Project Manager Medical

ALFREDA R. MITCHELL

**** *. ****** **** **.

San Tan Valley, AZ 85143

Home- 480-***-**** or Cell- 480-***-****

SUMMARY OF QUALIFICATIONS

APPLICATIONS: Proficient in MS Office Suite (Outlook, Excel, Word and Powerpoint), 3M-Coding

Software, ARC, HL7 interfaces, Resident Services, Hands On, Dashboards Applix, ABEL, PATCOM,

UDS, Team works, Star, Sunrise- SCM, SRM, AMPFM, Softmed, Cerner Millennium applications, CAC,

Clintrac, Medivance, Medisoft, McKesson/ GMIS edit clarification systems, Foresight edit

clarification systems. Knowledge of standard coding for health information exchange, such as

LOINC, SNOMED and ICD-9. Experience with relational databases, SQL, and performing health care

data analysis using SAS, including analyzing eligibility, claims/encounter, provider, health

care survey, as well as other forms of health care data.

LEADERSHIP: Ability to quickly- grasp workflow and documentation concerns and help centers work

through change management issues in an organized and methodical manner. Excellent verbal and

written communication skills. Proficient in presenting and teaching proper Dx. and CPT coding

techniques. Skilled in delivering presentations on training programs. Strong project management

and organizational skills. Superior time management and analytical skills.

PERFORMANCE IMPROVEMENT: Knowledge and understanding of the tools needed for continuous quality

improvement

EDUCATION AND CERTIFICATIONS

Lourdes College, Sylvania, Ohio

2000, Business Administration

The University of Toledo- Toledo, Ohio

2009, Health Information

Administration Post -Baccalaureate (CHIA)

Owens State Community College, Toledo, Ohio

2004, Health Technologies- Medical Coding/ Billing

OSHIP- Ohio Department of Insurance, Toledo, Ohio

Managed Care Insurance Specialist/ Consultant- 2000

. RHIA, 2011 Registered Health Information Administrator

. CM/PCS Trainer- ICD-10 - AHIMA 2012

. CPC-I -2013 Certified Professional Coding Instructor

. CPC, 2006 Certified Professional Coder

. BLS- Basic Life Support Instructor

PROFESSIONAL ASSOCIATIONS

AHIMA- American Health Information Management Association

AAPC- American Academy of Professional Coders

PROFESSIONAL EXPERIENCE

Medical Insurance, Billing and Coding Director/ Instructor

8/ 2011-Present

Brookline College- Phoenix, Arizona

Program Director: Software used: e-learning, Engrade, Blackboards, Ultipro,

Medisoft

. Ensure that program maintains compliance with corporate, state and

regulatory policies and procedures.

. Monitor and maintain suitable textbook, supply, instructor's material,

and equipment inventory for program that are within the

required/approved program. Ensure approved curriculum and ancillary

materials were being used by the instructors.

. Assist Registrar with student schedules, ensuring accuracy and accord

with approved curricula. Collaborate with other college leadership

staff to achieve desired organizational results in areas of customer

satisfaction, student retention, staff retention, graduation rates and

satisfactory student progress.

. Responsible for evaluating staff performance, developing standards and

ensuring basic competencies for all staff

. Assist the Director of Education with leading and managing the program

overseen through interviewing, training, reviewing and developing

quality faculty. Foster faculty and staff development and

professional growth. Participate in the informal resolution of

conflicts between students and faculty

Instructor:

. Educate and provide technological and academic training to medical

coding/ HIT students. Ensure students are aware of the competencies

necessary for all objectives in the syllabus. Design and carry out a

lesson plan for each class taught that recognizes students' abilities,

learning styles and provide accommodation for individual student's

differences.

. Analyze outward signs of problems that students may have that inhibit

their achievement and refer students to campus director or student

services to overcome those traits that appear to be keeping the

student from a high level of achievement.

Health Information Management Director 7/ 2010 - 8/

2011

HealthSouth Rehabilitation Acute Care Hospital - Scottsdale, Arizona

. Through concurrent medical record review, facilitate appropriate

clinical documentation that supports accurate diagnosis coding and

ensures that the level of service rendered to all patients is

documented. Query physicians on a concurrent basis to clarify

documentation in the medical record

. Educate members of the patient care team regarding specific

documentation needs and reporting and reimbursement issues identified

through daily perspective and retrospective documentation reviews and

aggregate data analysis.

. Perform health care data analysis using SAS, including analyzing

eligibility, claims/encounter, provider, diagnosis/treatments and

healthcare survey.

. Verifies and ensures the accuracy of all assigned tasks, including the

documentation and validation of SAS and other programs. Identifies

problem areas and assist in developing effective solutions.

. Participates in the analysis and trending of statistical data for

specified patient populations to identify opportunities for

improvement. Assist with preparation of clinical documentation

monitoring/trending reports for review with physicians.

. Utilizes software systems to collect, track, and report outcomes.

Clinical Applications Implementation Analyst

6/ 2008 - 2/ 2010

Good Samaritan Evangelical Lutheran Society - Toledo, Ohio

. Collaborate with the project manager to create and maintain a project

charter and plan with associated resources, milestones, and timeline

needed to complete the implementation of EMR. Assists with development

and maintenance of risk assessment & mitigation, communication, change

management, and quality management project plans

. Develop and implement go live plans, including task list, timeline,

staffing coverage, disaster and recovery and contingency plans, which

include risk management.

. Coordinate kick off and ongoing team meetings, prepare agendas and

lead recorded discussions.

. Assist in the creation of end user training materials and operational

policies and procedures related to day-to-day application

functionality

. Provide initial face- to face and ongoing training and support to

clinical and non-clinical users., which included development and

education tools. Respond to user questions and emails according to

established service levels

. Acts as liaison between IT and Clinical Departments, communicating

user requirements to programmers to ensure their understanding of

overall operational goals and user/ system needs. Responsible for

thorough testing of new features and development of documentation,

communication to users and go live support

Credentialing Manager

3/ 2006 - 3/ 2007

The Credentialing Source - Toledo, Ohio

. Credentials providers according to: specific company policies and

procedures, applicable staff bylaws, Payer requirements and Federal

/State regulatory requirements.

. Ensure accuracy and completeness of provider enrollment applications

in order to maintain current status with contracted insurance

carriers/payers.

. Ensure the accuracy and completeness of initial appointment and re-

appointment applications to in order to maintain current/active status

with hospitals.

. Enter and update provider demographic information in credentialing

database, which included updating CAQH.

. Request and maintain updated credentialing documents from clients on

an ongoing/as needed basis and prior to any expiration to ensure there

is no lapse in coverage or provider status, which included CME and

CEU.

Medical Coder/Edit & Review

11/ 2002- 2/2006

APS Medical Billing - Toledo, Ohio

. Analyzes medical information from medical records. Accurately codes

diagnostic and procedural information in accordance with national

coding guidelines and appropriate reimbursement requirements for

inpatient and outpatient medical records.

. Provides thorough, timely and accurate assignments of ICD and/or CPT4

codes, MS-DRGs, APCs, POAs and reconciliation of charges.

. Request query clarification when necessary.

. Submit claims through EHR billing system for reimbursement

. Responsible for performing an in-depth review of select inpatient

medical records to ensure that the assigned codes and DRG are

supported by clinical documentation and all diagnoses and procedures

are coded with the required specificity and the discharge disposition

and the POA are correct.

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