Information Management Quality
Resume:
**** ***** ***** ******, ***** *****
Objective: Position working in the Business/Health Information Management, directing, planning, guiding, analyzing information, researching, coordinating and implementing both current and new technology to enhance the Compliance, VERA Reconciliations, Coding ICD-10-CM, CPT, ICD-10-PCS, HCPCS, Documentation and coding of clinical care and directing billing for care rendered including collections and payables. Specific areas are in analyzing data, research development, monitoring, mentoring and teaching, program implementation with ongoing evaluation, working with legal counsel and public awareness. More specifically, working in the Business/Revenue Information Management Program enhancing the facility and VERA impact costs and include Community and Rural Care/Patient Administration Programs, Scanning, ROI and Privacy/ HIPAA/ FOIA Fields. Expert in Privacy and HIPAA Compliance as well as Corporate Compliance in Business Operations and Revenue Coordination.
Profile: Experienced HIM, Quality Management, Compliance manager with strong interpersonal skills. Strongly experienced Quality Management, Information Management, Coding (HCPCS, CPT, ICD-10-CM/PCS methodology), Auditing, Medico-legal Issues, State of Texas Medical Practices, Revenue Management, Joint Commission, OIG, Medicare, Medicaid, VERA, Financial and Budgetary Obligations, Contracting and Fund Control management, Image Scanning, Privacy, HIPAA and FOIA Management. In addition, commended for my experience of over 10 years of Quality Management, Risk Management Utilization Review and Utilization Management experience. Respected for ability to analyze problems, interpret data, assess resources, complex and intricate program planning (Financial and Departmental), organize/ present data and the enhancement of community relations. Experienced in Public Speaking, presentations to medical/non-medical personnel and community awareness. Personal qualities include creativity, maturity, and realism, with a systematic, self-reliant, dependable outlook.
PROFESSIONAL EXPERIENCE:
Texas A&M AgriLife Extension Service
Bell County Agent – Better Life for Texans
February 2023 to Present
Serve as a County Agent for Better Life for Texans providing health and nutrition education for all youth and adults that receive or are eligible to receive SNAP benefits. Education seminars and demonstrations are designed and empowered to ensure research and evidence-based nutrition, health and wellness knowledge to empower individuals’ families and communities to make positive changes for healthier lives.
Responsibilities include county wide coordination, planning, directing and implementing programs both developed locally and statewide educational opportunities to improve and promote healthier lifestyles to both children and adult. I have started 10 science classes in Temple, Killeen and Harker Heights ISD. Developed. Implemented and graduated gardening science in 9 elementary schools. Additionally, I have promoted and successfully implemented and taught diabetes, cardiovascular and hypertension education classes in conjunction with Baylor Scott and White, The McLane Foundation and Feed My Sheep.
My achievements are over 300 adult graduates and 250 child graduates in my 6 months tenure.
Supervisory, Medical Record Administrator, HIMS – Business Office Revenue Manager and Privacy Officer – Corporate Compliance
November 2004 through January 31, 2023.
Responsibilities for facility include coordinating and directing, implementing, and guiding the development of the Quality Improvement Plan, Policies, Utilization Review, Utilization Management Competency review, VERA inquires ad oversight, JC Standards for Health Care in Acute, CLC, Outpatient and Residential Treatment facilities at all five sites of the Central Texas Veterans Healthcare System. Responsible for implementation of Staff Development, Customer Service, Information Technology and Financial Resources for the Department. Supervision responsibilities for Release of Information, File Unit, Scanning Unit, Transcription, use and evaluation of CPRS (this includes building templates and assignment of electronic titles and management of the overall electronic medical record), Facility Privacy and FOIA Program Manager, Vera Coordinator, Coding and Processing, Physician Education on documentation and coding, Transcription and Scanning sections of Health Information Management.
Coordination of all components of the Medical Records Committee and the Medical Executive Committee. Member of the Medical Center Board of Ethics as a documentation expert. Relied on heavily for medico-legal issues within the Hospital. Served as representative for Community Nursing Home, Extended Care, Agent Orange
Achievements:
Implemented coding productivity standards recognized as VA best practice, staff have higher standard and accurately than national average.
No coding backlogs
Zero coder staff turnaround
Maintained 98% coding accuracy
Maintained and Enhanced Training on all Provider Audits and Trained 100% of Service Level provider through the HIMS and QM Team
Clinic Policy Manual development and implementation for coding
Quality Management Policy manual development
Staff Development Coordinator for Facility
HIPAA Policy Manual development and implementation for coding
Chair of Medical Record Committee for facility Chief of Staff
Maintained zero backlog in Scanning over 5 days
Sharing agreement coding with other medical center implementation experience
Revenue Committee chair for coding and compliance
Physician and Provider Audits
Detailed Encounter and Coding Trainer used by VISN 17
Excellent coding ICD-10-CM, CPTS, ICD-10-PCS, HCPCS, Medical
Excelled in achievement in both Nuance and 3M Software Encoder and Cerner Needs
Excelled Achievement in VERA and the Provider Productivity Modules
Zero IG or
Responsibilities:
Management of clinical coding staff (25),
Management of Information Staff of 50 excluding coding staff
Joint Commission subject matter expert facility records of care, information management, Patient Rights standards
Insurance Verification and Eligibility
Billing and coding denials – Medicaid, Medicare and Champ VA UR Denials
Coding Accuracy Training
Provider Training
ADPAC duties
Contractor
Privacy and FOIA Responsibilities
Billing and coding accuracy and timeliness.
