Cornelia Chalas, CPC, RHIT, CRC, RMA, AAPC Approved

Instructor, HEDIS Reviewer- Clinical Quality Specialist Lynn, MA 01904 ~ 781-***-****

Career

Summary:

Proficient maintaining confidentiality/security of all assigned records via HIPAA and DHS licensing standards, with Excellent coordination, follow up, interpersonal, analytical, time management, oral and written communication skills. With the following experience:

Management and Leadership experience: Mortgage documentation auditor/ trainer

(2000-2003), Director of Healthcare Program and Instructor at an educational institution

(2011-2013), which required me to oversee the instructor's workflow

Instructor/ Educator experience: Medical Coding Instructor (2011-2013) -by discussing chart deficiencies and potential improvement of documentation and coding accurately with thru guideline knowledge of CPT, HCPCS, ICD10-CM, and ICD10-PCS

Clinical Documentation Specialist experience/ HEDIS Hybrid Medical Record Review: HCC Clinical Documentation Improvement Specialist (2013- Current) (SCO, ONE CARE, PACE, ACO) by discussing chart deficiencies and potential improvement of documentation and coding accurately with thru guideline knowledge of CPT, HCPCS, ICD10-CM, and ICD10-PCS and daily clinician queries and HEDIS Hybrid method medical record review.

HCC Risk Adjustment Diagnostic Coder and Auditing/ HEDIS Administrative Method Data Reviewer experience: (2013- Current)

Abstract information for codes as correlated with Admin season for HEDIS.

HCC Risk Adjustment Coder, Chart Auditor, Quality Assurance, Performance Improvement, Diagnostic Coder, For both Inpatient and Outpatient diagnostic coding. tracking & submitting daily physician query and follow-up information-

Conduct retrospective, prospective, concurrent, and RADV audits, queries to improve clinical documentation to support an appropriate level of service rendered to all Medicare Advantage, PACE, and ACO members. Advise Healthcare Providers on processes that lead to better compliance with HEDIS administrative and STAR measures namely ensuring up to date health care maintenance.

Evaluation and Management: 2013-2015 as clinical documentation improvement specialist

Clinical Medical Assistant: 2005-2008

SOFTWARE:

● Meditech

● EPIC

● Apixio HCC Profiler

● eClinicalWorks

● Optum360

●Athena net

● COA

● NEXTGEN

● Code Right 2.0

EDUCATION:

Associates of Applied Science, Medical Billing & Coding- Lincoln College of New England 2010 Diploma, Medical Assistant-Everest College- 2005

Certification in Training Hours in HEDIS/ QRS -HLTI Solutions Learning MarketPlace-2020 PROFESSIONAL EXPERIENCES:

Ciox Health- Remote 2019-2020

Inpatient and outpatient Commercial and CMS HCC Risk Adjustment Diagnostic Medical Coder

● Audited medical records for HCC Risk Adjustment documentation and proper code capture and abstracted information for codes as correlated with Admin season for hedis Apixio-Remote (contract) 2017- 2019

Inpatient and outpatient Commercial and CMS HCC Risk Adjustment QA

●Audited medical records for HCC Risk Adjustment documentation and proper code capture Gebbs – Remote (contract) 2019-2019

Inpatient and outpatient Commercial and CMS HCC Risk Adjustment Medical Coder

● Audited medical records for HCC Risk Adjustment documentation and proper code capture Lynn Community Health Center 5/2019 - 07/2019

Accountable Care Organization HCC Medical Coder III

● Ran monthly KPI PHM reports

● Attended monthly coding meetings

● Facilitated daily retrospective, prospective, concurrent, and RADV audits with visit queries

● conducted Medical Record Review to set quality parameters

● Collecting and analyzing data

● Abstracting data from medical records and preparing reports

● Advise Healthcare Providers on processes that lead to better compliance with HEDIS codes and billing overview and STAR measures namely ensuring up to date health care maintenance.

● Mentored Medical Coder

Element Care 07/2018- 12/2018

Pace HCC coder and documentation specialist with daily clinician queries

● Facilitated daily retrospective, prospective, concurrent, and RADV audits visit queries, after chart review to improve clinical documentation to support an appropriate level of service rendered to all PACE members

● Advised Healthcare Providers on processes that lead to better compliance with HEDIS codes and billing overview and STAR measures namely ensuring up to date health care maintenance.

● Performed preventive action compliance chart audits to improve state audits. Queen Consultant Group- (contract) 2018

HCC Medical Coder

● Audited medical records for HCC Risk Adjustment and E&M proper code capture Care Dimensions, Danvers MA,- 2016 - 2017

Hospice and Palliative care Medical Coding Specialist

● Reviewed charts for proper documentation requirements and Coded accordingly

● Attend weekly team meetings

● Hands-on experience coding for Activities of Daily Living (ADL) and perform preventive action compliance chart audits to improve audits

Contact this candidate