Life Insurance Management
Resume:
Don Gahng CCS, NCP EHR, NCP EPM
********@*****.***
Torrance CA 90504
Objective: seeking an opportunity as a Clinical Documentation Improvement
Professional at the hospital with the knowledge and the experience that I
have gained from education and professional employment to improve patient
care, quality of care, and reimbursement.
Professional Experience:
Prime Healthcare Services (Coder Auditor/ Clinical Documentation
Specialist) Aug 2014 - current
Mostly using HPF to audit on most recently discharge patient on
finalizing coding. responsible for 4 hospitals under prime healthcare
services. day to day case review from daily inpatient census. Using the
coding regulation and rule, initial coding, concurrent coding to finalizing
coding by the methodology of DRG reimbursement considering MCC and CC
during the documentation review. understanding and maintaining possible
overall clinical picture is a crucial part of the duty since documentation
has possible missing gap from improvement of DRG. preparation of query,
daily communication with the local CDS in its facility to have most updated
information to accurately provide possible and accurate DRG for higher and
potential reimbursement. Day to Day case management meetings with CMO,
physician, RN, and Case management, Social Services to discuss the most
effective way to provide best and quality patient care. working with the
HIM/Coding, Meditech, HPF, EPIC. Nextgen & CCS Certified. Currently
helping out new CDS manager at the Orange County hospitals (La Palma,
Huntington Beach, West Anaheim, and Garden Grove) until work flow is
settling down with the new EHR system since I have been working in La Palma
and Huntington Beach. I will be responsible for helping out new CDS manager
as well as training new CDS at the local facility. Reviewing Performance
Improvement on present on admission to clearly define the condition was
clearly on POA which can be an important factor on the reimbursement.
Huntington Beach Hospital (Clinical Document Specialist)
Feb 2014 - current
day to day case review from daily inpatient census. Using the coding
regulation and rule, initial coding, concurrent coding to finalizing coding
by the methodology of DRG reimbursement considering MCC and CC during the
documentation review. understanding and maintaining possible overall
clinical picture is a crucial part of the duty since documentation has
possible missing gap from improvement of DRG. preparation of query, daily
communication with the physician, Nursing staff, Case Management to have
most updated information to accurately provide possible and accurate DRG
for higher and potential reimbursement. Day to Day case management meetings
with CMO, physician, RN, and Case management, Social Services to discuss
the most effective way to provide best and quality patient care.
documentation review on Adimission Criteria Form. RAC preparation, attend
reimbursement meeting. working with the HIM/Coding, Meditech, HPF, EPIC.
CCS certified.
La Palma Intercommunity Hosptial (Clinical Document Specialist)
Aug 2013 - current
day to day case review from daily inpatient census. Using the coding
regulation and rule, initial coding, concurrent coding to finalizing coding
by the methodology of DRG reimbursement considering MCC and CC during the
documentation review. understanding and maintaining possible overall
clinical picture is a crucial part of the duty since documentation has
possible missing gap from improvement of DRG. preparation of query, daily
communication with the physician, Nursing staff, Case Management to have
most updated information to accurately provide possible and accurate DRG
for higher and potential reimbursement. Day to Day case management meetings
with CMO, physician, RN, and Case management, Social Services to discuss
the most effective way to provide best and quality patient care.
documentation review on Adimission Criteria Form. RAC preparation, attend
reimbursement meeting. working with the HIM/Coding, Meditech, HPF, EPIC,
Nextgen, Magic. CCS Certified.
Desert Valley Hospital (Clincial Documentation Specialist)
Dec 2012 -Aug 2013
day to day case review from daily inpatient census. Using the coding
regulation and rule, initial coding, concurrent coding to finalizing coding
by the methodology of DRG reimbursement considering MCC and CC during the
documentation review. understanding and maintaining possible overall
clinical picture is a crucial part of the duty since documentation has
possible missing gap from improvement of DRG. preparation of query, daily
communication with the physician, Nursing staff, Case Management to have
most updated information to accurately provide possible and accurate DRG
for higher and potential reimbursement. Day to Day case management meetings
with CMO, physician, RN, and Case management, Social Services to discuss
the most effective way to provide best and quality patient care. Coordinate
with the medical group to follow up on post discharge process to meet the
meaningful use criteria. working with the HIM/Coding, Meditech, HPF, EHR
implementation of NEXTGEN. and CCS Certified.
DiagnosticOne (Director of Clinical Documentation Analysis)
2007 to 2012
review clinical documentation for insurance verification, analysis
and rating. provide risk factor information that life insurance company
needs to be aware from each specific applicant on their past medical
history. Review all the medical charts from hospital record to doctors
record, lab findings, radiological findings to define the risk. provide day
to day report to regional director of risk managements of insurance
company. use of Quest Diagnostic developed EHR, monitoring specimen
collection by the nurses and phlebotomists. coordinate with Quest main
laboratory with the insurance risk management department for the update and
analysis of the patient based on their ethnic group. provide ongoing
training to risk management group and explain medical issues on each case.
GCAM Inc. (Clinical Documentation Analysis) 2002 to 2007
review clinical documentation for insurance verification, analysis
and rating. provide risk factor information that life insurance company
needs to be aware from each specific applicant on their past medical
history. Review all the medical charts from hospital record to doctors
record, lab findings, radiological findings to define the risk. Assist
Director of risk assessment for the meeting preparation by gathering data,
report generation. use of Quest Diagnostic developed EHR, monitoring
specimen collection by the nurses and phlebotomists. coordinate with Quest
main laboratory with the insurance risk management department for the
update and analysis of the patient based on their ethnic group. provide
ongoing training to risk management group and explain medical issues on
each case.
University of British Columbia Hospital (Clinical Research Associates)
2000 to 2002
mainly assisting principal investigator Dr. David Kendler on his
research study on Osteoporosis of weekly dosage vs dalily dosage in phase
three of the research . interview patient for possible risk factors, gather
the data into the research software, prepare documentation for the meetings
with the university, school of medicine, division of endocrinology along
with pharmaceuticals.
Medical Education and Training:
Surrey Medical Center 1999
Psychiatry elective
Mc Master University, general surgery / plastic surgery electives
1999
University of Toronto Teaching Hospitals electives
1997 to 1999
program trainings were Cardiology, General Surgery, Internal
Medicine, OB/GYN, Radiology, Pediatric Allergy & Immunology, Pathology,
Neurology, Hand Surgery and Plastic Surgery.
Grace Medical University
1999
Doctor of Medicine. Qualified to sit for USMLE.
UCI BS in Biological Science
1995
License and skills
CCS
E.H.R. Nextgen
E.P.M. Nextgen
Strata IT comp.
CPT I for phlebotomy
Abdominal, Carotid artery Ultrasound, EKG obtaining
Computer usage
English/Korean speaking
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