Medical Project

Name : Dr. Usha Kommineni, MBBS, CPC, HITECH, CEMP

Phone : 913-***-**** (Cell)

E-mail : *************@*****.***

Summary

Has 15 years of strong HIT/HIM Clinical practice management experience in a combination of Inpatient and outpatient coding, auditing, billing and reimbursement processes. Work directly with the medical, clinical, and other administrative staff to ensure health information is properly governed and in accordance with The Joint Commission and state requirements. Provide organizational integrity and compliance guidance on internal and external audit results.

Education

CEMP, Certified EMR Management Professional, HIT, USA 2013

HITECH, Health Information Management Redesign Specialist, JCCC, USA 2011

Medical Coding Certificate, JCCC, USA 2005

MBBS (Bachelor of Medicine, Bachelor of Surgery), Medical Council of Karnataka,

India 2003

Certifications

Certificate of Clinical Documentation Improvement from AAPC

Certificate of ICD-10 –CM Proficiency from AAPC

Certificate of ICD-09 –CM Proficiency from AAPC

Certified Professional Coder (CPC) from AAPC

Certified EMR Management Professional (CEMP) from HIT

Skills and Knowledge

ICD-9-CM/ICD-10 CM, CMS and CPT code set.

3M/Cerner/Epic EMR

Edifecs

ICD-Data Tool

MS Office (Word, Excel, PowerPoint, Visio and Project)

TFS (MS Visual Studio Team Foundation Server)

SharePoint

Core competencies

Perform complex system analysis, design, integration, testing, implementation, maintenance and planning of assigned applications and/or projects.

Have strong knowledge in all facets of medical coding and medical terminology.

Have keen Customer centric approach with skills in addressing client priorities and resolving escalations.

Monitoring overall functioning of processes, identifying improvement areas and implementing adequate measures to maximize customer satisfaction level; deploying / implementing quality tools, managing processes and risks.

Ensuring the smooth transition from current to future business operations; transforming necessary processes, tools and environment from the “present” state to the agreed “future” state.

Experience in Medicare and Medicaid coverage guidelines.

Familiarity with HIPAA 4010/5010 regulations, alpha and numeric filing systems, and HIM.

Achievements

Received NTT DATA, Inc. “Best Employee performance” recognition in 2014

Honored by Executive Healthcare: Who’s Who Covington, 2013

Served as a General Secretary professional coder’s AAPC local chapter, 2011 Overland Park, KS

Professional Experience

1.COOK CHILDRENS HEALTH SYSTEM April 2016 – Till date

Title : Director

Role : Director of Provider coding network

Client : Cook Children’s Health system

Department : Cook Children’s Provider Network

Responsible for establishing policies and implementing changes, coordinating with other Executives.

Dealing with physicians, reviewing departmental procedures, and evaluating the effectiveness of E/M coding.

Coordinating with other hospital departments and adhering to current coding practices.

Collaborates with Division/Team leadership to understand external market financial, economic, and industry data, identifying market opportunities and threats.

Provides leadership and actively contributes to the design and implementation of program goals and objectives.

Establishes clear performance standards and ensures that cost effectiveness and continuous quality improvement forms the basis for all activities.

Formulates recommendations for continuous improvement, taking into account market demands, regulatory standards, and changes in clinical practice.

Contributes to the development of and implementation of processes to collect clinical and financial data focused on cost and quality.

2. NTT DATA March 2013 – April 2016

Title : Principal consultant

Role : Project Manager

Client : Commonwealth of Kentucky (KY State)

Department : Office of Administrative & Technology Services (OATS) / Cabinet for

Health and Family Services (CHFS)

Projects : ICD-9 to ICD-10 conversion (federal mandate), Medicaid Policies, and

Partner Portal

Responsible for supporting and managing all phases of project from planning through execution.

Developing and implementing contingency / business continuity plans to ensure uninterrupted and smooth business operations and attainment of budgeted objectives; implementing policies & procedures and developing documentation for the process

I have implemented ICD-10 project successfully and it was a smooth transition.

I have experience in managing large group of people.

Responsible for monitoring project deliverables and progress through continuous communication with project members.

Responsible for pushing projects forward despite obstacles.

Responsible to ensure that work assignments are complete promptly and efficiently, within budget.

Responsible for managing resources, and Serves as liaison between team members and functional area management requesting project.

Prepares reports on project progress and problems.

Prepare Work Breakdown and Scheduling.

Responsible for managing ‘Work Requests’/CRS/DCR.

Took ownership of decisions and actions that advance objectives.

Recognize co-workers for a job well done.

Seek feedback from stakeholders to help improve performance.

Facilitate JAD sessions, and proof of concept seminars.

Obtains sign-off on requirements from core SME team and stakeholders.

Coordinate UAT testing and Production Implementation.

Track Issue and Bugs.

Support process improvement efforts.

Provide monthly reports to all stakeholders.

Conducted post project analysis what went well, what went poor, and what can be

Improved.

Partner with the other project team members and stakeholders and seek the 'Win-

Win' situation to achieve goals.

3. Computer Science Corporation (CSC) Jan 2012– March 2013

Title : Consultant

Role : Sr. Business Analyst

Client : State of North Carolina

Projects : ICD-9 to ICD-10 conversion fedaral mandate

Support development of a complete inventory of ICD-9 codes of benefit services groupings, pricing manual and other areas as assigned.

Serve as a reviewer and support resource.

Support and reviewed, with other mapping team members, the development of an inventory of ICD-9 codes to their corresponding ICD-10 codes for codes not mapped to Purpose Built Maps developed in prior phases of work.

Participated in Mapping Work Sessions as required and directed.

Provide coding recommendations where required, and produced and revised maps in a structured and deliverable format.

