Clinical Documentation Medical Records

Debra L Brown

**** ********** ***** ● Oklahoma City, OK ● 405-***-**** ● *************@*****.***

CLINICAL DOCUMENTATION and DENIALS AND APPEALS SPECIALIST

Highly self-motivated and goal-driven professional expert in Clinical Documentation and Denials and appeals with over 13 years of experience providing full-range of supervision, day-to-day operations, global HR practices and clerical expertise to several corporate clients for organizational efficiency and productivity improvements. Detail-oriented, analytical, and methodical with insightful creative thinking to plan and execute medical records and physician documentations within legal bounds and assigned resources even under stressful work conditions. Strong leadership, people management, and interpersonal communication skills that inspire customer confidence, and boost effective teamwork synergies with colleagues across diverse functional teams and ethnicities in achieving shared commitments.

KEY STRENGTHS

Denials and Appeals ● Commercial Insurance Appeals

Operations & Supervision ● Customer Service ● Clinical Documentation ● Problem Solving

Client Relationship Building ● Patient Care ● Communication ● Office Management ● Strategic Planning & Analysis

PROFESSIONAL EXPERIENCE

NORMAN REGIONAL HEALTH SYSTEM, Norman, Oklahoma, 2002-current

Clinical documentation specialist – Denials and Appeals – Utilization Review 2011-2024

Dynamically work with commercial insurance and Medicare denials and appeals. Participated in planning, budgeting, human resource, and scheduling activities. Contributed to a cooperative operational connection with members of the CDI team, physicians, HIM, and other healthcare team members. Evaluated educational needs for ICD-10 documentation needs by specialty. Examined medical treatments and interventions to avoid payment denial and optimizing reimbursements by assessing the treatment’s appropriateness, effectiveness, timing and setting in a PRN position.

Accountable for denials and appeals of the clinical documentation to maintain accuracy in the medical record, as well as reviewed medical records for accuracy and complete physician documentation that appropriately supports the severity of patient illness, mortality statistics and proper reimbursement.

Productively coordinated and focused on education related to International Classification of Disease 9 and 10 and query process for physicians and mid-level providers, played a role of mediator between CDI department and the provider to address problems, issues or concerns as it relates to accurate documentation and answering queries.

Skillfully created an environment which fosters the enhancement of communication within the medical record and to support the hospitals overall compliance efforts designed to assure the accuracy of diagnosis coding, procedural coding, DRG assignments and reflect accurate case mix index.

House Supervisor/Intake Coordinator 2009-2011

Effectively supervised and directed staffing activities throughout the hospital, as well as retained administrative endurance within the hospital in the absence of administrative staff.

Proficiently coordinated bed assignments with physicians and staff; after hours emergency surgeries with ER, admitting physicians, and on-call surgery staff.

Reviewed charts for DRG denials while I was an intake coordinator. Appealed DRG’s when appropriate with ICD-9 CM/PCS.

ICU Charge Nurse 2002-2009

Competently organized daily assignments, respond to all Code Blues; proactive member of medical intervention team.

Liaised between physicians, patients, and families; care taking of critical patients including post op CABG, CRRT, Head injuries, multiple trauma, surgical and etc.

EDUCATION & TRAINING

Bachelor of Nursing, University of Oklahoma, Oklahoma City, 1996

Bachelor of Education, Northeast Missouri State University, Kirksville, Missouri, 1985

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