Margaret W., RN, CCDS, CPC

Fort Mill, SC

SUMMARY:

RN: New York

Years of Experience: CDI – 12+ years Clinical – 30+ years

Units/Clinical Strengths: Med/Surg, ICU, SICU, MICU, CVICU, PICU, NICU, Transplant (Heart, Lung, Kidney, Liver, etc.), Orthopedics, Cardiac, Telemetry, Oncology, Neurology, Neurosurgery, Urology, Vascular, Colorectal, Trauma, OB/GYN, ER, Moms/Babies, Critical Care, Psych, Bariatrics

Systems Experience: EPIC, EPIC CDI application, 3M 360, 3M Standalone Grouper, 3M CDIS, Cerner Powerchart, Chartwise, Clintegrity, JA Thomas, Allscripts/Eclipsys, McKesson, CDR2/Claro, Sovera, Meditech, Iodine, Zoom, Skype, & Microsoft Office Products

Environment: Multiple Level I trauma and teaching facilities across the country ranging from 200-1000+ beds

Level One Trauma/Academic facility experience

EXPERIENCE:

October 28, 2022-December 5, 2022

Harmony Healthcare (South Georgia Medical Center/ Valdosta, GA)

Clinical Documentation Specialist

Concurrent Chart review for DRG Optimization-New Admits & Re-reviews

Capture of MCC’s, CC’s, SOI, ROM

Query providers and subsequent follow-up

Covering General Medicine & Surgery, some Medical ICU

Applications used: 3M-360, EPIC, Microsoft Team

Productivity: 8-10 new cases/day, 8-10 re-reviews/day. Query response 90%

March 2022-August 2022

RCM Technologies (Vanderbilt Medical Center/Nashville, Tenn)

Clinical Documentation Specialist (Remote)

Chart review for DRG Optimization-New Admits and Re-reviews

Capturing MCC’s, CC’s SOI/ROM, Vizient Risk Factor

Querying providers & follow-ups

Applications utilized: 3M-360, Epic, Microsoft Team

Covering General Medicine & Surgery

Productivity: 8-10 reviews/day, 5-7 re-reviews, 97% Query response

June 2021 – December 2021

Brundage Group (Prisma Health)

CDI Consultant (Remote)20

Chart review for DRG Optimization-New Admissions, Concurrent reviews, Retrospective reviews

Capturing MCC’s, CC’s SOI/ROM, Risk Adjustment, Targeted diagnoses for Validation

Querying providers & follow-up

Coder interaction regarding DRG Mismatches

Applications utilized: 3M 360, Epic, Microsoft Team

Productivity: 8-10 new admissions, 5-10 concurrent reviews. 100% Query response rate

Jan 2021 – April 2021

AMN Healthcare (Yale New Haven Health System)

CDI Consultant (Remote)

Chart review for DRG Optimization-New Admissions, Concurrent reviews

Capturing MCC’s & CC’s, daily Mismatches, daily Reconciliations

Querying providers & follow-up, responding to coder generated Query request

Applications utilized: 3M 360, Epic, Zoom, Skype

Productivity metrics: 10 new admission, 14-25 concurrent reviews. 95 % Query response rate

Oct 2018 – April 2020

AMN Healthcare (Emory University Hospital)

CDI Consultant (Remote)

Utilizing the following computer applications: Cerner, 3M CDIS

Services specializing in are predominately: General Surgery, Colorectal, Surgical Oncology

Productivity metrics: 15-23 reviews/day, Query rate 17%, Query response rate 85%

Also performing reconciliation and financial impact statements

March 2018 – July 2018

Meleeo (Orlando Regional Medical Center)

CDI Consultant/Second Level Reviewer (Remote)

Consists of Concurrent reviews of 14 staff CDI’s

Based on findings proceed to educate staff CDI’s with both verbal & written recommendations, including missed opportunities, MCC’s/CCs, symptom diagnosis, verifying accurate principal diagnosis

Applications utilizing Sunrise/Allscripts, Sovera, CDR2 (Claro), Clintegrity (JA Thomas)

03/30/18: Certificate for HCPro CDI Competency Assessment

Nov 2017 – Dec 2017

Harmony Health Solutions (Good Samaritan Hospital in OR)

CDI Consultant (Remote)

Feb 2017 – Oct 2017

MedPartners (Rush Medical Center)

CDI Consultant

664 bed Magnet Hospital. Level 1 Trauma Center & Teaching institution

Worked with the following systems. EPIC, 3M 360, Iodine (application for selecting cases with high potential for queries)

Hospital consists of Complex, high acuity cases. Reviewed predominately SICU, MICU, CVICU, Neurology, Neurosurgery cases. 15-20 reviews/day. 12/day was the requirement

Identified PSI’s and made referrals to HIM Director.