Extended business office management.
Accounts payable, cost control.
Coding accuracy reporting.
Revenue cycle management.
Clinical provider training and auditing for coding accuracy
Release of Information and Scanning unit management
Community Care Documentation and Oversight
Quality Management
Utilization Review
Utilization Management
Patient Rights
Peer Review
Physician (provider) Credentialling
Humans Resource Initiatives
Utilization Review and Utilization Management
Corporate Compliance and Privacy Office for the VISN
Health Information Manager/Privacy Officer – VA Medical Center
October 1993- March 25, 2004 (promoted)
Privacy and FOIA Program Manager - Responsibilities included coordinating, implementing and guiding the development of the Privacy and FOIA Program to include quarterly Assessments, Improvement Plans, Facility and National Policies, Competency review, JC Ethics and Privacy Standards as well as coordination with the Privacy Services and FOIA Offices with and in the assistance of Central Office. I am Board Certified with the International Privacy Professional both Independent and Governmental Certification. Management responsibilities in the role were to coordinate, implement, direct, audit and maintain the Privacy and FOIA activities for the facility. Maintained close contact with DC Office to ensure releases and released items were within FOIA and/or Privacy Regulation and within the scope of which the information is warranted provided the reason for release or non-release. Ensured both the integrity and the security of both public and private information. This included, individual identity protection and situational as well as those requiring ethical requirements.
Responsibilities were coordinating, implementing and guiding the development of the Quality Improvement Plan, Policies, Competency review, JC Standards for Health Information Management Section at all five sites of the Central Texas Veterans Healthcare System. Responsible for implementation of Staff Development, Customer Service, Information Technology and Financial Resources for the Department. Supervision responsibilities for Release of Information, File Unit, Scanning Unit, Transcription, use and evaluation of CPRS (this includes building templates and assignment of electronic titles and management of the overall electronic medical record), Facility Privacy and FOIA Program Manager, Vera Coordinator, Coding and Processing, Physician Education on documentation and coding, Transcription and Scanning sections of Health Information Management.
Coordination of all components of the Medical Records Committee and the Medical Executive Committee. Member of the Medical Center Board of Ethics as a documentation expert. Relied on heavily for medico-legal issues within the Hospital. Served as representative for Community Nursing Home, Extended Care, Agent Orange and Persian Gulf Registries. Responsible for obtaining criteria, teaching and educating for compliance with regulations. Developed and maintained the Ambulatory Care Data Capture Project (Encounter Forms). Analyzed hard to difficult claims for medical care. Responsible for all MyHealtheVet operations and Privacy Office inquiries.
Tumor Registry - Responsibilities include coordinating, implementing and guiding the development of the Quality Improvement Plan, Policies, Competency review, JCAHO Standards for Cancer Registries as well as coordination with the College of Surgeons and Pathologists. These duties also include abstracting cancer reported cases, follow-up and reporting to the National Data Bank.
Coordination of all components of the Cancer Committee, Tumor Board and the Medical Executive Committee. Member of the Medical Center Board of Ethics as a documentation expert.
Clinic Administrator – Cedar Park VA Medical Center
March 25, 2004 to November 1, 2004 – Clinic Administrator/ Grade GS 9 Step10
Central Texas Veterans Healthcare System, Temple, Texas
Responsibilities included coordinating, implementing and guiding the development of the Quality Improvement Plan, Policies, Competency review, JCAHO Standards, Primary Care rules and Regulations. Responsible for implementation of Staff Development, Customer Service, Information Technology and Financial Resources for the Clinic and recruitment processes for employees. In my duties, responsible for the day-to-day operations of the clinic, as I was the only administrator within a 100-mile radius. Physicians, nurses, x-ray, lab and clerk personnel report to me for assignments and prioritization issues.
Patient Representative – VA Medical Center
November 1, 2004 to November 28, 2004 – Patient Representative/ Grade: GS 9/10
Central Texas Veterans Healthcare System, Temple, Texas
Received patient complaints and compliments. Assisted patients with needs and hospital policy. Attended meetings on Customer Service modules. Provided in-services to clerks. Responsible for understanding and communicating eligibility requirements to patients. Responsible to assist Veterans with all questions, concerns or comments that arose. Assisted in the completion and follow-through for the Veteran and family. Provided follow-through to both the requestor (Veteran) or family and the leadership. Experienced in eligibility determination, documentation and community relations.
