ad4hr9@r.postjobfree.com
Skills
Revenue Cycle
HEDIS Chart Reviews
ICD-9-CM & ICD-10- CM
CPT Coding
Risk Adjustment Coding
HCC Coding
DRG Reviews
Policy updates
Data analysis
JCAHO
Auditing
RADV Audits
Compliance reviews
Investigative reporting
Advance Clinical Documentation
CDI Best Practices
Clinical Data Management
NLP Technology enhancing CDS efficiency
EMR systems
Allscripts
Apixio
Care360
Cerner
DrChrono
E-Clinical Works
EPIC
NextGen
Point Click Care
Practice Fusion
Sigma
Tableau
3M Health Information Systems
Microsoft Office
Education And Training
11/2022 - 04/2023
CPC Training
AAPC
04/2021 - Present
Bachelor of Science:
Nursing
West Coast University, Miami Campus
Miami Beach, FL
09/2008 -06/2009
New York City Board of Education (NYCBOE)
Med-surg, Cardiology, Quality, HEDIS, Medical Documentation & Coding)
09/2009
Licensed Practical Nurse:
Nursing
New York City Board of Education (NYCBOE)
New York, NY
01/1998
Samuel J. Tilden H.S.
Diploma
Certifications:
02/2002
American Career Training Center:
ICD-9CM Diagnosis Coding
CPT, HCPCS Coding
09/2015
AHIMA & AAPC
ICD-10CM/ Diagnosis Coding
CPT, HCPCS Coding
Languages
English:
Full Professional
French-Patois :
Professional
DEBRA C. FLEMING
Summary
Highly experienced Nurse, skilled in administrative and clinical functions of Med-Surg, Cardiology, and Medical Compliance. Accomplished in HEDIS chart review, AHIMA ICD-10 Educational Program, AAPC ICD-10 CM Fundamentals, & NYHIMA, MAHIMA, ACDIS-CDI best practices. Strategic creative planning for staff development. Outstanding, long standing conflict resolution management. Instrumental in Hospital Corporations, Medical Groups, and Insurance Providers financial gain, pre/post auditing, and incentives. Patient & Medical Equipment Safety. Consistent practice of professional, clear, and concise communication with all levels of leadership, medical staff, and non-clinical employees. In addition, I am willing to perform other related duties, as assigned, which may not be specifically cited in my job description
Experience
Maxim Staffing & Cynet Health
United States, Travel Nursing – Emergency Room, Rehabilitation & Nursing
11/2023 – Present
Accurately assessing patient care needs in a diverse population
Initiating Triage and assist with discharge
Chaperone Physician during patient examinations
Report changes in patients’ conditions routinely, and when requiring
immediate attention
IV line placement & intravenous therapy
Urinalysis & culture and sensitivity testing
Ventilation and Oxygen Therapy administration
Tracheotomy Care; Nasopharyngeal and Oral Suctioning
Phlebotomy
Wound & Burn care
Administer PPD test, Flu vaccines, Immunizations
Documentation in EMR system
Orientate new staff in areas of patient care, medical practices, and
Procedures
Horizon Blue Cross Blue Shield of New Jersey- Professional Senior Coder
Newark, New Jersey – Remote Contract
6/2022 – 11/2023
Develop Chart Review & Audit workflow within the RADV Response leadership team
Training staff based on RADV & HEDIS best practice coding guidelines
Expertise in ICD-9-CM/ICD-10-CM coding guidelines, and AHA Coding Clinic
Accurate audits and overreads using both clinical and coding knowledge along with speed
Training and advising healthcare professionals and administrative staff on HEDIS compliance.
Applying hierarchical ranking associated with CMS defined HCCs, as well as the ability to navigate between different projects that are in place for HEDIS audit initiatives
Exceptionally knowledgeable of healthcare provider-specific regulations and policies related to documentation and coding
Technically savvy to interact and troubleshoot a wide range of computer-based applications
Exceedingly capable to work independently and collectively to accomplish projects within the allocated time to achieve excellent results.
Reviewing medical records and documentation to extract abstract, clinical data for HEDIS reporting
Meeting daily abstraction goals and maintaining a high abstraction accuracy percentage
Snap Nurse – LPN Travel Nurse
The Carillon Assisted Living - Boulder, Colorado
02/2022 – 06/2022
Modernize care team practices according to nursing standards, local, state, and federal guidelines, and organizational policy
Screening future applicant screening during hiring process
Orientate new staff in areas of patient care, medical practices, and procedures
Yearly performance evaluations, employee improvement/corrective action plans, development training
Revamping & implementing proper shift hand-off and reporting
Assessment of patients upon admission, and assist with discharge planning
Accurately dispensing of medicines via oral, GT, and NGT routes
Report changes in patients’ conditions routinely, and when requiring immediate attention
COVID-19 testing 150 residents 3x weekly
Urinalysis & culture and sensitivity collection
Ventilation and Oxygen Therapy, and Care
Tracheotomy Care; Nasopharyngeal and Oral Suctioning
Intravenous Therapy
Phlebotomy
Wound & Burn care
Administer PPD test, Flu vaccines, Immunizations, & Finger sticks levels
Manual & Mechanical Vital Signs
EMR charting
West Boca Medical Center LPN Med-Surg/Telemetry & LPN Quality PI Supervisor
Boca Raton, FL (Remote)
07/2021 – 02/2022
Quality Improvement Patient Safety Meeting with CEO, COO, Physicians, and Department Directors reporting Quality metrics and analytics
Risk Adjustment audits/RAF scoring prioritizing and linking HCC diagnosis
Inspection of both clinical, non-clinical work areas and medical equipment according to Joint Commission standards and accreditation process
Evaluating nursing proficiencies, identifying, and targeting areas for improvement.
