Medical Management

TAMARA DOWNS RHIT, CCS

***** ***** **** *****, **********, MI 48094

586-***-**** (mobile)

QUALIFICATION PROFILE

Highly motivated healthcare coding professional with experience in working with health care disciplines (Physicians, P.A.s, Pharmacists, Respiratory Care Techs, RN’s etc) on documentation requirements. Comprehensive knowledge of medical terminology, anatomy/physiology, pharmacology, disease processes and surgical procedures. Experience applying I/S and S/I criteria, working with Case Management on common goals in documentation requirements.

PROFESSIONAL EXPERIENCE

HIMAGINE SOLUTIONS - Tampa, FL 2012 - 2016

Inpatient Coding Consultant Cedars-Sinai, Kaiser-Permanente and San Joaquin Hospitals in CA

Responsible for accurate coding of professional services (diagnoses, conditions and procedures) from medical record documentation in a hospital setting.

Assigned appropriate MSDRG for inpatient accounts working with other health care disciplines (Physicians, P.A.s, Case Coordinators).

Assigned complex ICD-9-CM, ICD-10-CM, PCS codes, POA and PSI indicators, surgical complications, and CPT codes.

Followed up on complex coding of medical records as a result of internal or external reviews which identified Coding or DRG discrepancies.

BEAUMONT HOSPITAL - Troy, MI 2005 - 2012

Clinical Documentation Specialist

Worked with clinical disciplines to ensure efficiency and consistency in clinical documentation. Provided education and organized documentation improvement efforts to physician's/clinical staff.

Took the lead in attending Keystone rounds on ICU, CCU and SICU floors mentoring other Documentation Specialists in the patient safety initiative.

Coordinated, educated and reviewed retrospective records with Family Practice residents addressing documentation issues.

CARNEGIE SCHOOL OF ALLIED HEALTH TECHNOLOGY - Troy, MI 1996 - 2005

Instructor for Medical Assistant and Medical Billing curriculums

Developed all new course materials for each class.

Courses included ICD-9-CM and CPT coding systems, Medical Terminology, and three medical billing software applications.

Created appropriate teaching and learning strategies to communicate subject matter to students.

Encourage the development of communication skills and higher order thinking skills through appropriate assignments.

ST. JOSEPH MERCY HOSPITAL / HENRY FORD HOSPITAL - Clinton Twp., MI 1991 - 2003

Coding Specialist II 1997 - 2003

Acted as clinical reimbursement specialist independently initiated revenue cycle projects to improve reimbursement for the hospital via analysis of case mix, DRG, revenue, and other financial reports.

Recommended changes in documentation practice to improve coding and data management and to assure optional reimbursement, focusing on DRG pairing.

Conducted one-on-one and small group education to Physicians, Case Managers and Coders regarding reimbursement opportunities, new regulations, and new projects.

Worked with Patient Financial Office and Project Management teams to assure maximum efficiency and reimbursement for properly documented services, in both hospital inpatient and outpatient settings.

Independently created forms and tools for the physician, Case Managers and coders to use to enhance documentation and reimbursement.

Presented to Senior Management and Revenue Cycle teams, and many clinical areas in regard to financial data and DRG/APC opportunities.

Conducted inpatient and outpatient chart audits to insure compliance with coding and documentation guidelines and government requirements.

Submitted written reports to Director with results of audits. Provided education to coders and physicians resulting from monthly quality documentation and coding reviews.

Inpatient/Outpatient Coder 1991 - 1997

Coded inpatient, outpatient, E.R. and off-site psychology records.

Trained and audited new employee inpatient, outpatient coding and abstracting by conducting ongoing pre-billing reviews.

Key member of a clinical documentation management program targeting DRG pairs.

UNITED AUDIT SYSTEMS, INC., - Cincinnati, OH 1998 - 2001

Coding Consultant

Provided coding services to over 10 different clients nationally, which included hospital and ambulatory surgery center cases.

Conducted internal quality control audits of coding staff, providing results and education resulting from the audits.

MIDWESTERN AUDIT SERVICES, INC., - Troy, MI 1996 - 1998

Reimbursement Consultant

Conducted ongoing DRG audits with three local hospital facilities and consulted coding staff with coding discrepancies, DRG optimization and coding quality/accuracy.

Performed CPT audits on a quarterly basis (300 charts per quarter) with consulting feedback regarding CPT coding and proper ASC billing methods.

EMR Software Experience includes: EPIC, MIDAS, Cerner and multiple abstracting systems.

EDUCATION

Associate of Science, Health Information Management Ferris State University, Big Rapids, MI 1990

Certified Coding Specialist AHIMA 1996 - Present

References, available upon request

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