Health Information Medical
Resume:
Stafford, VA ****.*******@*****.*** 813-***-****(cell)
Isla Williams-Wiggins, RHIT
Professional Summary
High performing, strategic-thinking professional with more than 15 years’ experience in Health Information Management and Health Insurance. Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources. Cultivate strong professional relationships between facility service lines, physician groups, and technology departments with an innate ability to diffuse tension. Active in HIE establishments, governance, operations, and data submission. Improve quality data evaluation & submission, value-based purchasing, clinical workflow analysis & design and clinical decision support Registered Health Information Technician (RHIT)
Experience
05/2013 - Present
Fairfax Nursing Center
Fairfax, VA
Director of Health Information Management
Perform qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.
Extensive experience processing health care disputes/appeals involving managed care and both Part A and Part B Medicare services.
Trained employees on audit system, electronic health records, and coding
Interacted with providers and other medical professionals regarding clinical and ancillary documentation guidelines
Manage daily operations of the Health Information Department of 12 employees.
Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
Select, assign and audit diagnostic codes for a 200 bed facility
Maximized reimbursement by ensuring accurate ICD-9-CM coding
Develop and Implemented internal audit system
Coach and help develop team members; disciplines and counsel staff as necessary
Implementation of Electronic Health Record System
Utilization Review and Coding
09/2012 – 05/3013
Outcomes Health Information Systems
Alpharetta, GA
Medical Records Field Reviewer
Accurately and efficiently conduct medical record review for Healthcare Effectiveness Data and Information Set (HEDIS)
Schedule onsite visits with provider offices, clinic and other clinical facilities
Travel to medical facilities in specified area of region to complete chart reviews.
04/2011 – 07/2012
Ensign Facility Services
Mission Viejo, CA
Medical Records Resource
Primary Health Information Resource for 25 Healthcare facilities improving the Health Information Department.
Managed, coached and provided overall direction and guidance to Health Information Department
Identified, compiled, abstracted and code patient data using standard classification system
Redesigned workflow process in order to improve productivity
Established policies and procedures
Performed HIM department reviews and advise Administration/Director of Nursing of possible trends in inappropriate utilization and other quality care issues.
Attended clinic and departmental meeting to address issues of patient care and clinic/department administration and draft meeting minutes
Analyzed data or information for completion to support billing claim/appeals with a 92% success rate.
Implementation of Electronic Health Record System
01/2009 – 04/2011
Carmel Mountain Rehabilitation and Healthcare
San Diego, CA
Director of Health Information Management
Verify chart completion by conducting daily audits and follow up with appropriate staff for completion as necessary.
Organize and manage health information data by ensuring its quality, accuracy, accessibility and security.
Apply knowledge of Medicare guidelines, prospective payment system, MDS 3.0 accordingly
Coordinates research and collects information from internal and external providers to respond to member appeals.
Daily data entry of physician orders.
Prepare medical reports.
Managed department budget
03/2007 – 8/2008 St. Joseph Hospital Tampa, FL
Central Billing Office Management Support
Initiate inquiry to the insurance carrier, confirms patient eligibility and identifies benefits and authorization requirements.
Calculate, document and communicate monetary obligations to patient or family member.
Examined patients’ insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.
Updated patient financial information to guarantee accuracy
Determined prior authorization for medication and outpatient services.
Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
Collect co-payments for emergency room, services, and surgery and in-patient admissions.
04/2003 – 07/2006 Life Care Center of Corona Corona, CA
Director of Health Information Management
Maximize reimbursement by ensuring accurate ICD-9 coding and conducting quality audits while working collaboratively with patient account department to ensure accurate billing and resolve claim and medical necessity issues.
Managed chart completion, chart assembly, and analysis, patient admission, and patient information privacy/security.
Ensured credentialing applications process for new medical staff applicants and reappointment staff was maintained meeting facility and the Joint Commission standards.
Ensured medical records reflect the condition and progress of the patient.
Initiated, performed and documented quarterly coding audits of physicians
Education
August 2015
DeVry University
Online
Bachelor of Science Health Information Management
February 2012 DeVry University Online
Associate of Applied Science Health Information Technology
September 2013 HCPRO San Diego, CA
Clinical Documentation Specialist
September 2013 AAPC San Diego, CA
ICD-10 Trainer Course
Registered Health Information Technician – AHIMA certification
Skill Highlights
• Organizational leadership • Ambulatory EMR • Team building • HIE Governance • Staff Development/Training • Strategic Analysis & Internal Consulting • MPI Clean up, • Strategic/Tactical Planning Clinical Documentation Improvement • Clinical Data Analysis and Extraction • Operations and Data Submission • Performance Measures
References are available on request.
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