RACHAEL MARTIN

**** ***** ****** **., *** Orleans, LA 70130 / 504-***-****

Email: adiveq@r.postjobfree.com

linkedin.com/in/rachael-martin-chsp-60248053

CAREER OBJECTIVE

To obtain a position that will utilize my work experience and education while availing me with opportunities of advancement and professional development within the organization. QUALIFICATIONS

Ability to anticipate issues that adversely impact the function of the department and use deductive reasoning skills to solve problems. Proficient in the use of personal computers and Microsoft Office. Privacy Officer, Compliance Internal Auditor, Health Information Systems Administrator, HIPAA Compliance Auditor –working knowledge of HIPAA Security Privacy & Compliance. Experience working in EPIC, CERNER, One Content and the Avatar EMR Systems, FairWarning Compliance Auditing Tool, VMWARE, P2 Sentinel Compliance Auditing Tool, One Content, MedHost, Paragon, PLATO, RIMAGE. FORMFAST, CAC-Computer Assisted Coding, STAR, MOSAIC, RAC Auditing Tool, IODINE System, 3MDOC/ENCODER, FUGI -Synaspe, TRACE, MERLIN Ticketing System, CAC-CRM Ticketing System, LMS (Learning Management System), McKesson Software-The Horizon Patient Folder {HPF}, One Content (MPF/MBF), Citrix, Lawson Web Requisition, SoftMed, OCW/HPF Physicians Cross Reference Table, HPF Work Station and HPF Web Station, Error Correction Utility {ECU}, Index Correction Utility {ICU}, OCW, Promed, Medical Manager, HDX, Xactimed, Perse {Claim Track}, CAIC-ticketing system, Deferrals, Enterprise Document Management {EDM}, Mede Finance, SSI Optical, Signature, Siemens Interned at Delgado Community College in the IT Department: installing computers, software, printers, scanners and fax machines in their Administration Offices; set up new users with privileges while maintaining upgrades in the Computer Lab. CERTIFICATIONS * AFFILLIATES * SPECIALIZED TRAINING

Certified Healthcare Privacy Compliance CHPC {in progress}

Attended HCCA Compliance Academy {March 2017}

Certified HIPAA Security Officer CHSP {January 2019}

Certified FairWarning Professional - Compliance Auditor {Feb 2016}

Certified EPIC Software Trainer * ADT-Registration/Prelude/HIM Identity

Certified Forms Designer * FormFast Software Application

NAPW * National Association of Professional Women

AHIMA – American Health Information Management Association

HCCA – Health Care Compliance Association

GNOHIMA - Greater New Orleans Health Info Management Association

LHIMA – Louisiana Health Information Management Association

Cerner Software HIM Dept /ROI Dept/CDI Dept/ HIM Coding-CAC Workflow

McKesson Billing Software Training

AAHAM CPAT/CCAT Training

ICD-9/ICD10 and Procedural Code Training

Medicare, Medicaid and Commercial Insurance Web-Base Training

Medical & Legal Office Processes / Administrative Assistant Processes EDUCATION

Delgado Community College, New Orleans, Louisiana

Associates Degree, Computer Engineer Technology

Associates Degree, Criminal Justice Systems

EMPLOYMENT HISTORY

Applications Manager (Business Analyst) Sept 2019 – Jan 2020 Compliance / IT Department

Jefferson Parish Human Services Authority Metairie, Louisiana

Accountable for the daily management and operations of the EHS and all associated reporting.

Chaired the standing committee assigned responsibility for EHS oversight. Adhered to all components of the committee charter. Ensured development and distribution of agendas and detailed minutes as well as follow up to all open agenda items. Stored all committee documentation in a secure manner on the shared (G) drive of the computer network.

Developed and utilized a training curriculum and establishes competency measures.

Served as the HSA liaison with the EHS software vendor and any providers of reporting/analytics solutions.

Maintained detailed documentation of all vendor communications; stores in a secure manner on the shared drive of the computer network (release notes, notifications, etc.).

Supported service delivery areas with workflow development/revision.

Lead the implementation of EHS enhancements, updates, and new modules based on existing and new service/program requirements.

Developed and retained detailed documentation of all system modifications/improvements; stores in a secure manner on the shared drive of the computer network.

Developed and assisted with the development and update of EHS-related policies and procedures as a subject matter expert. Provide training on policy and procedure as needed or assigned.

Maintained active list of sequestered charts in EHS within the CPS folder on the shared (G) drive. Ensures list is updated appropriately per JPHSA's Release of Information policy.