Mapped codes from ICD-9 to ICD-10 as assigned using the Edifecs Code Management product

Facilitate peer review.

Review of content placed in the Master Index

Participated in mapping strategy development

Develop a complete inventory of ICD-9 codes of client business rules, edits and audits, benefit services groupings and other areas as assigned.

Primary resource in the mapping of codes from ICD-9 to ICD-10 as assigned

Primary resource for remediate ICD-9 code containing documents to ICD-10 as assigned

Participate in Mapping and Remediation Work Sessions as required and directed. In this role I will provide coding recommendations where required, capture group discussion and decisions and produce revised, version controlled maps in a structured and deliverable format.

Capture clear and concise mapping findings and work products into client deliverable format.

Scenario and case development for validation (as needed).

Data gathering for validation purposes using the available tools.

Validate case execution for assigned cases.

Discrepancy identification, reporting and re-validation of map changes

Status reporting of validation results.

Analysis to support the testing strategy development for the ICD-10 Remediation phase.

4. Accounting Principals June 2009 – Jan 2012

Title : Consultant

Role : EMR implementation Consultant

Client : Kaiser Health Insurance

Projects : EPIC/ICD-9 implementation

Document current and future process improvement workflows and M&P.

Responsible for ensuring that the bills and codes are accurately prepared and are free from any kind of discrepancies.

Handle the tasks of identifying billable claims, correcting and submitting insurance claims.

Responsible for posting payable bills and adjustments in billing databases.

Perform the tasks of creating, organizing, updating and maintaining accounts on data spreadsheets by using medical billing software (Lytec).

Document "collection policies and procedures", and "follow-up actions" for delinquent accounts.

5.CBIZ, Kansas Nov 2007- May 2009

Title : Sr. Claims Analyst

Role : Medical Coding/Billing and Claims Analyst

Client : Shawnee Mission Medical Center and Medical Park Hospital

Anesthesiology, Emergency Medicine, and diagnostic and Treatment Coding and billing using ICD-9-CM and CPT.

Medicare, Medicaid, and other Health care claims.

CCI editing (Work Suspended, Denied and Rejected Claims).

Review Physician documentation for coding accuracy and compliance.

Performs workflow analyses and recommends process changes to enhance departmental charge capture.

Analyze clinical status of patient, current treatment plan and past medical history and identifies potential gaps in physician documentation.

Communicates to departmental and Medical Center associates any necessary charge related process changes and corrections that are identified.

Attend Medical Center in-services related to documentation or charging procedures as directed by Corporate Responsibility Officer.

Keep up to date on all coding updates and changes.

Communicate audit knowledge and expertise by participating in Medical Center in-services, councils, and other departmental or Medical Center staff meetings as directed by Corporate Responsibility Officer.

Coordinate and assist departments with resolving their charges that are a “Candidate for billing” on a daily basis.

6.Saint-Luke’s South Hospital, Kansas Feb’2005 – Oct’2007

Title : Claims Analyst

Role : Medical Coding/Billing and Claims Analyst

Diagnostic and Treatment Coding using ICD-9-CM and CPT.

Review physician documentation for coding accuracy and compliance.

Validate coding, identify physician documentation gaps, and quantify and Qualify results in regards to compliance.

Medicare and other Health care claims.

Medicare Direct Data Entry (DDE).

Working Suspended, Denied and Rejected Claims.

Perform eligibility verification, bill secondary payers, and appeal denied claims.

Review medical record and billing documentation for coding accuracy and

Compliance.

Runs daily Charge Entry Batch Report.

Communicates to departmental and Medical Center associates any necessary charge related process changes and corrections that are identified.

Develop recommendations for charging changes based on chart and charge discrepancies.

Attend Medical Center in-services related to documentation or charging procedures as directed by Corporate Responsibility Officer.

Communicate audit knowledge and expertise by participating in Medical Center in- services, councils, and other departmental or Medical Center staff meetings as

Directed by Corporate Responsibility Officer.

Auditing the patient’s account.

7.Ashok Nursing home, Bangalore, India Jul’2003 – Dec’2004

Primary care Physician

Diagnosis and non-surgical treatment of common illnesses and medical conditions.

Transcribed preoperative history and physical, consultation, transfer and discharge summaries. Transcribed predominantly multispecialty operative reports.

Interviewing the patient to collect information on the present symptoms, prior medical history and other health details, followed by a physical examination.

Supervising patients about rehabilitative therapy.

Carry out planned patient care programs.

8.KC General Hospital, Bangalore, India Aug’2002 – Mar’2003

House Surgency / Internship

Diagnosis and non-surgical treatment of common illnesses and medical conditions

Interviewing the patient to collect information on the present symptoms, prior medical history and other health details, followed by a physical examination.

Transcribed preoperative history and physical, consultation, transfer and discharge summaries. Transcribed predominantly multispecialty operative reports.

Supervising patients about rehabilitative therapy.

Carry out planned patient care programs.

Training

Software/Tools

Year

University/ school

Microsoft Team Foundation Server 2013 (TFS, Defect and Change control management system)

2015

Commonwealth of Kentucky (KY State)

Certificate of Clinical Documentation Improvement Training

2014

AAPC

PMP Training

2014

EXIGENT

Certificate of ICD-10 Proficiency

2013

AAPC

Certified EMR Management Professional

2013

HIT

HITECH

2011

JCCC

Clinical Documentation Improvement in Preparation for ICD-10

2011

AHIMA

ICD-9 to ICD-10 conversion

2011

AAPC

HL7, DICOM, PACS

2009

Spectra Mind Solutions

Software testing in practice / Quality Center

2007

MetaPro

CPC- Certified Professional Coder

2006

AAPC

Certificate in Medical Transcription

2003

LVSSI

Contact this candidate