Jennifer Moore, MHA,AHCCA

Leesburg, FL *****

352-***-****

ad13lr@r.postjobfree.com

CAREER OBJECTIVE

A skilled, passionate, strategic Director of Revenue Enhancement & Cost Containment with diverse experience in organizing and guiding health center services. Seeking a challenging position in a renowned health organization to utilize skills and proficiency.

PROFESSIONAL EXPERIENCE

Aegis Medical Group/ Primary Care Alliance DCE Leesburg, Florida

Director of Revenue Cycle & Risk Adjustment Management Jan 2019 – Present

During the three years employed with Aegis Medical Group I developed a team of IMGs to conduct HCC risk coding chart reviews on patient charts. Expanded this function by creating live attestations for the practicing providers to use during patient encounters. This has helped not only improve HCC coding/ HEDIS gap Closing, but also decrease over coding and increase patient quality. In addition, I developed a billing department to assist in billing, coding, and documentation of MSO affiliate accounts as well as a claims processing department for claims payouts of the DCE.

Successfully established and led a team of International Medical Graduates (IMGs) dedicated to conducting HCC risk coding chart reviews on patient records. To further enhance this initiative, innovatively introduced live attestations for practicing providers to utilize during patient encounters. This strategic move has had a dual impact—it has not only contributed to improvements in HCC coding and HEDIS gap closure but has also played a pivotal role in reducing over coding while simultaneously elevating the quality of patient care.

Spearheaded the creation of a specialized billing department aimed at providing comprehensive support for billing, coding, and documentation related to MSO affiliate accounts. This step ensured accuracy and efficiency in billing processes while maintaining compliance with industry standards.

Championed the establishment of a dedicated claims processing department, specifically designed to handle the payouts of the DCE (Data Collection Entity). This department's role was instrumental in streamlining the claims payout process, contributing to operational efficiency and financial accuracy.

Tenure at Aegis Medical Group was marked by strategic leadership and innovative solutions that significantly improved coding accuracy, patient care quality, and operational efficiency.

Premier Medical Associates The Villages, Florida

Chief of Clinical Operations/ Center Administrator Oct 2004 – Jan 2019

Played a pivotal role in enhancing our operations by establishing and managing an offshore team based in India and Costa Rica. This team specializes in HCC/MRA coding compliance and HEDIS screening, ensuring our practice adheres to the highest standards of healthcare quality.

Spearheaded the introduction of various ancillary services, broadening our range of patient care options. These services include, but are not limited to, ultrasounds, pulmonary function testing, in-office IV treatments, stress testing, and ear lavages.

In a commitment to patients' well-being, led the implementation of hospitalist and rehab rounds, as well as home visits for those in less fortunate circumstances within the ACN (Accountable Care Network) counties. Aimed to provide comprehensive and compassionate care to patients.

Played a role in the development and promotion of in-office physician-owned pharmacy, offering convenience and accessibility to prescription medications.

To enhance the patient experience and prioritize preventive care, introduced Health Risk Assessments (HRA) and Annual Wellness Screeners, seamlessly integrated into our Electronic Medical Records (EMR) system.

EDUCATION

WUERZBURG AMERICAN HIGH SCHOOL Wuerzburg, Germany

2001

INTERNATIONAL BUSINESS COLLEGE Indianapolis, Indiana

Associates of Applied Science

10/2004

AMERICAN INTERCONTINENTAL UNIVERSITY Schaumburg, Illinois

Bachelors in Healthcare Administration

10/2017

AMERICAN INTERCONTINENTAL UNIVERSITY Schaumburg, Illinois

Masters in Healthcare Administration with specialization in geriatrics

11/2021

RISE NATIONAL Florida

AHCCA Certification (Advanced HCC Auditor)

Fall 2021

HIGHLIGHTS

Rise National Speaker 2020- Present

NAACOS Speaker 2019-2020

Risk Adjustment Software Development 2022- Present

SKILLS

Establishing positive and collaborative relationships with health plans.

Coordinating with offshore teams to oversee the review, extraction, and submission of HCC (Hierarchical Condition Category) data.

Creating and maintaining an action plan aimed at improving HEDIS (Healthcare Effectiveness Data and Information Set) scores.

Managing HEDIS projects, including task assignments, adherence monitoring, and quality assurance.

Conducting comprehensive quality audits and maintaining data and process controls to ensure compliance.

Utilizing analytics to identify targeted providers for Medicare Risk Adjustment training.

Reviewing and abstracting medical records from both electronic medical records (EMRs) and paper charts.

Developing and maintaining operations related to an ACO (Accountable Care Organization) preferred network and community consultants to achieve ACO goals.

Understanding referral sources and facilitating communication between sources and in-office clinical teams.

Interacting effectively with a diverse patient population.

Coding and abstracting data using the International Classification of Diseases, Tenth Edition (ICD-10), for CMS (Centers for Medicare & Medicaid Services) risk adjustment purposes.

Demonstrating a comprehensive understanding of CMS risk adjustment guidelines.

Conducting both retrospective and concurrent chart reviews.

Possessing an excellent grasp of medical terminology, disease processes, anatomy, and physiology.

Ensuring that diagnosis codes for each chronic or major medical condition are accurately captured and supported by clinical documentation.

Providing oversight of medical center operations, including purchasing, payroll, budget adherence, and monthly financial review.

Organizing recruitment, hiring, and training of qualified employees.

Developing and delivering diagnosis and coding tools to clinical staff.

Understanding and navigating the complexities of PQRs (Physician Quality Reporting) and MIPS (Merit-based Incentive Payment System).

Excelling in translating information for various audience levels.

Possessing an in-depth knowledge of medical laws and ethics.

Exhibiting exceptional verbal and written communication skills, as well as outstanding organizational and management abilities.

Proficiency in using basic operating systems such as Microsoft Word, Excel, PowerPoint, various EMRs, and internet applications.

Demonstrating expertise in Medicare Risk Adjustment strategies and proficiency in managing Medicare Advantage and Medicaid programs.

Displaying strong leadership qualities, adept at building relationships, making ethical judgments, critical thinking, and adapting to changing circumstances.

Analyzing the costs of different treatment alternatives to enhance productivity.

Developing and nurturing strong relationships with physicians and negotiating contracts effectively.

Handling hospital and physician billing processes.

Resolving patient grievances efficiently.

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