Inpatient DRG Coding Auditor, Educator

DONNA L RUDOLPH RHIT CCS

*** ******** ****, ********** ******** 40207

Home: 502-***-****

***********@***.***

Summary

An AHIMA Approved ICD-10-CM/PCS Trainer, Coding Auditor, DRG Validator, and Coding Educator with over 35 years of experience, seeking to assist hospitals with coding compliance.

At Health Revenue Assurance Association, procured several thousand dollars for clients through MS-DRG and coding audits.

At Ciox Health, answered over 10,000 coding questions, helping the company's coders to attain the correct reimbursement for the client.

At Norton Healthcare, educated the coders, improving their accuracy 20 percentage points within a year.

At Norton Healthcare, appealed MS-DRG denials resulting in a 98% turnover rate to the original MS-DRG.

Experience

Intellis, Incorporated January 2019 to September 2019

Senior Consultant Hours reduced, need full-time

DeLand, FL/Philadelphia, PA

Coding Decision Support - assist Intellis coding employees/associates regarding code assignment answering questions from their facility's current case documentation minus PHI, using medical research and applying ICD-10-CM and ICD-10-PCS Official Coding Guidelines and AHA Coding Clinics. Since July, 2016 have answered, with rationale, over 10,000 questions in a timely manner.

Answer questions from their facility's current case documentation minus PHI, using medical and coding research, applying ICD-10-CM and ICD-10-PCS Official Coding Guidelines, the AHA Coding Clinic publication, along with CPT Guidelines and the CPT Assistant publication. Since July, 2016 have answered, with rationale, over 10,000 questions in a timely manner.

Currently coding for two hospitals, inpatient and outpatient

Ciox Health, formerly IOD Incorporated March 2014 to January 2019

Manager, Coder Development/Auditing Specialist

Alpharetta, GA

Coding Decision Support - educated and assisted Ciox Health Inpatient Coders, Auditors and HCC Coders regarding any code assignment questions from their facility's current cases using medical research and applying ICD-10-CM and ICD-10-PCS Official Coding Guidelines and AHA Coding Clinics. Since July, 2016 have answered, with rationale, over 10,000 questions in a timely manner.

Assisted in the creation of lessons for Ciox Health's web-based learning tool, the "Coding Gym" - assigned ICD-10-CM and ICD-10-PCS codes to whole records and portions of charts such as operative notes and other documents depending on the lesson topic.

Co-facilitator/educator of the Coder Development Program-preparing individuals in ICD-10-CM and ICD-10-PCS for coding placement at Ciox Health client sites.

Responsible for retrospective reviews of ICD-10-CM/PCS medical records for external clients, along with discussion/presentation of results.

Previously responsible for auditing pre and post bill ICD-9-CM Coding of medical records.

Pre-bill reviews consisted of auditing the coding and abstracting of Coder Development Program's (new) coders.

Education was provided to the Coder Development Program graduate based on trends as well as appropriate use of the Official Coding Guidelines and AHA Coding Clinic(s).

Post bill review included a random sampling of internal coders' records.

Assisted in the review, maintenance, and correction of records of Ciox Health's ICD-10 "Coding Gym" Charts.

Health Revenue Assurance Associates Inc. November 2010 to March 2014

Director, Inpatient Services and ICD-10-CM/PCS Education

Plantation, FL

Responsible for providing ICD-10-CM/PCS education to clients.

Co-created the ICD-10-CM/PCS presentation learning sessions.

Responsible for the data quality of ICD-10-CM/PCS learning sessions.

Responsible for assigning ICD-10-CM/PCS codes to client records as part of their learning sessions.

Utilized Data Analytic Software to discover vulnerable documentation and reimbursement areas for clients.

Assisted in the development of HRAA's MS-DRG Inpatient Auditing software application.

Responsible for the hiring and managing of three ICD-10-CM/PCS Subject Matter Experts.

Wrote a White Paper regarding the importance of ICD-10-CM/PCS which was posted on the company website.

Spoke at the 2011 AHIMA Assembly on Education about why coders can perform well as a Clinical Documentation Specialist.

Spoke at the 2013 AHIMA Conference regarding potential hidden impacts of improper ICD-10-CM/PCS Inpatient coding.

Responsible for performing Inpatient Coding/MS-DRG ICD-9-CM audits and education.

Kiwi-Tek September 2009 to October 2010

Lead Coder (full-time)/Coder(part-time)

Carmel, IN

Full-time: responsible for retrospective auditing of company coders.

Coverage for Manager in their absence.

Part-time: responsible for coding inpatient and outpatient client records.

Norton Healthcare June 2001 to May 2010

Coding Educator/Healthcare Coder II

Louisville, KY

Responsible for the education, clarification and auditing of Norton Healthcare hospital coding.

Within the first year as Coding Educator/Auditor, the external auditing coding scores improved from 76% to 96% accuracy.

Responsible for assisting and educating the Clinical Documentation Program's nurses on MS-DRG's and ICD-9-CM coding.

Responsible for current and retrospective chart review on difficult cases or cases where there is a difference in MS-DRG's between the Coder and Clinical Documentation Nurse.

Liaison between the Clinical Documentation Nurses and Inpatient Coding Staff.

