Energetic, experienced RHIT with background as Senior DRG Auditor, Inpatient/Outpatient Coder, Revenue Cycle Specialist and Clinical Documentation Analyst. Results oriented with excellent communication skills, adept at maximizing productivity and knowledgeable of current CMS and HIPPA guidelines. SKILLS
Proficiency in ICD 9/ ICD 10 CM/PCS
3M Coding and Reimbursement System
BLUE CROSS BLUE SHIELD OF MICHIGAN
Senior Auditor 07/2007 to 04/2018
Perform retrospective DRG validation audits utilizing approved criteria. Manage all inpatient medical and surgical appeals. Audit Observation claims, ambulatory surgery facilities and Free standing end-stage renal disease facilities for appropriateness.
Works collaboratively with audit staff to assure appropriate results. Assisted in the creation of vendor contracts for outside vendors. DMC HARPER/HUTZEL HOSPITAL
Revenue Cycle Specialist 01/2009 to 11/2014
Resolved variances in accounts and reconciled claims Negotiates authorization for care from third party payors. Performs concurrent and retrospective of patient clinical record utilizing approved screening criteria. Utilized strong assessment skills to determine necessary patient care. ST. JOHN DETROIT RIVERVIEW HOSPITAL
Clinical Documentation Analyst 07/1995 to 06/2007
Observed strict confidentiality and safeguarded all patient-related information. Kept abreast of advances in medicine, computerized diagnostic and treatment equipment, data processing technology, government regulations, health insurance changes and financing options. Evaluated accuracy and compliance of all documentation and reports. Performed all tasks with a patient-centered focus while seeking opportunities for improvement of processes and treatments.
Ensured HIPAA compliance.
Kept detailed documentation on all utilization reviews. Referred cases to secondary review when they did not meet certain criteria such as Interqual. Contacted insurance carriers to obtain authorizations for services delivered to patients. Reviewed patient admissions to determine medical necessity as directed by criteria. ST. JOHN DETROIT RIVERVIEW HOSPITAL
Coder 07/1995 to 07/2007
Observed strict confidentiality and safeguarded all patient-related information. Evaluates and assigns appropriate codes for inpatient, outpatient and emergency room charts using current coding guidelines.
Abstract all charts using 3M Coding and Reimbursement system. EDUCATION AND TRAINING
BACHELOR OF SCIENCE: HEALTH SERVICES
University of Detroit Mercy, Detroit, MI
ASSOCIATE OF SCIENCE: MEDICAL RECORDS
Mercy College of Detroit, Detroit, MI
CERTIFICATE: CLINICAL DOCUMENTATION IMPROVEMENT
Ernst and Young, Detoit, MI
AHIMA APPROVED ICD 10 CM/PCS FOR TRAINERS
AHIMA, Southfield, MI
ACTIVITIES AND HONORS
America Health Information Management Association
Southeast Michigan Health Information Management Assositation Member, Alumni Association