Manager Medical
Resume:
Anna Francis, CCS-P
** ******** **** ****** ** **057
************@*****.***
EXPERIENCE
Berkshire Medical Center
Pittsfield, MA - Coding Auditor Consultant
April 2019 - Current
Perform coding audits for appropriate diagnostic and procedural accuracy of patient health information records. Consistently review all specialty areas assigned for analysis, inpatient, ancillary and out patient services. Examine records for length of stay, diagnostic related groups, and severity of illness opportunities. Ensure departmental policies, procedures, and regulations supporting the hospital standards are followed. Communicate with other personnel managers and physicians to support operational workflows and policies. Review third-party payer denials and distribute to appropriate departments according to hospital policy.
Clean Slate Centers Addiction/Behavioral Health,
Northampton, MA — Operations Coding Manager (Company Relocated to TN)
January 2017 - April 2019
Conducted medical record audits to ensure compliance with applicable state and federal guidelines. Prepared and reviewed audit analysis with providers. Performed presentations to new and legacy providers regarding appropriate coding and documentation regulations. Monitored and tracked trending reports (KPI’s) submitted findings to key stakeholders of audit analysis. Assisted with the development of educational training curriculum. Served as the coding liaison between compliance, billing, clinical, and coding departments to integrate necessary changes for documentation and process improvements. Collaborated with IT and Senior Leadership to develop new templates for the clinical software. Participated in beta testing of software updates pertaining to all coding and billing services.
Health South, Worcester, MA — HIM Director (Temporary) December 2015 - January 2017
Completed chart audits and analysis of coders diagnosis selection in accordance with CMS-13 federal regulations. Presented all relevant coding and HIM developments daily to upper management. Reported SKILLS
Accurate analysis and
reporting abilities.
Timely resolution of coding
denials.
Impassioned liaison
correspondent.
Tenacious team building
mastery.
Expert knowledge of
Medicare, Medicaid, and
third-party coding/billing
compliance regulatory
research.
Accomplished presentation
skills.
Exceptional business process
improvement solutions.
Software
Meditech
3M HDM
CIS
Microsoft Office
PowerPoint
Allscripts
Software
Facets
Claims Trust
CMS-13 quarterly ratings to the HIM Committee. Managed a team of six employees. Presented coding analysis to senior management. Identified and resolved physician delinquent documentation reports. Health New England, Springfield, MA — Risk Adjustment Analyst (Temporary)
May 2014 - December 2015
Reviewed medical records to ensure accuracy of CMS HCC correct ICD-9 code validation selection. Provided audit findings to rendering physicians. Conducted prospective and retrospective chart reviews. Researched and disseminated coding updates and changes from CMS, OIG and related entities in regards to HCC coding. Implemented and evaluated effective policies and workflows to increased HCC code capture prior to patients visit.
OptumInsight, Eden Prairie, MN — Senior Quality Auditor
(Telecommuter)
May 2011 - May 2014
Conducted daily chart audits of inpatient and outpatient medical records. Provided findings and detailed review to coders. Participated in rebuttal and final review process. Served as a coach and mentor to coders that fell below their accuracy rate. Responsible for training new clinical coding investigators in the audit process, as well as, navigate through a variety of system platforms.
UMASS-Wing Memorial Hospital, Palmer, MA — Coding
Manager
April 2004 - May 2011
Maintained chargemaster code updates and performed CDM reviews for compliant charge capture in Meditech software. Collaborated with clinical and fiscal teams as the coding subject matter expert for charge capture improvement and updates. Responsible for training staff in regards to coding and billing regulations. Performed charge capture and coding audits for accuracy. Managed coding and data entry staff of seven employees. Distributed daily assignments. Researched coding and compliance documentation requirements. Prepared daily reports to identify missing charges and accurate code selection. Monitored and edited the software claim scrubbing system for correct claim submission. EDUCATION
Bay Path University, Longmeadow, MA — Associate of Science in Occupational Therapy
September 1996- June 1998
Graduated Magna Cum Laude
CMS
NHIC
MediRegs
SSI Claim Scrubber
BA - Leadership and Organization Studies Estimated Completion Date April 2020
Springfield Technical Community College — Certification of Coding and Billing
September 1998 - June 2000
The Health Information Technologies Excellence Award Outstanding Graduate Award 2000
Credentials
AHIMA Certified Coding Specialist - Physician (CCS-P) AAPC Risk Adjustment/HCC Coding Certificate - CRC
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