ad4hr9@r.postjobfree.com

347-***-****

Skills

Revenue Cycle

HEDIS Chart Reviews

ICD-9-CM & ICD-10- CM

CPT Coding

Risk Adjustment Coding

HCC Coding

DRG Reviews

Policy updates

Data analysis

JCAHO

Auditing

RADV Audits

Compliance reviews

Investigative reporting

Advance Clinical Documentation

CDI Best Practices

Clinical Data Management

NLP Technology enhancing CDS efficiency

EMR systems

Allscripts

Apixio

Care360

Cerner

DrChrono

E-Clinical Works

EPIC

NextGen

Point Click Care

Practice Fusion

Sigma

Tableau

3M Health Information Systems

Microsoft Office

Education And Training

11/2022 - 04/2023

CPC Training

AAPC

04/2021 - Present

Bachelor of Science:

Nursing

West Coast University, Miami Campus

Miami Beach, FL

09/2008 -06/2009

New York City Board of Education (NYCBOE)

Med-surg, Cardiology, Quality, HEDIS, Medical Documentation & Coding)

09/2009

Licensed Practical Nurse:

Nursing

New York City Board of Education (NYCBOE)

New York, NY

01/1998

Samuel J. Tilden H.S.

Diploma

Certifications:

02/2002

American Career Training Center:

ICD-9CM Diagnosis Coding

CPT, HCPCS Coding

09/2015

AHIMA & AAPC

ICD-10CM/ Diagnosis Coding

CPT, HCPCS Coding

Languages

English:

Full Professional

French-Patois :

Professional

DEBRA C. FLEMING

Summary

Highly experienced Nurse, skilled in administrative and clinical functions of Med-Surg, Cardiology, and Medical Compliance. Accomplished in HEDIS chart review, AHIMA ICD-10 Educational Program, AAPC ICD-10 CM Fundamentals, & NYHIMA, MAHIMA, ACDIS-CDI best practices. Strategic creative planning for staff development. Outstanding, long standing conflict resolution management. Instrumental in Hospital Corporations, Medical Groups, and Insurance Providers financial gain, pre/post auditing, and incentives. Patient & Medical Equipment Safety. Consistent practice of professional, clear, and concise communication with all levels of leadership, medical staff, and non-clinical employees. In addition, I am willing to perform other related duties, as assigned, which may not be specifically cited in my job description

Experience

Maxim Staffing & Cynet Health

United States, Travel Nursing – Emergency Room, Rehabilitation & Nursing

11/2023 – Present

Accurately assessing patient care needs in a diverse population

Initiating Triage and assist with discharge

Chaperone Physician during patient examinations

Report changes in patients’ conditions routinely, and when requiring

immediate attention

IV line placement & intravenous therapy

Urinalysis & culture and sensitivity testing

Ventilation and Oxygen Therapy administration

Tracheotomy Care; Nasopharyngeal and Oral Suctioning

Phlebotomy

Wound & Burn care

Administer PPD test, Flu vaccines, Immunizations

Documentation in EMR system

Orientate new staff in areas of patient care, medical practices, and

Procedures

Horizon Blue Cross Blue Shield of New Jersey- Professional Senior Coder

Newark, New Jersey – Remote Contract

6/2022 – 11/2023

Develop Chart Review & Audit workflow within the RADV Response leadership team

Training staff based on RADV & HEDIS best practice coding guidelines

Expertise in ICD-9-CM/ICD-10-CM coding guidelines, and AHA Coding Clinic

Accurate audits and overreads using both clinical and coding knowledge along with speed

Training and advising healthcare professionals and administrative staff on HEDIS compliance.

Applying hierarchical ranking associated with CMS defined HCCs, as well as the ability to navigate between different projects that are in place for HEDIS audit initiatives

Exceptionally knowledgeable of healthcare provider-specific regulations and policies related to documentation and coding

Technically savvy to interact and troubleshoot a wide range of computer-based applications

Exceedingly capable to work independently and collectively to accomplish projects within the allocated time to achieve excellent results.

Reviewing medical records and documentation to extract abstract, clinical data for HEDIS reporting

Meeting daily abstraction goals and maintaining a high abstraction accuracy percentage

Snap Nurse – LPN Travel Nurse

The Carillon Assisted Living - Boulder, Colorado

02/2022 – 06/2022

Modernize care team practices according to nursing standards, local, state, and federal guidelines, and organizational policy

Screening future applicant screening during hiring process

Orientate new staff in areas of patient care, medical practices, and procedures

Yearly performance evaluations, employee improvement/corrective action plans, development training

Revamping & implementing proper shift hand-off and reporting

Assessment of patients upon admission, and assist with discharge planning

Accurately dispensing of medicines via oral, GT, and NGT routes

Report changes in patients’ conditions routinely, and when requiring immediate attention