Oversaw all aspects of system administration including: enhancements or changes to configuration, upgrade testing, issue resolution, and reporting.

Oversaw all aspects of EHS user set-up, access, and license management, including maintenance of all EHS Account Access Forms in an organized manner. Works with Directors to ensure licenses are utilized efficiently and only by users with legitimate needs for access.

Documented permission settings and configured permission groups and roles within the EHR.

Set up users per HIPAA "minimum necessary" requirements, limiting access only to those applications the user needs to complete his/her job functions. Maintained active database showing which users have access to which applications.

Lead all future EHS system or supplemental software implementations. Compliance Privacy Officer/Internal Auditor Sept 2018 - Sept 2019 Legal Services / Compliance Department

Slidell Memorial Hospital, Slidell, Louisiana

Responsible for ensuring governmental and payer regulations stay maintained. In addition, assisted with internal audits as needed in conjunction with the SMH Internal Audit Work Plan.

Provided HIPAA Privacy Training to all during new staff orientation. And offer HI

Performed the Planning, Fieldwork, Draft Report Preparation, and participates in Management Responses and Action Plan

Performed billing audits upon request of patient/Director in accordance with SMH Policy RI-022.

Identified trends/charging issues.

Performed internal audits.

Ensured the SMH policies relevant to HIPAA privacy are current/Attend Policy and Procedure Committee meetings.

Maintained working knowledge of HIPPA Privacy.

Ensured patient complaints regarding potential HIPAA Privacy violations are documented and each one investigated.

Received complaints from Office of Civil Rights (OCR) if a patient has filed a privacy complaint against SMH.

Documented and reported breaches of PHI privacy to OCR (electronically).

Maintained working knowledge/changes to both HIPAA legislation and CMS, OCR, etc. updated trends and/or law changes.

Participated in each New Employee Orientation Session on HIPAA Privacy education. Ensures, employees have completed all HIPAA Privacy Net-Learning training modules.

Distributed HIPAA privacy and security information to employees via the SMH employee newsletter, nursing newsletter and the physician newsletter.

Prepared summary HIPAA reports of each month's complaints and incidents for SMH Finance Committee/Board Package.

Performed other duties as assigned or directed to ensure smooth operation of the organization. Accomplishments

Embraced new role as Privacy Officer by researching and reviewing processes daily Create monthly articles for the SMH newsletter on HIPAA Privacy Created an in-service HIPAA Privacy training program Create Net-Learning Web Training module annually with questionnaire Joined the Safety Council Committee- used this opportunity to emphasize the importance of entering a safety event

Quarterly train incoming Pharmacy residents and students on HIPAA Privacy to avoid PHI exposure Created draft/policy enhancements while incorporating them into all HIPAA Privacy training sessions Initial contact for a patient complaint of Patient Portal PHI exposure – Reached out to the appropriate team members to have them review and research exposure of PHI. Informatics Manager April 2013 – Sept 2018

Health Information Management Dept.

West Jefferson Medical Center, Marrero, Louisiana

Served as the HIM Department Systems Administrator and HIPAA Compliance Auditor managing system access for payers, contractors, remote users and vendors. Served as a member of the HIM Department Management Team and provides input to department policies, procedures, job descriptions, staff development, performance evaluations and budget based on observations and area of expertise. Provided and oversee the evaluation, modification, installation, implementations, testing, maintenance, upgrades and training for all automated Health Information Management (HIM) Applications. Responsible for testing, implementation, upgrades, support and maintenance of all HIM Applications working closely with the IT Department for smooth transitions. Performed HIPAA Compliance Audits hospital wide using the FairWarning Auditing Application and the P2 Sentinel Cerner Auditing Application. Identified trends, investigated triggered alerts and all complaints of potential HIPAA violations. Prepared HIPAA Summary in which consisted of complaints and incidents for WJMC’s Quality Board and the Compliance Committee Board. Discuss triggered alerts with the Management Teams offering HIPAA Training and suggestions to assist with the eliminations of false positives. Informed Compliance Board executives of all findings in regards to alerts triggered in FairWarning,

(potential violations, violations, breaches and resolutions. Ensured patient complaints regarding potential HIPAA violations were documented and investigated. Contribute articles on HIPAA Privacy and Security in the Hospital’s Newsletter.

Additional responsibilities includes the oversight of System Access and Security, Data Capture and Information Workflow. I manage the hospital’s Forms Coordinator and sit as Chairman on the Forms Committee. Supervised the Release of Information Dept (ROI). My role also consist of maintaining the Data Mapping Spreadsheet for an OPTUM product Computer assisted Coding (CAC). