JANET E. JACKSON

Improving Healthcare . Enhancing Community Programs . Inspiring Systemic

Change

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EXPERIENCED EDUCATOR/Nurse/Quality Assurance Nurse/Auditor/SME in Coding

Compliance and General Equivalence Mapping (GEMS)

...dedicated to guiding students to succeed while inspiring an insatiable

passion for learning and reading and promoting health in communities, local

and statewide

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Visionary Leader, Bridge Builder and Licensed Educator with a Master's

Degree coupled with 31 years' experience in nursing; Clinical Documentation

Improvement Specialist, Auditor, Medical Chart Reviewer; instructing post

secondary education students in Medical Assisting, Billing & Coding

securing resources, and implementing effective programs.

SUMMARY OF QUALIFICATIONS

An enthusiastic, creative, and passionate educator, mentor and advisor who

believes that all adults can learn and thrive in an environment that is

stimulating, comforting and appropriate to their unique talents and

abilities.

. Specializations include: Medical Assisting, Billing and Coding Complex

Procedures, healthcare medicine, curriculum design and implementation.

. Proficient in delivering quality education to the MA healthcare field,

administrative procedures. Strategic/Critical Thinking, Testing

Techniques/Assessment Skills, Technical Writing Skills.

. Demonstrated knowledge in Assessment Skills of patients, Proficient in

Audit/Chart Review Skills. Strategic/Critical Thinking Skills, Quality

Assurance, Advanced Internet & Email Skills, Computer Networking Skills,

Problem Solving and Organizational Skills.

. Ability to work independently, prioritize and monitor progress of

assigned cases with minimal supervision.

. Managing safety or occupational health program elements; maintenance of

MSDS Catalog, Maintenance of biohazard containers within the facility,

Proficient with implementing instructional materials, writing and

curriculum design.

. Instructional Leadership - Implemented a balanced blend of motivational

and targeted instruction methodologies to enhance curricula, focus on

and emphasis on the three 'R's - rigor, relevancy and relationships.

Program liaison, reviewed textbooks for Westwood College and Anthem

College, implemented syllabi for use in instruction.

. Engaged Students - Work closely with other students as a team

throughout the career, repeated successes securing a higher level of

student involvement.

. Leverage Resources / Strategic Collaborations - Work closely with

district leaders and community partners to encourage student

involvement in strong community alliances.

. Utilize a visionary approach with consistency to help students past the

threshold of not-knowing to knowing and develop to their fullest extent

and potential.

. Entry-level experience in handling accreditation reviews and external

reporting

Providence Hospital March 2014 - May

2014

Clinical Documentation Specialist

. Reviews medical records, checking for accuracy and completeness;

evaluated, reported and interpreted records, with a query as to the

accuracy and determination of documented material by the physician.

. Proficient in with a thorough understanding of medical terminology,

medical procedures and applicable laws to collect and evaluate medical

documentation.

. Preparation of written reports, which are submitted to decision

makers, medical professionals and the public so health-care efforts in

a facility can be judged objectively.

. Interpretation of their own or others' reports, to discover positive

and negative patterns and solve health-care problems.

. Train health information technicians and medical staff on

documentation and how to analyze health records. Track and graph

statistics on disease and recovery, produce reports on the efficiency

of collection methods and recommend strategies for improving

processes.

. Collaborates with Physicians, Nurses, Case Managers and Health

Information Management Coders to identify principal diagnosis options,

secondary diagnoses, and procedures to assign working DRGs

. Clarified documentation discrepancies and works with the health care

team to facilitate documentation with medical records that support

patient's severity of illness and risk of mortality.

. Attend coding conferences, workshops, and in-house sessions to receive

updated coding information on changes in coding and/or regulations

. Facilitated clinical documentation improvement through extensive

concurrent interaction with providers in order to support revenue

integrity and appropriate reimbursement based on clinical severity to

all patients with a Diagnosis Related Group (DRG).

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PROFESSIONAL TEACHING EXPERIENCE

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Anthem College, Aurora Colorado Oct 2011 - Aug

2012

Medical Billing and Coding Instructor, Program Head; SME

Administrative Skills:

. Taught and implemented the procedures and regulations in coding (ICD-

9; ICD10 PCS), Meaningful Use

. Demonstrated knowledge of contrasting and related differences between

ICD-9 code set and ICD-10 code sets

. Proficient in the ICD-9 body systems terminology while instructing

students in the parameters of medical records use of filing

. Tutored students in the operations of various insurance programs and

prepared an analysis of their working protocol.

