Manager Medical

Regina A. Williams, RHIT

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

Home: 301-***-**** Cell: 301-***-****)

Bowie, Maryland 20721

Email: ablm4m@r.postjobfree.com

PROFESSIONAL

SUMMARY

Health Care Industry Professional with diverse health information

management experience. Excellent

customer support/problem resolutions, DRG s, ICD-9-CM, CPT, HCPCS,

medical terminology, anatomy

and physiology experience. Leads staff to creatively meet or exceed

customer expectations. Expert

knowledge of Electronic Medical Record training, medical claims

management, and medical coding.

Demonstrate excellent research, analytical, and problem-solving skills

of current industry standards,

provider delivery systems, and practices relating to electronic

medical records.

PROFESSIONAL HISTORY

Specialty Hospitals of Washington, DC

01 - 2009 / present

Capitol Hill and United Medical Center Long Term Care Hospitals

Director of HIM

Working as a Director, directs the health information management functions

of all the facilities in the healthcare system. Develops and deploys

health information management systems as part of the healthcare system's

overall information system plan. Monitors health information management

systems and sets the healthcare system's standards for data quality and

ethical practice. Participates in the development of health information

management policies and procedures on release of information,

confidentiality, information security, information storage and retrieval,

and record retention. Documents and enforces the healthcare system's health

information management policies and procedures. Provides education and

training to the healthcare system's employees in areas relevant to health

information management policies and procedures. Supports and facilitates

clinical, administrative, and external data use functions. Monitors local,

national, and international trends in healthcare delivery. Monitors changes

in legislation and accreditation standards that affect health information

management. Serves as an internal consultant on health information

management issues including release of information, confidentiality,

information security, information storage and retrieval, and record

retention as well as authorship and authentication of health record

documentation, standardization of medical vocabularies, and use of

classification systems. Performs and reports research on topics related to

health information management. Forecasts the healthcare system's future

technical and information needs. Manages 2 LTAC facilities.

Dimensions Healthcare Systems, Cheverly, Maryland

03 - 2008 / 12 - 2008

HIM Operations Manager

Health Information Management Operations Manager performs all phases and

functions of the daily departmental operations while providing direct

supervision to assigned Health Information Management Staff in order to

meet the production requirements and quality of the services provided by

the Health Information Management Department. Daily responsibilities

include developing staff, maintaining, interpreting, evaluating,

implementing and coordinating Health Information Management policies and

procedures and processing as related to specific job responsibilities.

-

2-

ACS Affiliated Computer Services, Inc., Washington, DC

11 - 2006 / 02- 2008 Government

Healthcare Solutions

Health Information Analyst

Maintain Procedure Drug and Diagnosis (PDD) File, including large volumes

of updates. Training, tracking, and follow through with Medical Assistance

Administration Medicaid DOH (MAA) procedure code update requests. Worked

with the QA Team member to conduct a quality review (Report Card) of all

deliverables prepared for the District, including reports, memos, and

transmittals. Resolved procedure

code related inquiries routed from the Provider Relations Supervisor and/or

Claims Supervisor as needed. Maintained File Update Request (FUR) database

to track all changes made to the Reference File, as initiated by the

District or internally. Update individual recipient rates on the recipient

file, maintain log, and notify Claims manager of mass adjustments as

requested. Draft Transmittals for MAA regarding any pricing or coding

changes that affect the provider community. Responsible for updating Fee

schedules and Reimbursement Manual as coding and pricing changes are made.

Publish Fee Schedules to the provider community as needed. Work with IT to

run Fee Schedule programs as needed. Run Ad-Hoc reports for the QA unit on

a monthly basis or as needed. Recommended necessary changes to reports via

CSR request as needed. Initiated CSR when required for any system changes

needed related to job duties. Initiated, update and test UR Criteria as

required according to providers specific limitations. comprehensive

understanding of specific provider type reimbursement methodologies,

including Dental, Anesthesia and DME. Assist with internal audits as

requested by the Account Manager. Assist with internal security audits and

security database updates and staff training as requested by the Systems

Manager.

Kaiser Permanente, Largo, Maryland

8 - 2003 / 11- 2006

Health Information Manager/ROI

Managed the medical records department, and release of medical

information. Retrieved medical information, reviewed authorizations

for release. Performed chart reviews with patients from client

companies.

Responsible for providing customer support to employees of Kaiser

Permanente largest clients and claims department. Responsible for training

14 staff members. Within three weeks, eliminated to a two-month

backlog and was recognized by senior management for exemplary

performance. Provided medical information

in response to subpoenas regarding lawsuits, custody proceedings, etc.

Ensures information arrives to court in

a timely manner. Communicated with regional medical records, Claims

department, worker's compensation, insurance companies, and others to

provide required medical information.

Aspen Systems Corp, Rockville, Maryland

2002 / 2003 Medical Coding Project Manager

Managed the Medical Records Coding Department which comprised of 14

coders at various site locations. Responsible for development and

marketing of health information management products, ISO 9000,

training

and services. Medical coding of ICD-9-CM, medical Drug coding,

terminology, anatomy and physiology.

Kaiser Permanente, Rockville, Maryland

1998 / 2002

Utilization Management Compliance Specialist / Analyst

Health Data Coder / HIM Assistant / Business Office Representative/

Medical Record Technician

Managed the Medicare Institutional Database projects, coordinating all

aspects related to hospital and

referral data integrity, data compliance, and denial procedures

Monitored and analyzed the utilization management data entry and

denial processes using concurrent and retrospective audit processes.

Independently created and maintained Medicare databases and manuals

using a variety of software

programs. Collected data for analytical purposes and maintained

related databases. Assigned ICD-9-CM,

CPT, and HCPCS codes for Medicare billing and reimbursement. Assigned

DRG codes to those entries

not grouped by computer. Maryland Tumor Registry files and training.

Conducted Quality Assurance

Audits to ensure patients completed their well visits (preventative

health exams). Conducted ongoing training sessions with medical

providers and ancillary staff on proper coding. As part of a project

team, designed and

implemented new Inventory Coding forms for all medical specialties.

Abstracted and retrieved medical information, reviewed authorizations

for release, managed the release of information. Provided necessary

documents to assure complete and accurate billing. Processed workers'

compensation claims and Medicare coordination of benefits. Performed

cash reconciliation functions including deposits, change funds and

petty

cash. Assisted patients, attorneys, and medical facilities with

information related to revenue recovery. Visited health care centers

and trained staff and physicians on the proper handling of cash and

credit transactions. Accounted for $30,000 - $50,000 per day for

medical co-payments.

EDUCATION

A.A., Health Information Management, Prince George 's Community

College, Largo Maryland Health Information Technology Program (RHIT),

Medical Coder/Abstractor Certification Program Radiology

Student, Washington Hospital Center School of Radiology - 50%

completed (1991 - 1992)

PROFESSIONAL

AFFILIATIONS

District of Columbia Health Information Management Association

American Health Information Management Association

SKILLS

Director of HIM, Operations Manager, Project Management, EPIC

Electronic Medical Records training, Management, WordPerfect, Access,

Excel, Business Objectives, BETOS, SNOWMED-CT, Pharmaceutical, HIPAA,

compliance, ISO 9000, medical coding, ICD-9, CPT, HCPCS, data

extraction and manipulation, information systems, population-based

studies, relational databases, Microsoft Outlook, CPSI, GroupWise,

medical claims, and Encoder, SMS system, Soft-Med systems. JACHO, CMS,

DOH, & NCQA, healthcare applications.

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