Chief, HIMS and Health Services Administrative Officer, Health Services Administration and
Health Information – VA Medical Center
January 1993 to October 1993 – Chief, Health Information Management Section/
Grade: GS 10 Step 3 VA Hospital, Kerrville, Texas
Responsibilities included coordinating, implementing and guiding the development of the HIMS Program, Quality Improvement Plan for HIMS and MAS, Policies, Competency review, JC Standards for Health Information Management Section at all five sites of the Central Texas Veterans Healthcare System. Served as the Medical Care Cost Recovery Facility Manager/Officer and responsible for all legal and third-party billings for the Kerrville facility. Ensured that all coding and billing were done promptly and within prescribed time frames. Served as Interim Chief, MAS for a durational period of my tenure.
Coordination of all components of the Medical Records Committee and the Medical Executive Committee. Member of the Medical Center Board of Ethics as a documentation expert. Relied upon heavily for medico-legal issues within the Hospital. Served as representative for Community Nursing Home, Extended Care, Agent Orange and Persian Gulf Registries. Responsible for obtaining criteria, teaching and educating for compliance with regulations. Developed and maintained the Ambulatory Care Data Capture Project (Encounter Forms). Analyzed difficult claims for medical care.
Chief, Health Information Management Section/Administrative Officer, Medical Service
September 1988 to January 1993 – Chief Health Information Management
Section/Administrative Officer Medical Service/ Grade: GS 9 Step 6
VA Hospital, Marlin, Texas
Responsibilities included coordinating, directing, implementing and activating all administrative responsibilities for the service. Served as facility representative for medico-legal obligations. Performed quality improvement activities for the respective disciplines. Supervised employees: managed this section which provided quantitative and qualitative review of medical records; coding transactions, release and exchange of medical information including insurance reports, statistical reporting, billing, medical transcription, and medical record audits. Served the Professional and Administrative Staff as a resource for medical records and policy and involved in the various committees. Responsible for the gathering of statistical data for the facility AMIS program and responsible for medical record file room activity.
OTHER PROESSIONAL EXPERIENCE
Instructor – Temple College – Legal Aspects of the Medical Office Assistant and Medical Terminology/Coding, ICD-10-CM/PCS and CPT/HCPCS Methodologies
Employment not listed as part-time is full time 40 per week plus. Part-time employment is 10 to 20 hours per month.
Fall Semester 2005 to 2013– Part time instructor both online and on campus–
Temple College – Temple, Texas Pay is confidential as a statement was signed.
Responsibilities include coordinating, implementing and guiding students to learn the basic aspects for Medical Terminology, Privacy and Legal Aspects and Inpatient and Outpatient Coding (ICD-10-CM/PCS and CPT, HCPCS) and Medical Office Assistant for their Certification and future employment in the Healthcare field. Within these realms I mentor these students to ensure their career paths are on target and assist each student in job placement through my work with the community.
Instructor – Temple College – Medical Transcription and
Medico-Legal Aspects
September 1996 to December 2002 – Instructor, Temple College, Part-time.
Responsibilities included coordinating, implementing and guiding students to learn the basic aspects for Medical Transcription and Hospital Legal Policies for their Certification and future employment in the Healthcare field.
Professional Affiliation:
Phi Theta Kappa Alumni
Alpha Phi Theta Gold Light Alumni
Young Business Women’s Society
Outstanding College Students of America
American Insurance Regulation Board, Certified
American Health Information Management Association
National Association for Healthcare Quality
Texas State Teachers Association
American Association of Medical Transcriptionists
Small Business Association
Certified Pharmacy Technicians Association
Education:
University of Phoenix – Phoenix, AZ
Degree: Master of Health Administration, April, 2006
Southwest Texas State University - San Marcos, Texas
Degree: Bachelor of Science, Health Information Management, 1988
Temple College – Temple, Texas
Degree: Associated Applied Science, 1986
Licenses Held:
Registered Health Information Technician, 1986
Registered Health Information Administrator, 1988
Certified Pharmacy Technician, 1989
Certified Professional Healthcare Quality Leader, 1993
Licensed Professional Counselor, 1994
Certified Coding Specialist, 2000
Certified International Privacy Professional, 2008
Career Testing:
Mindscape/Perfect Career
Testing highly in areas of Administrative Support, Management. Tested high in investigation processes.
Awards:
Sterling’s Who’s Who in Business, 1990, 1991, 1992, 1993, 1995, and 1996.
Who’s Who Among American College Students 1986 thru 1992 again 2004 thru 2006
Certified Professional Hospital Quality Review License
Received numerous awards for leadership and public speaking
Woman of the Year Among Young Professionals in Central Texas and Small Business 1996, 1998
Volunteer of the Year, Free Clinic, Falls County, 1991
References:
Available upon request.
Bruce Gordon
Central Texas Veterans Health Care System
Director -Retired
Ph: 254-***-****
Sharon White
Central Texas Veterans Health Care System
Chief Medical Administration Service – Retired
Ph. 254-***-****
Carol Nelson, MSN
Central Texas Veterans Health Care System
Nursing Manager -ICM - Retired
Ph. 978-***-****
Patricia Navarrete
Phoenix VA Health Information Management
Ph: 915-***-****
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