Doctor in Medicine degree with extensive knowledge in medical terminology, emergency, medical procedures, anatomy, physiology, pathophysiology and pharmacology. Experienced as a leader, quality manager, coder, auditor, research, clinical documentation improvement specialist and medical appeals analyst/liaison with statistical data analysis experience. Thorough knowledge of ICD-9 CM, ICD-10, CPT coding and DRG methodologies. Knowledge of 3M, Allscripts, Onbase, eCharms/healthstream, CDI monitor, Epic, Quadramed, Misys CPR, Excel, Word and PowerPoint. Experienced in remote working.
A highly personable competent a team spirited individual that loves to work as a team player with strong analytical and critical thinking abilities.
11/2018- Present. Hackensack UMC at Pascack Valley Medical Center. Westwood NJ. Clinical Documentation Integrity Specialist
-My typical role is to create and/or champion an initial idea for performance improvement, and then persuade and guide the hospital's service to develop the principles and adopt the interventions needed.
-Work with Director of HIM, Attending's, CDI staff, Coders and Nursing staff to provide and coordinate education related to compliance, coding and DRGs to properly support clinical documentation and identify opportunities for education.
-Knowledge of all DRG and their structure, as well as, SOI, ROM, CCs and MCCs
-Liaison between system management, CDI, coding leadership and physicians to create, implement and monitor of departmental policies and new changes according to new regulations.
-Review inpatient medical records on a daily basis, concurrent with patient stay, to identify opportunities to clarify missing or incomplete documentation using the hospital’s designated clinical documentation system.
-Facilitate improvement in the overall quality, completeness and accuracy of medical record documentation.
-Knowledge of clinical documentation requirements per ACDIS, AHIMA and CMS guidelines.
10/2015- 11/18 Mount Sinai Beth Israel, NYC
Clinical Documentation Improvement Specialist/ Appeal Analyst Liaison.
As a CDI Specialist, review inpatient medical records on a daily basis, concurrent with patient stay, to identify opportunities to clarify missing or incomplete documentation using the hospital’s designated clinical documentation system.
-Collaborate with providers, case managers, coders, and other healthcare team members to facilitate comprehensive health record documentation that reflects clinical treatment, decisions, diagnoses, and interventions.
-Knowledge of all DRG and their structure, as well as, CCs and MCCs.
-Apply ICD-10 coding guidelines appropriately and have an 80% DRG accuracy.
-Review of all patient's records in assigned unit(s) between 24-48 hours of inpatient admission and subsequently between 2-3 days until discharge, as needed. Managing approximately 16 charts daily.
-Responsible for improving overall quality and completeness of clinical documentation to accurately reflect patient SOI and ROM through extensive interaction with staff.
-Submit and conduct follow-up of posted queries to ensure that queries have been answered and physician responses have been appropriately documented.
-Provide or coordinate education related to compliance, coding, and clinical documentation issues within the healthcare organization. This include rounding with the multidisciplinary healthcare team in the ICU and other units.
-Conduct pre-bills reviews to ensure proper assigned diagnosis. -Reconcile DRG assignment with coding department.
As DRG Appeals Analyst liaison, I am responsible for analyzing medical records, claims data, and coding of all diagnoses and procedures (both medical and surgical) to assure proper assigned diagnostic related grouping (DRG) for purposes of appeal, I also analyze denials and draft appeal letters, including the coding argument, to support the hospital’s coding decisions.
07/2009- 10/2015 Bellevue Hospital, NYC Coordinator Manager. (Quality Management Department)
-Data quality reviews of Concurrent and Retrospective cases for inpatient and outpatient surgical units. Maintain and monitor compliance and enter data into premier software for CMS SCIP. -Communicate with individual providers on a one-to-one basis, to facilitate complete and accurate documentation.
-Work in collaborative fashion with coders concurrently reviewing the inpatient medical record to assure coding accuracy and compliance.
-Participate in Joint Commission and Department of Health (DOH) survey.
-Maintain current knowledge of federal, state and TJC regulations.
-Liaison between management and physicians to implement new changes according to new regulations. Provide feedback for documentation improvement
-Identify trends and areas for improvement; monitor and analyze corrective actions taken to ensure continuous improvement of assigned outpatient and inpatient areas. -CMS Review for AMI, PSYCH, HEART FAILURE.
-SEPSIS review of cases for the NY STATE DEPARTMENT of HEALTH.
-Assist in assembling Quarterly Board Reports for the New York City Health and Hospitals Corporation Central Office.
-Create Data collection tools and statistical analysis of the multiple quality improvement projects in the hospital.
-Perform or coordinate risk management processes (e.g., risk identification, risk analysis and evaluation, incident report review, sentinel/unexpected event review, root cause analysis, and failure mode and effects analysis).
-Participate in hospital wide performance improvement meetings, monthly General Surgery Clinical Service Line Meetings, Surgical specialties meetings and as well departmental staff meetings and conferences.
07-200*-**-****/ Santiago, Dom. Rep. Medical Doctor Emergency Department (Centro Medico Cibao)
-Provide treatment to those in need of urgent medical care.
-Trauma care such as fractures, soft tissue injuries and management of other life threatening situations.
-Making recommendations for improvement, diagnosing and treating patients.
-Reviewed and prepare clinical records for patients.
-Evaluated and treated patients in the emergency department including follow-up Communications with primary health providers.
-General Medicine degree at PUCMM ( Pontificia Universidad Catolica Madre y Maestra). Santiago, Dominican Republic. 1999-2006
- Lean- Breakthrough, Green Level .2015 NYC Health and Hospitals Corporations (HHC)
-Advanced Supervisory Skills. 2015 NYC Health and Hospitals Corporations (HHC)
-Emotional intelligence .2015 NYC Health and Hospitals Corporations (HHC)
-Certified Clinical Medical Assistant (CCMA). National Health Career Association, NYC. June 2007
-Certified Patient Care technician (CPCT). National Health Career Association, NYC. June 2007 -Certified Phlebotomy Technician (CPT). National Health Career Association, NYC. June 2007 -Certified EKG Technician (CET). National Health Career Association, NYC.
*Currently working in the CCDS
References upon request.