Anita Patel, BS, RHIA

678-***-**** (mobile)

ac23u6@r.postjobfree.com

EXECUTIVE SUMMARY

Results-driven healthcare consultant/manager with 14+ years experience in the Healthcare Industry

Specialized in Healthcare, Risk and Compliance, HIPAA regulations, Medical Records management, Medical coding, Chart auditing and Medical Billing

Strong experience in Revenue Cycle Management such as CDM, Charge Capture and Charge Routing

Experience in ICD-9 and CPT/HCPCS coding (inpatient, outpatient and ER) and auditing

Experience in ICD-9 to ICD-10 conversion (ongoing process and training)

Experience with EHR and coding systems such as EPIC, Cerner, Meditech, Eclipsys, Enterprise, Allscripts, CPSI, 3M Encoder and Ingenix

Experience with HHS and CMS and Medicaid programs

Knowledge and experience with medical necessity, Meaningful Use, software validation and healthcare compliance auditing and RAC auditing

EXPERIENCE

Northwest OBGYN, Oklahoma City, OK 07/2017-Current

Medical Biller/Coder/Auditor

Read and analyze patient records

Determining the correct codes for patient records

Create encounters and submit claims to Medicare, Medicaid and 3rd Party Insurance Companies

Interact with physicians and assistants to ensure documentation and coding accuracy

Keep track of patient data over multiple visits

Manage detailed, specifically-coded information

Maintaining patient confidentiality and information security

Analyze Explanation of Benefits (EOB) forms to ensure insurance companies have paid for charges

Generate and review accounts receivable reports

Follow up with the appropriate parties (insurance companies and patients) to ensure bills are paid

Review and appeal all denials as necessary

St. Anthony’s Hospital – SSM Health, Oklahoma City, OK 07/2015-07/2017

Coding Auditor/Educator

Audit medical records documentation to identify under-coded and up-coded services; prepare reports and meet with coders and other departments, as necessary to provide education and training on accurate coding practices and compliance issues

Provide second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices

Train, instruct and/or provide technical support to coders and other departments, as appropriate, regarding coding compliance documentation, and regulatory provisions, and third party payer requirements

DRG reviews and audits

Research, analyze and respond to inquiries regarding compliance, inappropriate coding, denials and billable services

Attend coding conferences, workshops and in-house sessions to receive updated coding information and changes in coding and/or regulations

Act as a liaison between coders and CDI to ensure correct coding and optimal reimbursement

Performed RAC audits and handle appeals as necessary

Independent Consultant 03/2014-07/2015

Consult clients with document integrity including everything from chart prepping and abstracting to quality control

Consult clients with ICD-9 coding for inpatient, outpatient and emergency diagnoses and procedures

Perform inpatient, outpatient and emergency coding audits and educate coders as needed

DRG reviews and audits

Educate clients on federal and state regulations including JCAHO and CMS requirements

Perform coding audits for clients on an as-needed basis

Assist clients with ICD-9 to ICD-10 upgrade

Performed RAC audits for clients on an as-needed basis

Integrate transcription software to work with within the clients’ existing workflow and medical records departments

Sumner Regional Medical Center 04/2013-02/2014

Manager of Health Information Management

Manage 5 FTEs working in the EMR (Cerner) in various settings including, Chart analysis, Chart completion, Chart abstracting, Coding and Auditing, Release of Information and Transcription

Initiating and managing the ICD-9 to ICD-10 transition including coding and clinical documentation

Responsible for creating and maintaining job descriptions and process work flows within the HIM department

Manage the HIM department aspect of the Revenue Cycle and maintaining the necessary relationships with the various departments to ensure maximum revenue

Manage open positions, recruitment efforts, and hiring and training of permanent and temporary staff.

Set departmental goals and individual productivity standards. Delegate work to department and issues to CEO

Work closely with CEO, CFO and Business Office to decrease DNFB and maximize cash flow

Interact with Physicians and Nurses to ensure proper clinical documentation and timely chart completion.