. Performed make shift audits on medical records, to engage students on

the parameters of identifying details of an audit and correcting

mistakes.

. Ensured the students understood the relations of the ICD-9 code sets

and the ICD-10 Coding under the Reimbursement manuals of Centers for

Medicare and Medicaid Services (CMS)

. Introduced students to Electronic Medical Records, through MediSoft v

17 and OSHA compliance in health care (ergonomics);

. Engaged students in the proficiency of HIPAA/Privacy Act regulations

. Instruction in medical administrative procedures; billing, checking

patients in, RVUs, DRGs, RBVUs, instruction in different insurance

companies, and their payment methods according to type of insurance;

. PPOs, HMOs, IPAs; instruction in determining EOBs, participating

providers, nonPAR providers.

. SME in the instruction of ICD-10/PCS, advanced medical terminology,

A&P and general office skills

Clinical Skills:

. Instruction in drawing blood, glucose testing, cholesterol testing,

other blood components

. Proficient in the instruction of EKGs, HbA1c testing, childhood

injections, starting IVs

. Proficiency in the instruction of assessment skills

. Proficiency in the use of various medical machines in a laboratory

environment

. Instruction in determining EOBs, participating providers, nonPAR

providers. Instruction in the coding aspect of the medical field to

include but not limited to ICD-10/PCS

. Instructed students on Medicare Regulations, Medicare as secondary

payer, and COBRA

. Medical terminology, anatomy and physiology; teaching of general

office skills, along with management skills within the physician's

office.

. Demonstrated knowledge and the ability in providing one-on-one

academic learning support to students especially in writing and study

strategies.

. Instructional Leadership - Implemented a balanced blend of

motivational and targeted instruction methodologies to enhance

curricula, focus on and emphasis on the three 'R's - rigor, relevancy

and relationships. Program liaison, reviewed textbooks for Anthem

College and implemented syllabi for use in instruction., Medical

Billing & Coding Program Head; SME (Subject Matter Expert),

demonstrated experience and knowledge using CMS Reimbursement Mapping

. Engage Students - Work closely with other students as a team

throughout the career, repeated successes securing a higher level of

student involvement. Graduation rate 85% with retention.

. Leverage Resources / Strategic Collaborations - Work closely with

district leaders and community partners to encourage student

involvement in strong community alliances.

. In-depth knowledge of research principles and the writing process, APA

and MLA manuals of style, and grammar

Utilize a visionary approach with consistency to help students past the

threshold of not-knowing to knowing and development to their fullest extent

and potential.

Westwood College, Denver, CO

September 2009 - May 17, 2011

Private College Instructor/Professor

Administrative Skills: Associate Degree Education

. Facilitate two classes consisting of 30 students for post-secondary

learning (Medical Assisting)

. Utilize multiple assessments in compliance with district and state

requirements to inform instruction.

. Use innovative methods and materials to produce effective learning

experiences including cooperative learning, thematic instruction and

differentiation.

. Instructed students in analyzing and determining EOBs

. Instruction in the coding aspect of the medical field to include but

not limited to ICD-10/PCS

. Instructed students on Medicare Regulations, Medicare as secondary

payer, and COBRA

. Instruction in reviewing medical record and correcting entries to re-

submit the information for charge recovery of billed funds

Clinical Skills:

. Instruction in drawing blood, glucose testing, cholesterol testing,

other blood components

. Proficient in the instruction of EKGs, HbA1c testing, childhood

injections, starting IVs

. Proficiency in the instruction of assessment skills

. Proficiency in the use of various medical machines in a laboratory

environment

Highlighted Achievements

. Contributed to a significant increase in student performances on

standardized testing within the college community.

. Provides instructional and administrative leadership to attain the

program goal of enlisting students as mentors and resources to

encourage problem solving, critical thinking and research.

. Mentor and coach students to help boost their confidence and

competencies, as evidence by scores and completion of work.

Understanding of ICD-10 Mapping;

. Source Code: The origin of the map, or the data set from which one

maps

. Target Code: The destination map, or the data set in which one

attempts to find equivalence or establish the code relationship

. Forward Map: A map that translates an ICD-9 code, as source code, to

ICD-10 as its target code

. Backward Map: A map that links the two coding systems in the opposite

direction, moving from the newer ICD-10 version to the older ICD-9

version

. 1:1, Cluster, Combination, and Complex: The types of mapping relations

between source and target codes that exist both in forward and reverse

directions

. Cluster: This is an entry in a GEM where one code from the many target

codes can become a map to the source code ('OR')

. Combination: This is an entry where more than one code is required in

the target code set to replicate the complete meaning of the source

system ('AND')

. Complex: This mapping represents multiple code combinations and

alternatives that are required to translate a source to a target code

('AND' and 'OR')

COMMUNITY COLLEGE OF DENVER, Denver, CO Sept

2009-Aug 2011

Adjunct Instructor/Professor

. Instructs continuing adult education students in Medical Assisting

courses, providing various levels of instruction in grammar,

conversation, reading, writing and pronunciation.

