Quality Assurance Manager
Resume:
Alison H. Vincent
Alison Hildreth Vincent, CPC, CEMC, B.S.H.A.
Thornton, Colorado 80602
Email: abnm8z@r.postjobfree.com
Professional Profile
Success-oriented healthcare coding professional with proven results in improving coding accuracy, reimbursement optimization,
reengineering processes, training and education, and quality assurance initiatives. Team-focused experience with diverse programs
and skill-sets and energetic style supports a successful environment that ensures achieving desired goals and objectives. Highly-
motivated, energetic, driven healthcare professional with multi-faceted experience in electronic health records, consulting, quality
assurance, coding, training, education, compliance, quality, business process re-engineering, and process improvements.
Education and Professional Associations
Bachelor of Science, Health Care Administration
o University of Phoenix
Graduated 2006 with honors, cum laude
Certified Professional Coder, CPC (AAPC)
CEMC-Certified Evaluation and Management Coder (AAPC)
Project Management Program, University of Texas, San Antonio-Distance Learning Program, 2006
Member of AAPC, AHIMA, Colorado Association of Healthcare Executives
Member of the AHIMA Publications Review and Advisory Group
Member of management advisory panel for ADVANCE for Health Information Professionals
Ongoing education; healthcare industry issues, CMS, HIPAA and OIG rules, regulations and policies, ICD-9 and CPT, coding,
reimbursement, financial and contracting, E&M and procedure auditing, Department of Defense coding compliance and
guidelines, insurance plan updates
Structured coding seminars, self-study programs, and computer-based training program
SKILLS
Detail-oriented, excellent verbal, analytical and written communication skills, effective presentation, grammar, spelling,
usage
Knowledge of MS Applications, Windows XP Operating Systems, Armed Forces Health Longitudinal Technology Application
(AHLTA), Composite Health Care System I (CHCS), McKesson Physician Practice Manager, MedAssist, Meditech, Clinical
Messaging, VERSYSS, Health Agency Management System, Quick Books Accounting, Peachtree Accounting, TDS 7000, Lotus 1-
2-3
Type 125 wpm with rapid accurate entry of data, 10-key by touch
G/L, A/P A/R, billing, collections, payroll, training and education, personnel and practice management,
Financial, contract and reimbursement analysis, Physician credentialing
Certified Professional Coder (AAPC), Evaluation and Management Specialist (AAPC), auditing, training, education, ICD-9-CM,
CPT, HCPCS, DRG, PDR, AHA’s Coding Clinic, TRICARE Professional Services and Outpatient Coding Guidelines, DoDI 6040.10
(MHS Data Quality Management Procedures), DoDD 6040.41 (Medical Records Retention and Coding at Military Treatment
Facilities), DoDD 6040.42 (Medical Encounter and Coding at Military Facilities
Extensive knowledge of the healthcare/finance industry, managed care, (Medicare/Medicaid, CICP HMO, PPO, Indemnity,
.