Assist CEO and CFO with planning, implementing and monitoring of the HIM budget.

Effectively utilize supplies, reference materials and educational opportunities to ensure maximum productivity

Inpatient, Outpatient, ER and Long-term stay ICD-9 and CPT coding

DRG review

Perform departmental chart audits and report results to coders as well as CEO

Completed all RAC audits and follow ups

TSVI, St. Louis, MO 07/2004-4/2013

Director of Medical Transcription/Operations

Assist clients with transition to EMR

Consult clients with document integrity including everything from chart prepping and abstracting to quality control

Consult clients with ICD-9 coding for inpatient, outpatient and emergency diagnoses and procedures

DRG reviews and audits

Educate clients on federal and state regulations including JCAHO and CMS requirements

Perform coding audits for clients on an as-needed basis

Assist clients with ICD-9 to ICD-10 upgrade

Performed RAC audits for clients on an as-needed basis

Implement and train all transcriptionists and Physicians/office staff on software

Manage all US customer support staff and India-based transcriptionists and managers

Integrate transcription software to work with within the clients’ existing workflow and medical records departments

Provide on-going client support with software and transcription quality

Proofread files prior to delivering to the client, to ensure accurate transcriptions

Liaison between Physicians/Office Managers and transcriptionists

DELOITTE, Atlanta, GA 8/2001-11/2003

Healthcare Consultant

Cash payment reconciliation – daily, weekly and monthly

Managed Accounts Payable and Accounts Receivables

Revenue Cycle Redesign and Implementation

CDM Review

Medical Records (HIM) Department Redesign and Implementation

Rebilling

ABN Process

Charge Capture

Coding Audits – Inpatient, Outpatient, Ancillary and Physician Office

Experience with 3M Encoder and Quadramed Encoder and

Experience with EPIC hospital system

ICD-9 and CPT coding

Directed all functions related to ICD-9 coding seminars with staff and Physicians on Medicare issues and guidelines

Medical Transcription, Coding and Billing backlog

HEALTHSOUTH REHAB HOSPITAL, Rock Hill, SC 04/2000-07/2001

Director of Health Information Management

Directed all functions and provided leadership and supervision of the HIM Department staff (10 FTEs) and ensured proper staffing to assure proper completion and flow of records and reports

Responsible for the development, documentation, monitoring and enforcement of Health Information Management policies and ensured all policies were in compliance with all federal, state and local regulations

Analyzed statistical data and made recommendations for performance improvement

Monitored Health Information Management Systems and enforced standards for data quality and ethical practice

Served as JCAHO team leader and served on Hospital committees including Quality Council, Ethics and Compliance, Market Security and as Chair of the Records Management Committee

Started up Medical Records Department for a start-up facility

Worked with IT to develop and implement Health Information Management systems as part of the overall information system plan and provided IT support

CARDINAL GLENNON CHILDREN’S HOSPITAL, St. Louis, MO 06/1999-10/1999

Technical Area Manager (HIM Department), St. Louis, MO

Managed file room staff for all shifts

Coordinated on-site and off-site medical record storage

Assured appropriate and efficient staffing

Evaluated, hired and trained personnel

Assessed customer needs for medical records and schedule record pulls

Assisted the Director of HIM and Operations Manager

Assist Physicians in completing and retrieving medical records for completion

Quality Improvement analysis reports

Coding Audits

EYE ASSOCIATES, St. Louis, MO 06/1997-06/1999

Administrative Assistant

Implemented a computer program to improve the flow of information within the Practice

Admitted and discharged patients

Retrieved and filed medical records

Coded in medical records

Insurance payments and reimbursements

Receive cash and credit payments

Reconcile end of day payments

CERTIFICATIONS

1999 - RHIA – Registered Health Information Administrator – AHIMA

In progress – ICD-10 Trainer Certification

EDUCATION

1995-1999 Saint Louis University Saint Louis, MO

Bachelors of Science in Health Information Management/Certificate in Business Administration

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