. Incorporates in-house collegiate and external resources to develop

lesson plans; create and administer tests; and provide students with

feedback targeting areas of improvement to help align their strengths

with course objectives and intended outcomes.

. Consults with adults regarding learning techniques, such as active

learning, total activity approach, total physical response and all

forms of learning abilities (kinesthetic, hands-on, audio, visual).

COMMUNITY COLLEGE OF DENVER, Denver, CO Sept 2009 - Aug 2011

Medical Assisting Instructor/Professor/Online

. Develop daily lesson plans and testing materials;

leveraged the use of technology to enhance instruction,

infusing the use of the latest technology to conduct

research and prepare reports, including: the Internet,

department websites, PowerPoint presentation software,

and on-line library research, and proficient in online

technology.

. Serve as an instructional leader by modeling high expectations for

students and implementing results focused programs.

. Ensure compliances with laws, regulations, rules and policies

prescribed by the Private Occupational School regulations and

community colleges regulation in the Colorado School District.

. Teach students basic application software usage, such

as Microsoft Windows, Word, PowerPoint, Internet access

using various search engines through browser programs.

. Prepares assignments for student reports; assists

students in organizing and writing research findings,

bibliographies and final reports.

. Implements various classroom management techniques for

maintaining student attention, involvement and

discipline.

Everest College Thornton, CO

January 2009-August 2009

Adjunct Instructor/Medical Assisting

Administrative Skills

. Conducted classroom instruction; prepared daily lesson

plans; administered tests; provided feedback on

learning achievements and needs for improvement.

. Teach students basic application software usage, such

as Microsoft Windows, Word, PowerPoint, Internet access

using various search engines through browser programs.

Clinical Skills:

. Instruction in drawing blood, glucose testing, cholesterol testing,

other blood components

. Proficient in the instruction of EKGs, HbA1c testing, childhood

injections, starting IVs

. Proficiency in the instruction of assessment skills

. Proficiency in the use of various medical machines in a laboratory

environment

PROFESSIONAL NURSING EXPERIENCE

Professional Home Health Care, Arvada, CO

December 2007-December 2008

Home Health Care Nurse/Administrator

. OSHA, CLIA, 88 with demonstrated methods, general health insurance

applications (interpretation of different health insurance companies)

. Mastered proficiency in the OASIS software for home health

. Conducted internal audits on patient records to ensure compliance with

state regulations and accuracy of billing

. Proficient in documenting the details of the medical review record.

. Maintained case conferences for field nurses, assigned physicians to new

patients, documented policies and procedures of the company, and followed

internal protocol. Exhibited standards of pre-authorization of patients

insurance. Obtained pre-certification for special procedures, assigned

patient to field nurses and maintained all medical records.

. Accomplished home health nurse, proficient in the use of the Horizon

Software for home health business

. Knowledge & proficiency in assessment skills

. Accomplished home health nurse, proficient in the use of the Horizon

Software for home health business

. Identified deficit(s) relating to policy/procedures and developed and

drafted new policies for review

. participated in facility pre-surveys/monitored compliance with State and

Federal guidelines and regulations.

Evaluate the appropriateness of services/supplies with respect to the

patient's medical condition.

WYNNWOOD AT BROOKDALE May, 2007-July, 2007

Health Care Coordinator

. Provided direct health care to the assisted living residents

. Assisted with training, supervision, appraisals and corrective action

for nursing personnel as well as Residents Assistants

. Supervised RA's to comply with regulations of the assistant living

program, supervised with passing of medications.

. Communicated any changes in resident's condition and medication

. Perform all administrative duties such as: completing medical forms,

reports, evaluations, studies, and charting, reviewed charts/ audits

for accuracy of billing

. Coordinate adequate pharmaceutical supplies with consulting pharmacy.

. Respond to family concerns and complaints.

. Responsible for the assessment of individual patients for admission

into the assisted living facility

. Establish open lines of communication between all nursing personnel.

