Home Health Quality Assurance/Coding Director

Jeannie M. Anscomb

**** *. ********** **.

Saginaw, MI 48604

989-***-**** *******.*******@*****.***

OBJECTIVE

Opportunity that allows me to utilize my expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs to promote continuity of care and cost effective measures.

QUALIFICATIONS

•Case Management Comprehensive assessment of the physical, social, psychological, and financial need of patients, to promote continuity of care in a cost effective manner. Serves as a patient advocate.

•Promotes effective and efficient utilization of clinical resources • Facilitates and promotes patient self-management through education.

•Excellent organizational, detail oriented and time management skills.

SKILLS AND ABILITIES

PROFESSIONAL SUMMARY Registered Nurse Highly skilled career professional with more than 22 years practical experience in hospital and home health including provision of direct nursing care, nurse management and supervision, educator, case manager, quality assurance review, performance improvement and agency Director of Nursing. Strong knowledge base of CMS regulations. Excellent organizational, interpersonal, communication and critical thinking skills. The ability to work harmoniously with a variety of people and all levels of staff, and to interact professionally as a leading member of a multi-disciplinary team. Strong commitment to the goals, mission and philosophy of the organization. Good judgment and absolute integrity in handling the professional and confidential nature of personnel, patient and Company information. Leadership in promoting and maintaining standards for giving quality patient care.

Skills Category

●Remarkable experience in conducting medical review and data analysis, with sound knowledge

of care delivery documentation and medical record document

●Detail oriented with extensive knowledge of disease processes and clinical medicine, able to

perform concurrent review of medical records

●Excellent communication and organizational skills with superior time management and analytical

skills

●Mobilizes resources and interventions to achieve expected goals / clinical outcomes within a desired

time frame

●Conducts review for appropriate utilization of services from admission through discharge/evaluating . Patient Satisfaction and Quality of Care.

●Serves as a patient advocate. Enhances a collaborative relationship to maximize patient's ability

to make informed decisions.

EMPLOYMENT HISTORY

Quality Assurance /OASIS-C1/ ICD-9 Coding Nurse 7/19/2014 to current

Absolute Home Health Care

8273 S. Saginaw St. #A

Grand Blanc, MI 48439

Provided complete review of all documentation to ensure admission of appropriate patient’s to home health care based on the referral, comprehensive assessment and needs of the patient according to Medicare Conditions of Participation. Identified deficiencies, collaborated with clinicians for clarifications, and provided oversight of the development of a comprehensive Plan of Care for each patient. Completed the appropriate ICD-9 coding based on Coding Guidelines. Completed clinical record reviews to ensure accurate complete documentation, providing education as needs were identified. Participated in quality assurance and quality improvement activities of the agency.

Quality Assurance Review Nurse, 12/2012-6/2014

National Coding Center, LLC

28120 Dequindre

Suite 300

Warren, MI 48092

Provided coding from a consulting perspective to ensure accuracy and profitability for the agency using a four step approach to coding which included comprehensive quality assurance review of the OASIS, accurate coding according to ICD-9 guidelines based on supporting clinical documentation, provided recommendation related to medical necessity for proper recertification of the patient, and also provided home health agencies with recommendation for clinical education opportunities on each individual review completed.

Home Health Case Manager, 8/2012-12/2012

Compassionate Home Health Care

950 Corporate Office Drive

Suite 200

Milford, MI 48381

Responsible for management of approximately 25 patients. Conducted comprehensive assessment of each patient, developed the patient plan of care in collaboration with the patient, physician and other multi-disciplinary team member based on the patient’s needs and provided timely completion of the OASIS. Implemented the Plan of Care and evaluated the health care services and outcomes throughout the continuum of care to meet the individual health care needs and ensure that the care provided was safe, effective and efficient. Ensured that resources were being used in a timely and cost effective manner in order to obtain optimum value to both the patient and the agency

Director of Quality Assurance, 03/2012 - 08/2012

Helping Hand Home Health Care, Grand Blanc, MI

Direct coordination and oversight of all Quality Assurance activities including review of OASIS, ICD-9 coding, Clinical record review, Performance Improvement Plan development and implementation, OBQI/ OBQM activities, Annual Agency Evaluation, PAC meeting presentation, development of standardized orientation for all staff, provision of inservices.

Home Health Care Administrator, 06/2011 - 01/2012

Family Nurse Care II LLC, Bay City, MI

Oversight of all clinical and financial aspects of day to day operations of the home health care branch. Responsible for quality patient care, staffing, clinical record review to ensure compliance with Medicare requirements.

Provision of quality patient care to home care patients Financial oversight of agency Interviewing/

Hiring Clinical record oversight Performance Improvement OASIS accuracy ICD-9 Coding

National Quality Assurance Director, 03/2011 - 06/2011

Guardian Angel Home Health Care, Rochester Hills, MI

Responsibilities included performing all Quality Assurance audits related to home care, gathering and analyzing data to identify trends and areas for improvement, presenting education to staff regarding trends and opportunities for improvement, and analyzing proper utilization of services based on patient acuity and needs. Organized Professional Advisory Committee Annual Meeting, developed and presented Quality Assurance Findings and developed and presented the Performance Improvement Plan to committee members and clinical staff. Monitored the implementation of the plan on an ongoing basis.