Endorsing & Developing improvement plans to meet data analysis target benchmarks
Negotiating contracts with leading clientele, encompassing industry-leading organizations and multitude of projects.
Determining medical necessity and cost-effectiveness of services through utilization review processes
Consulting with local and state health departments to report infectious cases.
Fulfilling the CDC and OSHA driven infection prevention and control policies to guide hospital departments
HHC-Bellevue Hospital - Assistant Director of Medical Records-
LPN Clinical Documentation Specialist
New York, NY
06/2014 - 06/2021
Reviewed charts ensuring highest level of accuracy.
Ensured primary & secondary diagnosis codes support and meets specificities of patient’s condition.
Educate and guide physicians & staff with approved documentation. risk adjustment documentation standards and coding guidelines.
Queried providers regarding missing, unclear, or conflicting health record documentation.
Supervise Medical Coders & DRG validators workflow and provide guidance throughout billing process.
Applying knowledge of medical terminology and procedures to evaluate clinical documents.
Collecting medical information from healthcare providers and updating medical records.
Monitoring diagnoses, treatments, and follow-up entries in medical records.
Interpreting and preparing clinical reports for healthcare professionals and public health officials.
Meeting with healthcare stakeholders to explain findings and facilitate actions.
Verifying the accuracy of patient medical information and obtaining missing information.
Ensuring that the content and storage of medical documents comply with federal laws.
Training medical and administrative staff in standard medical recordkeeping procedures.
Keeping abreast of advancements in the field of clinical documentation and changes in regulations
Advantage Care Physician – LPN Care Team Supervisor
Brooklyn, New York
09/2012 – 06/2014
Ensures nursing practices of the care team as well as own practices are in accordance with nursing standards, local, state, and federal guidelines, and organizational policy.
Assists with applicant screening, selection, training, providing feedback for performance evaluations, and providing information related to employee discipline and termination of staff.
Provides general nursing care to patients, including administering prescribed medications and treatments in accordance with nursing standards and per orders; planning, articulating, and coordinating care and interventions; maintaining consideration for specific age-related characteristics, needs related physical development, communication, and socialization and safety, in collaboration with other members of the care team.
Directs and manages daily huddles. Prepares and manages materials and deliverables. Reviews patient charts for missing labs, reports, and/or open orders and reviews as part of care team huddles. In coordination with the Manager, Nursing and Practice Administrator, manages and inventories clinical supplies.
Prepares equipment and aids physicians during treatment, examination, and testing of patients. Verifies chief complaint and takes vital signs as requested. Reviews the Electronic Health Record (EHR) active medication list with patients. Conducts and document point-of-care tests based on protocol. Administers medications as directed by provider.
Identifies patients who may need point-of-care testing as well as patients with special needs (i.e., transportation). Coordinates outpatient work-up and or treatment plans when patient situation requires it (i.e., further clinical testing, x-rays, and facilitates communication between physicians and health care providers). Pends tests and procedure orders for physician approval and co-signature. Prepares prescriptions or medication refills, for review and signature by provider.
Contacts patients with test results and provides recommendations on cases per physician determination and/or standards of care. Adds recommendations to individualized care plan(s) and reviews After Visit Summary (AVS) with patient. Facilitates clinical messages and chronic condition management education to patients.
Triages urgent same day or double-booked appointment requests.
Documents progress notes in electronic health record within 24 hours.
Manages in-basket requests and responds to all requests in a timely manner. Will serve as a clinical liaison between the call center and medical office.
Performs other job-related duties as required including participation in nursing practice work groups and committees.
Emblem Health Care-
Quality Specialist/HEDIS Chart Reviewer (Contract)
Melville, New York
2012-2014
Reviewed appeal files to update administration data.
Conducted field visits to hospitals and physicians’ offices to extract medical documentation.
Engaged in outreach implementation strategies to help increase HEDIS scores.
Relied on knowledge of legal, regulatory, and policy compliance issues related to HEDIS/QARR.
Abstracted and evaluated data from patient chart based on HEDIS measures requirements.
Accomplishments
Year 2020-High Priority Medical Groups awarded 5-star ratings with CMS in Medication Adherence and Diabetes Measures
Consistently surpassed benchmark targets quarterly and yearly.
.