Commercial, Private and Self-Funded, Worker’s Compensation, Occupational Health), PMGs, IPAs, RBRVS
Medicare, HIPAA, JCAHO, HSI, Department of Defense, Air Force, and OIG coding, documentation, and policy compliance
Adhere to the AHIMA and AAPC Standards of Ethical Coding
Project management, advanced skills in planning, organizing, prioritizing
Superior customer service skills, high standard of ethics, integrity and professionalism
Specialize in assessing and implementing A/R policies and procedures to exceed industry standards
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Alison H. Vincent
Demonstrate ethics, integrity, and dedication to establish and maintain appropriate business practices
Proven leader with measurable results of objectives and goals set forth by an organization
Team leadership, excel within a team environment, problem solver, high degree of independence
ANACI Security Clearance
EXPERIENCE
United States Air Force, 460th MDG, Buckley, A.F.B., Aurora, Colorado 2006-Current
Armed Forces Health Longitudinal Technology Application (AHLTA) Clinical Systems Analyst-Functional Subject Matter Expert
Provide information technology services and support tasks for Air Force Medical Treatment Facility
User training, functional integration, change management, and business process re-engineering (BPR)
Technical and functional user assistance in support of the enterprise application, AHLTA, and other applications designated
for support in support of the Air Force Medical Treatment Facilities
Support incremental implementation training (over-the shoulder, formal, and informal)
Change management
Responsible for detailed knowledge and understanding of system configuration, data, file and table relationships to business
processes and modules to provide appropriate functional and technical assistance to users
Conduct system health and system status checks, file and table maintenance
Provide training and integration support while assisting to drive change management
Develop and submit trouble tickets and perform necessary troubleshooting
Data gathering and analysis
Provide coding and clinical documentation support for system users to achieve the highest integrity in documentation,
compliance, and informatics
Parses, Inc., Tampa, Florida 2005-Current
Quality Assurance Review Auditor
• Remotely audit multi-specialty claims for State of Florida, Aetna, Anthem, Cigna, Humana, United Healthcare, State of
New York, and other insurance companies for post-payment recovery audits using 1995 and 1997 Documentation guidelines
• Provide feedback and identification to corporation for possible fraud and abuse trends, present clear and concise feedback
to improve E/M accuracy and coding compliance
• Training, education, and support for auditing team to ensure complete cohesiveness and compliance among corporate
auditing team
United States Air Force, 460th MDG, Buckley A.F.B., Aurora, Colorado 2004-2006
Coding, Auditing, Training, Education, and Compliance
Supervise all coding processes, ensure accuracy of data entry, timeliness, and completeness per Air Force/DoD guidelines
Responsible for abstracting, coding, and reviewing all charts for providers of service; 8 physicians (2 Primary Care, 2
Aerospace medicine, 1 Pediatrician, and 3 Family Practice), 2 Physician Assistants, 10 Medical Technicians, 3 Physical
Therapists, 2 Mental Health providers, Nutritionists, Clinical Pharmacist, Public Health, Medical Readiness, Occupational
Health, Immunization, and Laboratory staff. Approximately 1,400 charts per month
Responsible for improving E/M accuracy from 75% to 93%, ICD-9-CM accuracy from 63% to 97%, CPT accuracy from 59% to
99%
Responsible for implementing programs to capture unaccounted procedures which result in increased Relative Value Units
and implementing programs to capture lost encounters and procedures
Increased RVU production of 81% of business plan target goal to exceeding target goals (over 100%) by identifying problems,
training, education, and process improvements, and consistent management of program
Improved ADM timeliness of having all encounters closed within 3 (DoD requirement) from 74% to 98% bringing MTF from
being ranked 79th out 89 AFBs to consistently in the top 8 bases, AF wide
Responsible for improving ADM completeness from 94% to 100%
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Alison H. Vincent
Direct monthly meetings for training and education on various items related to coding procedures, DoD guidelines, audit
results, process improvements, lead regular trainings that include, but are not limited to pre-audit, post-audit, initial,
periodic, and formal sessions
Prepare, implement, and provide an Annual Education Plan for all staff that will be coding and interpreting coded data
Responsible for quality assurance and compliance for all coding policies and procedures for the MTF, trend analysis,
documentation, internal coding practices, confidentiality, internal coding compliance plan oversight, and retention of
records
Appointed member of Space Command Coding/Auditing team
Appointed Point of Contact for Business Plan Executive Team Action Plan 2005-2006
Appointed committee member of Air Force Population Health Team-Data Analyst