Quality Assurance Review Nurse, 11/2010 - 03/2011

Phoenix Home Health Care LLC, Troy, MI

Responsible for Clinical Documentation Audits including OASIS events (SOC/ROC/Recertifications/ Discharges/Transfers), Therapy Evaluations/Plan of Care, to ensure accurate initial OASIS/ assessments, accurate ICD-9 Coding, accurate development of the Plan of Care including all indicated services. Responsible for ensuring that all assessments reflect qualifications necessary to meet Medicare guidelines, reflect the need for skilled care and that frequency and duration are reasonable and necessary based on the clinical status of the patient reflected in the patient assessment. I am also responsible for audits of the daily visit notes to ensure that skilled care is reflected and according to physician orders reflected in the Plan of Care, audits of therapy evaluations and Plan of Care to ensure skillable need and that frequency is reasonable/necessary based on assessment findings, Interim order review to ensure that orders are complete and appropriate, Final Claim audits to ensure that all claims submitted are skillable and billable.

Quality Care Coordinator, 01/2009 - 11/2010

Amedisys Home Health Care

Responsible for: Processing and transmitting OASIS, ICD-9 Coding and development of the plan of care based on clinical assessment, clinical tracks, utilization, reasonable/necessary, Standards of Care Noted inconsistencies in diagnosis coding, patient history, OASIS responses, MD orders, track selection and schedule calendar - Educate clinicians as needed to process assessments correctly - Participate in Care Team Conference to provide education in deficiencies noted - Role includes aspects of the Clinical manager, Episode Manager, Clinical ops and patient Advocate. - QCC addresses scheduling throughout the entire episode (LUPA management), appropriate therapy management, Quality management consisting of Utilization (SN according to track recommendations, HHA visits scheduled appropriately, Therapy evaluation ordered when indicated by F2 Score. Episode management/ coordination of care

Director of Operations, 08/2008 - 01/2009

Amedisys Home Health Care, Flint, MI

Assured state / federal regulatory compliance applicable to home health and reimbursement issues - Educated staff members on state/ federal rules and regulations - Acted as a liaison between staff, patients, physicians, and other health care providers. - Continually monitored clinical episode management and provided direction/redirection as necessary - Worked with all members of the medical community to promote home care services. - Recruited, hired, oriented, assigned, evaluated and guided staff positions to meet agency and patient needs - Ensured delivery of quality care to patients, enhancement of business development, and continuous improvement of agency efficiency and success

Director of Performance Improvement/Quality Assurance, 02/2008 - 08/2008

Tender Loving Care Home Health Care, Saginaw, MI

Responsibilities included data collection and analysis of all clinical and operational processes to identify areas requiring improvement, development of performance improvement plan to address all deficiencies identified. Responsible for the implementation of the plan including education of staff, follow- up data collection to evaluate plan, revise plan as necessary. Participated in the review, analysis and appraisal of the agency's total program annually.

Director of Clinical Services/Branch Man, 06/2004 - 02/2008

Tender Loving Care Home Health Care, Saginaw, MI

Organized and directed professional and para-professional services and is accountable for adherence to federal, state and local laws, accreditation, and company policies and standards for compliance and reimbursable patient care services. Utilized extensive knowledge of comprehensive patient assessments, clinical and financial care planning, and multi-discipline care management, focused on direct patient care, the theory and practice of adult health maintenance, and the assessment and management of common health problems of adults. Provided interdisciplinary education and training to manage disease processes, program management consultation, and direct patient care skills impacting both individual health and environmental factors that affect the health of everyone Implemented agency's professional and clinical services and performance improvement programs . Established, maintained and managed safety programs, hazardous material and waste, emergency preparedness, fire safety, medical equipment and blood borne pathogen clinical management. Maintained Infection Co

• Infection Control Program, and assured completion of documentation for Respiratory/TB Risk Assessment and OSHA to meet regulatory requirements

EDUCATION

Associates Degree - Applied Science - Nursing Delta College, MI Graduated April 1991

Licensed Registered Nurse State of Michigan 470-***-****)

Licensed Registered Nurse State of Florida (RN3271542)

CERTIFICATES / LICENSES

ICD-10 CM HH Coding Services

Association of Home Care Coding and Compliance (AHCC)

OASIS Certification

Fazzi Associates, MI

OASIS C Review/Instructions

Selman-Holman & Assoc., MI

HONORS AND ACTIVITIES

Phi-Theta Kappa

NOTES / OTHER INFORMATION

Quality patient care with excellent outcomes is #1 priority. Extensive knowledge of care delivery documentation and concurrent medical record reviews.

Excellent patient teaching skills based on disease management and standards of care

Ability to effectively communicate with all levels of authority

Proficient in conflict resolution Lead by example

Proficient in MS Word, MS Outlook, excellent writing skills

Remarkable experience in conducting medical record reviews with detail oriented focus. Competent in

Data analysis and development of Performance Improvement Plans and staff education.

Excellent communication skills Detail oriented Knowledgeable in Medicare regulations/CHAPS

Excellent organizational skills Self-motivated

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