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Clinical Documentation Specialist

Location:
Philadelphia, PA
Posted:
September 22, 2019

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Resume:

EDUCATION Wilmington University Oct **** – June **19

Master of Science in Management (M.S.M) - Healthcare Administration

University of Tirana, College of Medicine Aug 1990 – Aug 1995

Medical Doctor (M.D.) Tirana, Albania

EXPERIENCE

TEVA PHARMACEUTICAL INDUSTRIES, LTD, Spectraforce Technologies, Inc.

SR. RECORDS AND INFORMATION ANALYST FOR LEGAL AFFAIRS May 2019 - Present

Conduct business process analysis to develop a conceptual model of how records and information relate to the organization’s business and its business processes.

Provide input for organizational procedures and guidelines by analyzing processes.

Assess information flow for workflow analysis and planning.

Oversee entry of inactive records inventory into records management system to ensure accuracy and compliance with retention schedules and disposition procedures.

Develop and coordinate correspondence and status reports on current projects.

Evaluate user needs based on inventory of records and interviews with users.

HAHNEMANN UNIVERSITY HOSPITAL Philadelphia, PA

CLINICAL DOCUMENTATION SPECIALIST May 2018 – April 2019

Conduct accurate and timely medical record review.

Identify opportunities for documentation improvement to support severity of illness and quality of care and then formulate clinically credible documentation clarifications/queries.

Follow up on cases especially those with clinical documentation clarifications/queries.

Collaborate with physicians in order to secure their commitment to improved clinical documentation.

Collaborate with inpatient coders to determine appropriate Medicare Severity-Diagnosis Related Groups (MS-DRG, APR-DRGs, etc.) assignment for compliance and reimbursement purposes.

Work with Coding and Quality Management teams to identify Hospital Acquired Conditions (HAC) and Patient Safety Indicators (PSI).

ROXBOROUGH MEMORIAL HOSPITAL, Prime Healthcare.

CLINICAL DOCUMENTATION SPECIALIST Philadelphia, PA

UTILIZATION REVIEW COORDINATOR June 2015 – May 2018

Responsible for reviewing patient charts to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to requests for records from payers/fiscal intermediary etc.; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review (UR) and Case Management reporting.

Worked with health information management staff, coding staff, physicians, financial services, onsite and remote utilization review teams regarding admission criteria, medical necessity, payment denials, and documentation issues.

Participated in Case Management and UR Meetings; Served as on-going educator to all departments.

Conducted clinically based concurrent and retrospective reviews of Emergency Room and inpatient medical records to evaluate the clinical documentation is reflective of quality of care outcomes and reimbursement compliance for acute care services provided.

Determined medical necessity for inpatient admissions/level of care based on Milliman and/or Interqual guidelines.

CHARTPROS, LLC Philadelphia, PA

HEDIS MEDICAL RECORD REVIEWER Jan 2014 – Nov 2015

Jan 2016 – Nov 2016

Conducted record reviews to monitor quality of patient care and compliance with Federal and State regulatory standards for Keystone first and Keystone VIP members.

Performed onsite medical record reviews for HEDIS or other related compliance or quality improvement initiative.

Trained in ICD10 and CPT coding.

AMERICAN RED CROSS Philadelphia, PA

BLOOD DONOR COUNSELOR Feb 2011 – July 2013

Responded to and provided appropriate donor care to blood donors who have suffered an injury or had a reaction during or following a blood donation.

Maintained Blood Services records in accordance with ARCBS directives and FDA, state and federal regulations.

Researched records to retrieve requested information.

Provided referrals to support groups and physicians or clinics in the donor's geographical area.

Performed all duties and responsibilities in compliance with standard operating procedures, Safety Quality Identity Potency Purity (SQUIPP), regulations outlined in the Code of Federal Regulations (CFR), Occupational Safety and Health Administration (OSHA) and other applicable Federal, state and local regulations.

FLORIDA MEDICAL PAIN MANAGEMENT St. Petersburg, FL

MEDICAL /SURGICAL ASSISTANT Aug 2004 – Jan 2011

Administered injections or treatments and performed routine laboratory tests; Assisted in trigger point injection procedures and performed various diagnostic procedures and ancillary tests (e.g., EKGs, urine drug test); Completed patient’s visit e-Note for doctor’s review.

Operated fluoroscopy guidance and assisted anesthesiologist/pain specialist during epidural steroid injection procedures, lumbar nerve blocks and radiofrequency – RF rhizotomy or spinal cord stimulator implant.

Interviewed patients, measured vital pulse rate, temperature, blood pressure, weight, and height, and recorded information on patients' charts.

UNIVERSITY HOSPITAL CENTER “MOTHER TERESA” Tirana, Albania

RESIDENT PHYSICIAN – ONCOLOGY DEPARTMENT Sep 1999 – Feb 2001

Worked with patients diagnosed with cancer at the chemotherapy ward.

Examined patients.

Analyzed clinical records.

Diagnosed patients’ conditions and prescribed appropriate treatments.

Educated patients in remission about precautions and future health issues.

STATE HOSPITAL OF FIER Fier, Albania

OUTPATIENT HEALTH CENTER Jan 1996 – Sept 1999

GENERAL PHYSICIAN / FAMILY DOCTOR

Provided and managed direct patient care.

Prescribed pharmaceuticals and treatments.

Referred patients to specialists.

Reviewed plans for patient rehabilitation.

Reviewed clinical records of patients.

Directed and coordinated patient care activities.



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