Reconciliations & query impact determined and documented every month in 3M 360

Sept 2016 – Dec 2017

Optum (Subsidiary United Healthcare)

Medicare Risk Adjustment Coder

Coding out-patient charts according to Medicare Risk Adjustment criteria

Feb 2016 – Aug 2016

MedPartner (University of Wisconsin and University of Colorado Hospitals)

CDI Specialist

Specialized reviews in area of Transplant (kidney, liver, lung, etc), Ortho/ Neuro service reviews., previous experience w/ Heart Transplant reviews

Achieved 20+ reviews/day,

Utilized EPIC CDI application

Nov 2015 – Dec 2016

MedPartners (Orange Regional Medical Center)

CDI Specialist

Improves coding specificity by educating physicians and clinicians, regarding the necessity of complete and clear documentation of the care provided during the patient’s stay, which includes medical necessity and capturing complications and co-morbidities.

Obtains a timely, accurate and complete documentation of clinical information using hospital-approved query formats and evidence-based practices.

Transitioned to ICD 10 and continues to apply appropriate ICD 9 coding guidelines information to ensure accuracy of codes assigned and to ensure physician and hospital compliance.

Worked remotely, works independently while keeping regular communication with Providers, Medical Coders and CDI team utilizing all resources available i.e. EPIC in-basket messaging, EPIC comment box for clinicians, email, telephone, text messaging and audio conferences.

Nov 2012 – Oct 2015

New York Presbyterian Medical Center (Columbia and Cornell University)

CDI Specialist

Responsible for facilitating improvement of inpatient medical record documentation by Intervening and interacting with, as well as educating physicians, residents, and other licensed independent practitioners.

Responsible for responding to retrospective requests for clinical information required for reimbursement and retrospective denials from third party payers.

Generating queries on initial & concurrent admissions.

Utilizing 3M 360, Allscripts/Eclipsys EMR

March 2009 – Nov 2012

HCA – JFK Medical Center

CDI Specialist

Review Medicare & Blue Cross charts for accurate & specific documentation by Attending Physicians in HCA hospitals (JFK Medical Center, Atlantis,FL)

Assign DRG’s (Diagnosis Related Groups); target co-morbid conditions & ensure proper documentation as per Medicare guidelines; query physicians for more complete documentation

Interface with Medical Records at hospital to discuss discrepancies in co-morbid conditions picked up by nurse & coder to ensure more accurate billing.

Physician Education with regard to Medicare & HCA expectation in area of documentation

Aug 2008 – Dec 2008

Avmed Health Plans

Onsite Case Manager

Performs on site & telephonic concurrent utilization review on all assigned hospitalized members using Milliman criteria: coordinate care & services of selected members; promote continuity of care & member satisfaction.

Jan 2008 – Aug 2008

United Healthcare

Onsite Inpatient Case Manager

Perform case review onsite & analyze clinical information & the patient’s condition to determine the appropriateness of hospitalization

Discharge Planning & refer to Disease Management or Case Management programs

Collaborate w/ appropriate members of health care team to provide continuity & quality of care in a cost effective manner

May 2005 – Jan 2008

Careplus Health Plans

Auditor

Audit physician offices for HCC diagnosis and code appropriately for Medicare submission

Perform exit interviews/teaching of physicians and office staff regarding findings of audits

Summarize results of audit and any recommendations communicated to physician/office staff

Designed “cheat sheet” for hand-out and utilization in office staff training.

Revised written material that is part of training material left with physicians

Peer Review in Quality Management Dept.

Dec 2004 – May 2005

Coordinated Care Solutions

Case Manager

Concurrent Review & determination medical necessity of patients for purposes of authorizing continuation of Home Health Care services

June 2004 – Dec 2004

South Florida Oncology-Hematology

Chemotherapy Nurse

Access peripheral and central lines for administration chemotherapy infusions in MD practice

March 2001 – Feb 2004

Pride Care, Inc. & Comprehensive Home Care Service

Homes Infusion Nurse

Insert peripheral I.V.’s in home-based patients for purposes of medication administration

Port access and central line maintenance

Assessments of patients pre & post infusions

April 1995 – Dec 1999

American Pharmaceutical Services

Field Nurse Representative

Maintenance of Nursing Home accounts (largest in NYC) through servicing and rapport building

Conduct reviews of patients charts to determine whether products meet Medicare Part B criteria

Inventory and order products (enteral, urological, ostomy, wound care and tracheostomy) for N.H. usage

1969 – Present

Various Nursing positions

NY Presbyterian, Registered Nurse (Per Diem)

Coney Island Hospital, Registered Nurse

Kings County Hospital, Registered Nurse

NYU Hospital, Med/Surge Nurse

EDUCATION:

Marymount Manhattan College

Associates: Business Administration: Finance and Economics, Dec 1981

Kings County Hospital Center School of Nursing

Diploma: Nursing, 1969

LICENSES / CERTIFICATIONS:

New York State Registered Nurse (RN) License

ACDIS Certified Clinical Documentation Specialist (CCDS), since 2018

AHIMA Certified Professional Coder (CPC), since 2007

Certificate of Continuing Education (HCPro): CDI Competency Assessment, 2018

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