Appointed committee member of Data Quality Assurance Team (DQAT)
Manage quality control program which recognizes the judgmental nature of clinical coding and ensure consistency in its
application
Assistant to Air Force Health Care Integrator-Responsible for re-design of all medical record documentation
Skilled at using specialized references such as medical nomenclatures, medical dictionaries, medical texts, and medical
journals
Responsible for clean up of CHCS I in preparation of implementation to CHCS II so that all data was accurate before
conversion to AHLTA. CHCS Point of Contact for resolution of process, scheduling, and deficient encounters
Point of Contact for system implementation of Armed Forces Health Longitudinal Technology Application (AHLTA), identify
system strengths and weaknesses and provide feedback to AHLTA support team
Provide education and training to providers of service and support staff for documentation in AHLTA on correct code
assignments, documentation deficiencies, and providing solutions to identified problems
Foothills Surgical Associates, P.C., Wheat Ridge, Colorado 1997-2004
Billing and Reimbursement Manager
Responsible for management of general surgery billing office (8 surgeons - General, Vascular, Thoracic, Endocrine,
Oncology)
Accountable for design and improvement of financial operations of organization, provide creative initiatives that produce
productivity, quality and accuracy
Developed and implemented systems to decrease outstanding collections and increase cash flow
Responsible for integrating policies and procedures to promote effective claims processing, appeals, contract
reimbursement, referral tracking, pre-authorizations, benefit verification, financial analysis/reporting
Manage A/R, A/P payroll, billing, claims processing, insurance follow-up, claim appeals, collections,
ICD-9-CM, CPT, HCPCS coding
Maintained 3-4% below industry standard of average outstanding A/R balance
Compliance officer for financial policies and procedures
Conduct chart audits per Medicare and OIG guidelines and educate physicians/staff on policies and protocols
Provide leadership and direction to administrative, clinical and billing staff for education and training on all insurance,
fiscal, and system related policies, procedures, protocol
Provide training and support to physicians on ICD-9-CM and CPT coding, Medicare, HIPAA and OIG compliance, chart/E&M
documentation
Centennial Valley Women’s Clinic, P.C., Louisville, Colorado 1996- 1997
Billing Operations Manager, Assistant Practice Administrator (APA)
Oversee operation of business office
Manage A/R, billing, claims processing, insurance follow-up, claim appeals, collections
Develop strategies which promote efficiency and quality
Coordinate staff training, computer systems, policies, procedures, protocol
Responsible for all ICD-9-CM, CPT, and HCPCS coding
Fiscal and Human Resources management, meeting planning, correspondence, research, reporting, marketing, budgeting
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Alison H. Vincent
Centura Health Portercare-Avista Surgery Center, Boulder, Colorado 1994- 1996
Ambulatory Surgery Center Office Manager
Oversee administrative and coding operations of ASC
Schedule all surgeries and pre-surgical/admission testing
Assist manager/director in personnel and fiscal management, correspondence, meeting/events
ICD-9-CM, CPT, and HCPCS coding for all outpatient surgeries
Monthly fiscal/statistic reporting to hospital administration
Professional Home Health Care, Inc., Boulder, Colorado 1990- 1994
Home Health Care Agency Office Manager
Direct daily administrative operations
Manage A/P, A/R, payroll, billing, collections
Assist CFO/COO in correspondence, reporting, meeting/events, personnel and fiscal management
Responsible for guiding and directing staff on policies and procedures
Prepare and present financial proposals, grant proposals
Process all Worker’s Compensation and Unemployment claims, administer employee benefits
PROFESSIONAL PUBLICATIONS WRITTEN
In collaboration with Dennis Mihale, M.D., MBA, C.E.O. Parses, Inc.
The Impact of Medical Necessity on Electronic Health Records: The Trump Card
CONSULTS: The Most Misunderstood Visit Type
AWARDS of ACHIEVEMENT
Professional Performer of the Year presented by Commander of 460th MDG, 2008
“Medic-of-the-Month” presented by Commander of 460th MDG for outstanding service and dedication to the United States Air Force
for providing superior initiatives and accomplishments in support of military readiness, January 2008
Professional Performer of the Year presented by Commander of 460th MDG, 2007
Professional Performer of the Year presented by Commander of 460th MDG, 2006
Superior Service Award of Excellence, 2006
Professional Performer Award, 460th Medical Group, 2005
Recognition of Outstanding Dedication and Performance, Contractor, presented by Commander of 460th Medical Group, 2005
Outstanding Customer Service and Work Excellence, 460th MDG, 2005
Employee of the Quarter, 4th Quarter, 2005,
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Alison H. Vincent
REFERENCES
Professional and Personal References will be provided upon request
Contact this candidate