. Maintained clinical and medical records according to policy and

procedure (HIPAA & Facility)

. Release of information in accordance with the established laws, rules

and regulations, maintaining confidentiality (HIPAA and other

regulations).

BROOKDALE SENIOR LIVING May 2002-Feb 2004

Wynwood at Canterbury Gardens

LPN Health Care Assistant Coordinator

. Performed professional and restorative nursing services which

included, resident assessments, recording of vital signs,

administering medications and treatments

. Kept timely documentation of written reports and verbal reports to

ensure that quality care was provided

. Performed duties of a front line supervisor in absence of RN and other

Health Center Associates

. Interacted with resident's physician, pharmacist and medical personnel

when needed

. Supervised 25 resident assistants, performed evaluations of care and

records of pay rate increases, weekly meetings to evaluate the

performance of their required skills and work

. Sent RAs to medication school to qualify for QMAP

. Followed guidelines as outlined in the Resident Care Plan; assisted

residents with activities of daily living, including some bathing

dressing, eating toileting, hygiene and mobility

. Assisted with in-services and on the job training and mentoring of

associates

. Participated and attended all required in-service training and

education programs as scheduled

. Performed evening supervisory methods to the night shift

. Performed other duties as assigned (Assessments of residents to be

admitted to the facility)

Medical Assistant Instructor

Remington College

Mar 2004 - June 2005

Administrative Skills:

. Broadened students developmental skills in the practice of

Administrative Medical Assisting and Clinical Assisting skills

within the MA program

. Proficient in the instruction of anatomy & physiology

. Introduced students to billing & coding procedures

. Instruction in determining EOBs, participating providers, nonPAR

providers. Instruction in the coding aspect of the medical

field to include but not limited to ICD-9/CPT

. Instructed students on Medicare Regulations, Medicare as

secondary payer, and COBRA

Clinical Skills:

. Facilitated students learning by incorporating hands-on-skills

. Demonstrated knowledge in the instruction of phlebotomy,

injections, various medical office machines; managed classroom

students 20:1

. Proficient in the instruction of anatomy & physiology

. Team teaching with other instructors in the program

. Provided support to students with different learning

disabilities

. Analyzed and evaluated students performance.

Nurse Liaison

Plaza Regency at Sun Mountain Sept

2005 - Feb 2006

. Visits to various hospitals for the assessment of patient/appropriate for

nursing home admissions or assisted living

. Interviewing skills related to patients health, and admissions into the

facility

. Completed necessary paperwork for admissions

. Worked with dialysis patients for admission to the facility

. Responsible for the assessment of patients/residents

. In homes, other nursing homes, assisted livings, hospitals for

the appropriateness of admissions into Plaza Regency

. Responsible for the assessment of ventilator patients in LTAC's

. Applications of HIPAA & OSHA regulations

. Applying knowledge of insurance companies to assess for

appropriateness of funds

. Understanding of billing and coding procedures (ICD-9, CPT,

HCPC)

. Headed appropriate meetings with assessment nurses, DON, and

ADON

. Admissions procedures/paperwork distribution, alerting

departments of the admissions, and discussing and instructing

families of nursing home procedures and signing of paperwork to

secure rights of the patient as well as family.

. Community Health Plan of the Rockies, Inc. Utilization Review

Specialist: 5/2001-4/2002

. 400 S. Colorado Blvd, Suite 300

. Denver, Colorado 80246

. Responsible for independently receiving call from the queue,

making decisions on prior authorizations per department protocol

. Customer service

. Answering calls and obtaining initial information regarding

request for authorizations to complete various medical tests;

i.e. blood work, x-rays, visiting specialists and general health

care visits.

. Confirmed the eligibility of health insurance holders

. Obtained and confirmed diagnosis status with ICD-9 codes, CPT

and HCPC codes to include inpatient hospital stays

. Followed InterQual criteria for assessing quality assurance and

managing number of hospital stays for case management

department, in addition to applying standard criteria to

clinical information to allow an authorization determinant

. Ability to maintain constant contact of discharge planners,

physicians office, and other stakeholders in representative of

the said insurance

EXPERIENCED AUDITOR:

C. J. Health Records & Consulting Services, Inc. Nurse

Auditor: 10/1996-3/1998

Chattanooga, Tennessee

. Audited chosen medical records from the company for accuracy and

complete documentation according to the illness of the patient

. Ensured the accuracy of medical documentation that coincides with the

billing record with assignment of medical billing codes to properly

create new UB's and continuously reviewed all and complete bills for

other errors in addition to certifying funds for corrected billing

statements.