Responsible for 100% review and training of Inpatient Coding Staff.

Participated at the Norton St. Matthews Hospital OB/Peds Physician Peer Review Committee Meetings.

Developed a facility coding guideline regarding the coding of Uterine Atony/Hemorrhage, with the assistance of the Incumbent Chairperson of the Norton St. Matthews Hospital OB/Peds Physician Peer Review Committee.

Responsible for Quality/Core Measure Chart review on questionable cases.

Attended Quality Committee meetings when requested.

Provided ICD-9-CM codes to the organization's statistical department, other departments and committees, when requested.

Responsible for the coordination of external coding audits and follow-up education.

Responded to MS-DRG Validation Letters from the PRO and various other agencies, including insurance payers.

Responsible for dispersing coding information from sources such as the American Medical Association, the American Health Information Management Association, The Center for ICD-9-CM and other related institutions

Participated at the Norton Corporate Compliance meetings.

Responsible for the maintenance of Norton Corporate Compliance relating to coding quality.

Responsible for the coordination of additional coverage of coders at all facilities to maintain appropriate staffing levels to maintain timely coding.

Assisted other departments, their staff and physicians in coding related issues of all types, when requested.

Worked to maintain a low dollar amount on the Discharge Not Final Billed account list.

Responsible for the determination of whether to combine charts/accounts that fall into the 72 hour rule.

Responsible for coding Inpatient records.

United Audit Systems, Inc April 1999 to May 2000

Coding Consultant

Cincinnati, Ohio

Responsible for assisting designated hospitals in coding inpatient and outpatient records.

Extensive travel.

Advocate Good Shepherd Hospital

Health Information Coordinator

Barrington, Illinois

Responsible for the management of the Health Information Department during the Manager's absence.

Participated in the Medical Record Committee monthly meetings.

Supervision of the coding team including completing performance evaluations.

Assisted in coding and abstracting inpatient and outpatient records

Expedited all customer requests relating to billing/coding issues.

Participated in a monthly discussion with other Advocate Hospital Associate equivalents regarding coding/billing issues.

Jewish Hospital June 1991 to April 1999

Health Data Analyst - Coding

Louisville, KY

Member of self-directed work team with two month rotating position as team leader.

Responsible for coding, abstracting and data entry of inpatient/outpatient records for Jewish Hospital, Jewish Hospital Shelbyville, Frazier Rehabilitation Center.

Assisted in the Joint Application Design for Jewish Hospital's Optical Imaging System.

Participated in coding accuracy reviews for performance appraisals of co-workers.

Trained and oriented new employees, students regarding the coding and abstracting processes of Jewish Hospital.

Floyd Memorial Hospital

Medical Records Manager

New Albany, Indiana

Responsible for supervising, monitoring, hiring, and completing performance reviews on associates of Utilization Review Department, Cancer Registry, Statistical Analyst, Record Processing, Medical Transcription, Release of Information, and Physician Suspension/Record Completion.

Advocate Lutheran General Hospital October 1984 to June 1986

DRG Coder/Abstractor

Park Ridge, IL

Coding, abstracting and data entry of inpatient records.

Advocate Lutheran General Hospital July 1986 to December 1988

DRG Coding Analyst

Park Ridge, Illinois

Analyzed DRG coding assignment for accuracy of co-worker's Medicare cases.

Assisted Medical Staff with face sheet validation completion of Medicare cases.

Followed up any and all delinquent bills to ensure timely completion.

Assisted DRG Information Manager/Coding Supervisor with the creation of new performance expectations for the DRG Coder/Abstractor position

Conducted a DRG In-service for First Year Internal Medicine Resident Physicians.

Trained new DRG Coding/Abstracting associates.

Assisted with special assignments, PRO activities and billing/coding issues.

Education and Training

Western Kentucky University 1983

Associate of Science: Medical Record Technology; Business and Language Studies

Bowling Green, Kentucky

Glenbrook South High School

Diploma: College Preparatory

Glenview, Illinois

1990

Dale Carnegie Course on Public Speaking

1989

Certificate of Achievement for participation in "The Uncommon Leader", the Course In Managerial Excellence

Skills

Competent with the following:

ICD-10-CM/PCS Code System

ICD-9-CM Code System

TruCode Encoder

3M Coding for Reimbursement, Health Data Management coding software

Microsoft Office Products - Excel, Word, PowerPoint

Clintegrity Coding and Compliance Software

Epic Electronic Health Record Software

Quadramed Codemaster and Medicus coding software

SMS Allegra 2000, Invision

Meditech Magic, Client Server Systems

American Management Systems Optical Imaging Systems for Medical Records

IBM Officevision email software, Lotus CCMail

Affiliations

American Health Information Management Association (1983 - present)

Kentucky Health Information Management Association (1989-1999),(2001-present)

Illinois Health Information Management (1983 - 1988)(2000)

Accomplishments

Selected to speak at 2013 AHIMA National Convention

Selected to speak at the 2011 AHIMA Assembly on Education

Improved Norton Healthcare Coding Accuracy 20 percentage points within one year

Credentials and Certifications

Registered Health Information Technician

Certified Coding Specialist

AHIMA Approved ICD-10-CM/PCS Trainer

References

Available upon request

Contact this candidate