DONNA DI MOLA, MCS, CPC

**** ******** ***** **

Nashville TN 37221

608-***-****

acrmn1@r.postjobfree.com

Qualification Summary

Coding, Data and Billing Administrator with record of exceptional service ratings in communication, customer service, teamwork, and employee job performance. Demonstrated ability to direct, manage, coordinate and plan business office activities to optimize income and minimize expenses. Proven strengths as an educator. Proven ability to maximize productivity and maintain quality. Work with IT to create and maintain key systems. Effectively monitor changes in coding requirements and manage coding, compliance, billing and reporting policies and procedures.

Experience

TENNESSEE ORTHOPAEDIC ALLINCE (Nashville TN)

DIRECTOR OF CODING (May 2014 – Present)

Responsible to accurately code and abstract professional services documented in the medical record. Audit office visits & procedures. Conduct quality control audits provided education on coding procedures that included specific Medicare & Medicaid guidelines.

Work with physicians and coders to assure

correct coding and to optimize reimbursements.

Conduct Coding audits 10 charts per provider

Present educational sessions on correct documentation and coding practices.

FERGUSON MEDICAL GROUP (Sikeston MO)

DIRECTOR OF BUSINESS SERVICES (July 2013 – May 2014)

Manage coding, billing & reception departments for large primary care medical clinic. Clinic’s averaged 800 patients per day. Hired, trained and managed performance of all coding, reception and billing staff for the clinic. Managed relationships with outside agencies and trained staff on Federal regulations and contracted accounts.

Developed protocols and worked with physicians and coders to assure correct coding and to optimize reimbursements.

Centralized business office functions for five medical clinics.

Created and maintained Quality Assurance programs that complied with Medicare standards.

Monitors appropriate internal control of A/R records and collection of cash

DEAN HEALTH SYSTEMS (Madison WI)

SENIOR CODING/COMPLIANCE ANALYST (February 2009 – July 2013)

DHS are multi-specialty clinics with over 500 providers. Created and maintained quality assurance programs that complied with Medicare & Medicaid standards. As a compliance analyst this position served as a key educator in abiding by the Standards of Ethical Coding as set forth by the American Health Information Management Association and coding guidelines.

Developed protocols & worked with physicians and coders to assure

correct coding and to optimize reimbursements.

Conducted annual Coding audits 10 charts per provider

Presented educational sessions on correct documentation and coding practices.

Set up shadowing sessions with new and existing providers to review Medicare, Medicaid and commercial regulations.

Active member in LEAN teams; provider documentation standards, meaningful use standards, Medicare wellness visits

Conducted new employee training on HIPAA regulation

Team lead for ICD-10 staff & provider training

SVA MedCode SPECIALISTS (Madison WI)

SENIOR CODING/COMPLIANCE ANALYST (June 2011 – July 2013)

Assignments in surgery center coding, emergency room visits, & hospitalist coding. Responsible to accurately code and abstract professional services documented in the medical record. Audited office visit & procedures for multispecialty hospital physicians. Conducted quality control audits provided education on coding procedures that included specific Medicare Trailblazer guidelines.

Worked with physicians and coders to assure

correct coding and to optimize reimbursements.

Conducted Coding audits 10 charts per provider

Presented educational sessions on correct documentation and coding practices.

SPRINGFIELD SERVICE CORPORATION (Tinley Park IL)

DIRECTOR of CODING (April 2008 – January 2009)

Director of the coding department including hiring, training and managing performance of all staff. Responsible for more than 50 accounts within the professional medical billing practice. This includes developing relationships with external auditing and training agencies. Acquiring knowledge of Federal regulations & informing internal & external clients of potential compliance concerns.

Developed protocols & worked with physicians and coders to assure

correct coding and to optimize reimbursements.

Conducted annual Coding audits 10 charts per provider

Presented educational sessions on correct documentation and coding practices.

Set up shadowing sessions with new and existing providers to review Medicare, Medicaid and commercial regulations.

