Medical Quality Assurance

Melissa Mills

**** ** ******* ******* **** D

Portland, Oregon 97219

503-***-****

E-mail r603818 @yahoo.com

Summary of Qualifications:

Ten years experience coding inpatient records: internal medicine, neurology/ neurosurgery, pediatrics, burns, cardiology and traumas. Seven years experience working in hospital audit, auditing hospital inpatient claims, reviewed medical records for proper ICD-9-CM coding and DRG assignment. Reviewed medical records for inpatient medical necessity and changed some hospital stays to outpatient reimbursement if the hospitalization didn’t meet inpatient criteria. InterQual medical necessity criteria used to determine inpatient vs. outpatient level of care.

EDUCATION:

Associate of applied science in health information management, Portland Community College, Portland, Oregon. Attended Alcorn State University, majored in Sociology and minored in psychology earned 120 credits. Attending Concordia University to complete a baccalaureate degree in Healthcare Administration still in the process of completing. Credentials: RHIT.

EXPERIENCE

Legacy Emanuel Hospital & Medical Center

Trauma Center Level 1

Trauma Registrar 6 /29/09-to current

Analyzing and coding trauma records for the trauma registry ICD-9-CM & AIS codes assigned to diagnoses & surgical procedures Epic electronic records used to review the entire medical record. Trauma cases are reported to the State of Oregon and the American College of Surgeons. Maxim Health Information Services

Traveling coding consultant, 10/8-3/9

Travel to various hospitals out of state coding and abstracting inpatient records. Skills in MS-DRG coding methodology, proper DRG assignment and the use of the 3M coding applications as well as the Quadra-Med coding system. Medical management coordinator: 2/2001-10/2007

Regence Blue Cross/Blue Shield

Audit inpatient hospital post pay claims for the correct DRG assignments Travel 50% of the time to hospitals within the Portland metropolitan area to review inpatient medical records.

InterQual inpatient level of care criteria used to adjudicate hospital admissions less than 48 hours. The InterQual criteria were used to determine if hospitals should be reimburse at an outpatient rate, inpatient level or as observation stays. Re-calculate hospital reimbursements for over payment on claims. I am skill in 3M inpatient coding software program, Microsoft word, ICD-9-CM and CPT coding and Epic software.

Achievements: Save over one million in over payments with a year. Bess Kaiser Hospital & Medical Center

Inpatient Coder using ICD-9-CM 1/89-4/96

Priority coding of Medicare & Medicaid for DRG reimbursement Quality Assurance analyst: 3/1983-1/1989

Legacy Emanuel Hospital & Medical Center

Quality Assurance Analyst assigned to code internal medicine, pediatrics, burns, and neurology/neurosurgery inpatient records. Inpatient coding using ICD-9-CM codes Priority coding of Medicare and Medicaid inpatient stays. Determined medical necessity based on our internal quality assurance criteria. Utilization reviews on all Medicare and Medicaid inpatient stays.