Josianne Occidasse

Miami, FL 305-***-****

ad2hc3@r.postjobfree.com https://www.linkedin.com/in/josianne-occidasse-mba-cpc-crc-372b0b203/

DIRECTOR OF CODING AND RISK ADJUSTMENT

MSO AND VENDOR ENVIRONMENT HEALTH INSURANCE RISK ADJUSTMENT

Summary of Qualifications

Diversified, Scrupulous Medical Coding and Auditing Manager with 14+ successful years performing expert medical coding, medical billing, Auditing and risk adjustments in clinical settings throughout the managed care industry

Forward-Thinking, Perceptive Liaison who leverages influential client management skills to build long-term relationships across providers and partners, securing their trust through honest and ongoing support

Cross-Functional, Systematic Leader who loves balancing priorities across departments according to ever-changing guidelines, embracing the challenge of continually updating tactics with confidence and grace

Engaged, Collaborative Employee Champion who communicates, shares wisdom, and learns from others as frequently as possible, becoming a true resource and advocate for individual and company growth

Key Achievements

Upholds quality staffing levels by consistently recruiting, selecting, and training up to eight new coders annually; joined forces with director and manager to present HR with a well-researched proposal, raising coder pay to a fair wage and thus further amplifying retention.

Introduces annual coding proficiency test to better identify strengths and weaknesses of coders, yielding more applicable trainings that truly reflect areas for improvement and decrease error rate by 30%.

Reviews 100+ claims monthly for the Agency for Health Care Administration, coordinating with medical director to verify proper diagnoses and billing along with passing all inspections to date.

Areas of Expertise

Medical Coding: Auditing CMS Compliance Risk Adjustment Data Validation Audits HEDIS Stars Trend Analysis CDI Project Management Budget Management Goal Setting Program Infrastructure Corrective Action

Methodologies: ICD-9 ICD-10 Current Procedural Terminology (CPT) Healthcare Common Procedure Coding System (HCPCS) Hierarchical Condition Category (HCC) Risk Adjustment Factor LCD NCD

Technical: ECW EPIC IMO Medisoft Network Professional Practice Fusion Care 360 Practice Management Lucidchart Watson Analytics Microsoft Windows

Women’s Healthcare Executive Network of South Florida (WHEN) – Treasury Chair Elect (January 2020)

Fluent in Haitian Creole

Professional Experience

Sanitas Medical Center, USA Miami, FL

National Risk Auditor Manager February 2022 – Present

Manage 10+ on-site and off-site certified auditors, serving as a liaison across coding, clinical Documentation Improvement (CDI), Healthcare Effectiveness Data and Information Set (HEDIS), revenue, compliance, upper management, systems, ambulatory, Resolute Professional Billing, and

Health Information Management departments. Carries out strategies and plans to yield ideal physician output. Guarantees coders are up to date on industry changes, compliance, and new codes through studying and disseminating insights from American Medical Association coding quarterly, health plan data, and CPT and ICD-10 annual releases.

Establishes multiple educational options to best disperse information across clinics, including company-wide live sessions, site-specific classes adapted for certain needs or language barriers, and individual meetings

Defines standardized workflows, including a three-day lag clarification period, for timely and accurate recording of revenue – adjusts KPIs and processes to best suit each center

Maintains meticulous eye over direct work and weekly corrections to understand resubmission rates, resolve challenges, and close knowledge gaps

Spearheads complex transition from capitation to fee-for-service for multi-specialty physician group, assisting revenue center through connecting with providers regarding local and national coverage determination

Assesses claim denials and rejections pertaining to coding, identifying opportunities and developing action plan for similar future prevention

Leon Medical Centers Miami, FL

Clinical Coding Manager May 2017 – February 2022

Promoted to manage 30+ on-site and off-site certified coders and a Medical Risk Adjustment (MRA) team, serving as a liaison across revenue, compliance, upper management, systems, ambulatory, Resolute Professional Billing, and

Health Information Management departments. Carries out strategies and plans to yield ideal physician output. Guarantees coders are up to date on industry changes, compliance, and new codes through studying and disseminating insights from American Medical Association coding quarterly, health plan data, and CPT and ICD-10 annual releases.

Establishes multiple educational options to best disperse information across clinics, including company-wide live sessions, site-specific classes adapted for certain needs or language barriers, and individual meetings

Defines standardized workflows, including a three-day lag clarification period, for timely and accurate recording of revenue – adjusts KPIs and processes to best suit each center

Maintains meticulous eye over direct work and weekly corrections to understand resubmission rates, resolve challenges, and close knowledge gaps

Spearheads complex transition from capitation to fee-for-service for multi-specialty physician group, assisting revenue center through connecting with providers regarding local and national coverage determination

Assesses claim denials and rejections pertaining to coding, identifying opportunities and developing action plan for similar future prevention

Medicare Risk Adjustment Auditor March 2016 – May 2017

Trained 52 providers and coders (in-house and off-site) on importance of properly documenting charts and codes; audited reports for compliance, precision, and transparency and gave feedback and solutions to superiors for approval.

Facilitated error refinement regarding most common coding mistakes through abstracting submitted data and comparing it to provider documentation, partnering with Emergency Medical Records to validate charts

Audited provider documentation and reports to certify assessment, diagnosis, and treatment plans are present, clear, concise, and aligned

Suncoast Medical Network, Inc. Miami, FL

Manager of Provider Relations June 2014 – February 2016

Guided providers in understanding monthly outcomes, updating them on statuses and overall financial wellbeing. Directed 10-15 on and off-site coders in daily operations and confirmed on-time billing and submissions; also prioritized team value and improvement, holding daily and quarterly reviews to garner feedback and extend continuous support.

Recruited to serve in contracting and credentialing role, overseeing 25 provider accounts from Monroe to Palm Beach County as well as their MRA scores, HEDIS gaps, and memberships

Promoted various program options such as the Medicare Advantage Program (full risk or partial risk) to providers, tailoring selection with oversite from CEO based on patient population, desires, and risks

Gomez Medical Billing, Inc. Miami, FL

Medical Billing and Coding Specialist June 2008 – June 2014

Interacted with managers, office staff, patients, and insurance companies via email or phone to collect copays, deductibles, and billings, employing friendly and persuasive approach to quickly close out accounts and move them out of the queue. Completed payment data entry and account adjustments for patients.

Executed collections of Medicare, Medicaid, commercial, worker's compensation, and motor vehicle insurance payments on an impressive level, earning recognition for having lowest outstanding total of accounts receivable and securing all within a 30-day range

Evaluated provider Progress Notes and submitted CMS-1500 (HCFA) Form claims for 10 accounts ranging from $500K in annual billing to over $2M

Licenses/Certifications

Certified Coding Specialist (CCS) AHIMA In process

Home Health Coding Associate Certification AHCC August 2017

Lean Sig Sigma (Yellow and Green Belt) May 2017

National Institutes of Health (NIH) Certificate May 2017

National Alliance of Medical Auditing Specialist (NAMAS) April 2016

Certified Professional Coder (CPC) American Academy of Professional Coders (AAPC) August 2015

Certified Risk Adjustment Coder (CRC) American Academy of Professional Coders (AAPC) August 2015

Certified Medical Professional Auditor(CPMA) American Academy of Professional Coders (AAPC) October 2023

Education

Master of Business Administration in Healthcare (HCMBA) May 2017

Florida International University Miami, FL

Bachelor of Science in Supervision and Management Associate of Business Administration December 2015

Miami Dade College Miami, FL

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