COVID-19 testing 150 residents 3x weekly

Urinalysis & culture and sensitivity collection

Ventilation and Oxygen Therapy, and Care

Tracheotomy Care; Nasopharyngeal and Oral Suctioning

Intravenous Therapy

Phlebotomy

Wound & Burn care

Administer PPD test, Flu vaccines, Immunizations, & Finger sticks levels

Manual & Mechanical Vital Signs

EMR charting

West Boca Medical Center LPN Med-Surg/Telemetry & LPN Quality PI Supervisor

Boca Raton, FL (Remote)

07/2021 – 02/2022

Quality Improvement Patient Safety Meeting with CEO, COO, Physicians, and Department Directors reporting Quality metrics and analytics

Risk Adjustment audits/RAF scoring prioritizing and linking HCC diagnosis

Inspection of both clinical, non-clinical work areas and medical equipment according to Joint Commission standards and accreditation process

Evaluating nursing proficiencies, identifying, and targeting areas for improvement.

Endorsing & Developing improvement plans to meet data analysis target benchmarks

Negotiating contracts with leading clientele, encompassing industry-leading organizations and multitude of projects.

Determining medical necessity and cost-effectiveness of services through utilization review processes

Consulting with local and state health departments to report infectious cases.

Fulfilling the CDC and OSHA driven infection prevention and control policies to guide hospital departments

HHC-Bellevue Hospital - Assistant Director of Medical Records-

LPN Clinical Documentation Specialist

New York, NY

06/2014 - 06/2021

Reviewed charts ensuring highest level of accuracy.

Ensured primary & secondary diagnosis codes support and meets specificities of patient’s condition.

Educate and guide physicians & staff with approved documentation. risk adjustment documentation standards and coding guidelines.

Queried providers regarding missing, unclear, or conflicting health record documentation.

Supervise Medical Coders & DRG validators workflow and provide guidance throughout billing process.

Applying knowledge of medical terminology and procedures to evaluate clinical documents.

Collecting medical information from healthcare providers and updating medical records.

Monitoring diagnoses, treatments, and follow-up entries in medical records.

Interpreting and preparing clinical reports for healthcare professionals and public health officials.

Meeting with healthcare stakeholders to explain findings and facilitate actions.

Verifying the accuracy of patient medical information and obtaining missing information.

Ensuring that the content and storage of medical documents comply with federal laws.

Training medical and administrative staff in standard medical recordkeeping procedures.

Keeping abreast of advancements in the field of clinical documentation and changes in regulations

Advantage Care Physician – LPN Care Team Supervisor

Brooklyn, New York

09/2012 – 06/2014

Ensures nursing practices of the care team as well as own practices are in accordance with nursing standards, local, state, and federal guidelines, and organizational policy.

Assists with applicant screening, selection, training, providing feedback for performance evaluations, and providing information related to employee discipline and termination of staff.

Provides general nursing care to patients, including administering prescribed medications and treatments in accordance with nursing standards and per orders; planning, articulating, and coordinating care and interventions; maintaining consideration for specific age-related characteristics, needs related physical development, communication, and socialization and safety, in collaboration with other members of the care team.

Directs and manages daily huddles. Prepares and manages materials and deliverables. Reviews patient charts for missing labs, reports, and/or open orders and reviews as part of care team huddles. In coordination with the Manager, Nursing and Practice Administrator, manages and inventories clinical supplies.

Prepares equipment and aids physicians during treatment, examination, and testing of patients. Verifies chief complaint and takes vital signs as requested. Reviews the Electronic Health Record (EHR) active medication list with patients. Conducts and document point-of-care tests based on protocol. Administers medications as directed by provider.

Identifies patients who may need point-of-care testing as well as patients with special needs (i.e., transportation). Coordinates outpatient work-up and or treatment plans when patient situation requires it (i.e., further clinical testing, x-rays, and facilitates communication between physicians and health care providers). Pends tests and procedure orders for physician approval and co-signature. Prepares prescriptions or medication refills, for review and signature by provider.

Contacts patients with test results and provides recommendations on cases per physician determination and/or standards of care. Adds recommendations to individualized care plan(s) and reviews After Visit Summary (AVS) with patient. Facilitates clinical messages and chronic condition management education to patients.

Triages urgent same day or double-booked appointment requests.

Documents progress notes in electronic health record within 24 hours.

Manages in-basket requests and responds to all requests in a timely manner. Will serve as a clinical liaison between the call center and medical office.

Performs other job-related duties as required including participation in nursing practice work groups and committees.

Emblem Health Care-

Quality Specialist/HEDIS Chart Reviewer (Contract)

Melville, New York

2012-2014

Reviewed appeal files to update administration data.

Conducted field visits to hospitals and physicians’ offices to extract medical documentation.

Engaged in outreach implementation strategies to help increase HEDIS scores.

Relied on knowledge of legal, regulatory, and policy compliance issues related to HEDIS/QARR.

Abstracted and evaluated data from patient chart based on HEDIS measures requirements.

Accomplishments

Year 2020-High Priority Medical Groups awarded 5-star ratings with CMS in Medication Adherence and Diabetes Measures

Consistently surpassed benchmark targets quarterly and yearly.

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