Centralize business office functions for multiple coding locations and at home staff.

ST. MARY’S / DEAN VENTURES, INC. (Madison WI)

SMDV Surgery Center/REN Business Office Manager (2003 – April 2008)

Manage business office operations for the SMDV Surgery Centers, Endoscopy Clinics,

Core Biopsy Clinic and the Regional Eye Network. Office operations include coding, insurance reimbursement, payment entry, collections, customer service, patient statements, accounts receivable management, payer management and contract maintenance. Conduct coding reviews to assure compliance with HIPAA, NCCI, Medicare/Medicaid and optimal reimbursement. Meet regularly in operational meetings with physicians to resolve issues regarding billing and coding. Oversee staff of 30 with responsibility for more than 2500 surgical cases per month.

Oversaw updating of CPT’s, ICD’s and HCPCS codes, including updating of encounter forms and communication with the Epic team.

Worked with the Epic team to create, design and build programs to convert the Ambulatory Surgery Centers to the Epic billing system.

Maintained coding turn-around within five business days

Planned in-services on coding education for new and existing physicians, mid-level providers, clinical staff and other corporate business staff

Initiated a more pro-active prior authorization policy, reducing the uncollectible insurance cases to less than 5%.

Worked with clinical managers for continued accreditation of the Surgery Center through AAAHC.

Combined nine Accounts Receivable systems into one, reduced AR days from 45 to 23.

Directed the analysis of office functions, workflows and the centralization of 16 business offices into two offices.

Analyzed existing contracts and potential vendors, resulting in renegotiated fees and more useful utilization reporting.

Created statistical reports for VP of Finance and the Board’s review of utilization trends, reimbursement trends, Medicare, Medicaid, and 3rd party payer fee schedules.

Patient Accounts Manager (1997 – 2003)

Managed the coding and billing for Ambulatory Surgery. Hired, trained and managed performance of all coding, medical records and billing staff for the Surgery Centers. Managed relationships with outside agencies and trained staff on Federal regulations and contracted accounts.

Developed protocols and worked with physicians and coders to assure correct coding and to optimize reimbursements.

Centralized business office functions for three Surgery Centers.

Brought AR from 63 to 42 days.

Created and maintained Quality Assurance programs that complied with Medicare standards.

Coding and Medical Records Coordinator (1989 – 1997)

Supervised and trained medical records/coding staff for three multi-specialty surgery centers. Trained new employees on computer and medical records systems. Assisted in billing and reception departments.

Established the Medical Records department and MR/coding policies and procedures.

Created the MR and Billing protocols for breast core biopsy, cosmetic surgery, and pediatrics specialty clinics.

Coordinated interfacing between the OR Star and Cvikota computer systems to create patient labels.

Initiated resolution of payment conflicts between Worker’s Compensation carriers and Ambulatory Surgery Centers.

Education and Certifications

Nationally Certified Procedural Coder (CPC) since 1993 – maintain 18 CEU’s per year.

Graduate of Medical Coding Specialist program, Madison Area Technical College.

COTA program, Madison Area Technical College.

Graduate, Unit Clerk Training Program, U.W. Hospital.

Professional Associations and Service

Wisconsin Representative at 2007 Washington DC Leadership Conference – Presented issues with New ASC Payment changes

Advisory Committee Member, Medical Coding, Madison Area Technical College (10 years) and Herzing College (2 years)

Wisconsin Ambulatory Surgery Center Association (WISCA) – since 1999

President, 2003

Current Chair person for Education Committee

Compliance Committee – 3 years

3rd Party Reimbursement Chair – 10 years

Coding Education Liaison – created and conducted coding and billing training workshops throughout Wisconsin for Ambulatory Surgery Centers 2003 – 2007

Software Experience

Microsoft Office, Excel, Outlook, Power Point

EPIC EMR & Practice Management

G.E. HealthCare Systems

McKesson HealthCare

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