/Billing Oct.

2004 - Feb. 2005

Part-time teaching position. Provided training and orientation for all new

instructors and served as a backup instructor as needed. Maintained all

student records and grades for the department and handled all student

related issues. Also conducted a weekly retention meeting with other

program directors.

Georgia Medical Institute Instructor- Billing/Coding

Jan. 2003 - Oct. 2004

Part-time teaching position. Provided training in Medical Terminology, ICD-

9 and CPT coding as well as utilization of software such as Medical Manager

and Medisoft.

Baptist Medical Center Hospital- Billing Specialist

March 2002 - Dec. 2002

Follow-up on all commercial claims, rebilled claims before timely filing

limit.

Research for missing payment for all commercial claims with hospital

system.

Worked all outstanding EOB's for commercial carriers that were not yet

posted.

Billed all professional fees for commercial claims.

Montefiore Medical Center-HIM Supervisor Sept. 1987

- Feb. 2002

Supervised a department of 55 employees with duties ranging from handling

all HIM and Business Office functions to performing physician education and

chart audits and coding updates within the physician education department..

Also resolved complex and escalated claim issues and patient related

issues, analyzed fee schedules and performed on-site enrollment meetings

for managed care plans.

Technical Skills

Software Utilized:

3M Encoder, Encoder ProMisys Tiger, Medisoft, Centricity, Medical Manager,

HBOC, AS400, Meditec, Lytec, Famous,Cerner, Merritt, Peoplesoft, Epic,

Practice Partner, ChartMaxx, RPMS, Stockell, Powerchart

Education:

Anthem College - Phoenix, Arizona

Associate of Science Degree, Medical Coding & Billing, February 2005

Associations & Certifications:

NCCT- CICS Coding and Billing Certification- Received 2004

AMCS-American Medical College Specialists-Received 2007

AAPC-American Academy of Professional Coders-Member 2009

PHIA-Professional Healthcare Institute of America-Received 2008

References Provided Upon Request

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