. Reconciled medical/insurance disbursements on accounts, certified the

availability of funds for corrected billing statements, recognized

discrepancies in the different billing departments within the hospital

and negotiated with insurance company to recreate new UB's for

billing.

. Recorded final findings of medical bills with billing manager and

reconciled permanent medical record with missing documents.

. Performed audits on doctor's offices for re-credentialing of doctors

to be able to accept various medical insurances within the Tennessee

area (Medicare & Medicaid).

. Audited for Medicare and Medicaid fraud.

. interacted effectively with employees, managers physicians and

executives during the audit and compliance process

Hospital Billing Analysis, Inc. Nurse Auditor: 8/1987-

4/1992

Palm Beach, California

Proficient in Charge Recovery Auditing

Defense Auditing/Insurance Auditing

Utilization Review Auditing/Compliance Regulations

. Auditing of hospital records to recover charges billed

. Participated in training other nurses and allied health personnel in

the auditing process and setting up other hospitals in the Anchorage,

Alaska area

. Analyzing medical records documents for their authenticity, applying

audit techniques to obtain the maximum charge return for the hospital.

Negotiating with insurance companies to arrive at a determined amount

for billing and settling cases.

. interacted effectively with employees, managers physicians and

executives during the audit and compliance process

. Conducted research on medical policies & practices, provider

characteristics, and related topics.

. Identified, communicated and recovered losses as deemed appropriate

for the hospital.

. Performed audits with accuracy; audited $1 million dollars per day on

case by case reviews

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PART-TIME INSTRUCTOR EXPERIENCE

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Kaplan College, Thornton, CO MA Instructor

July 2008 - June 2009

Kaplan College, Las Vegas, NV MA Instructor

March 2006 - May 2007

Academy of Healing Arts MA Instructor

Mar 2006 - May 2006

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NURSING EXPERIENCE

George Washington University Hospital Aug

1986 - Jan 1987

Penrose Hospital Jan 1981 - Mar

1982

St. Mary Corwin Jan 1981 -

Mar 1982

Proficiency: Medical-Surgical; Oncology; Surgical; Cardiac-Step Down

Medical; Orthopedics

COMMUNITY SERVICE

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African-American Health Fair, Denver, CO Volunteer Instructor

Jan 2009 & Jan 2010

9 News Health Fair, Denver, CO Volunteer Instructors/Coordinator

April 2010 & April 2011

EDUCATION

Taft University (Taft Law School) 6

January 2014-present

Executive Juris Doctorate Healthcare Law

Walden University

PhD, Community Health Education and Prevention, Baltimore, MD

December 2010-02/2012

MPH Walden University, Baltimore, Maryland

February 2011-02/2012

American Intercontinental University, Chicago, IL June 2008 July- 2009

M.Ed., Educational Leadership/Curriculum and Design

B.S., Business Administration/Leadership

American Intercontinental University, Chicago, IL October 2006- June 2008

Madisonville Community College, Madisonville, KY:

License Practical Nursing Program Oct 1979-Nov 1981

{Diploma Program/Proficient in the care of patients, Critical

Thinking, Human Development and Basic Nursing Skills}

United States Army - Fort Jackson, South Carolina

Veterans Preference

ASSOCIATIONS & CERTIFICATIONS

CPR Certification/BLS, AED; IV Certification

Colorado Department of Higher Education (Division of Private

Occupational Schools)

Colorado State Certification (CTE, 2010)

American Medical Technologist: Certified RMA Allied Health Instructor-2010

Who's Who Cambridge Honorary Member

Registry of Executives, Professionals, and Entrepreneures-2010-2011

CampusVue on line software, Desire2learn online software.

Presently working on Certification through American Institute of

Healthcare Compliance

References:

{Barbara Whitlock} {Friend /Accountant/Finance} 933 E 13th Street,

Hopkinsville, KY 42240

Home Ph: 270-***-****

Mobile: 270-***-****

{Shelly Salisbury} {Friend/Professional / Nuclear Medical Technician}

Cell Number 443-***-**** Address: 1009 Thomas Run Road Bel

Air, MD 21015

{Robert Plick} {Friend/Professional/College America/Director of

Outreach/Externship Coordinator}

720-***-**** Cell

{Regina Buxton} {Former Supervisor/Community College of Denver/Workforce

Program}

720-***-**** Cell

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3206 Loud Pl, SE Washington, DC 20019

Cellular: 202-***-**** Home: 202-***-****

acelp2@r.postjobfree.com

Contact this candidate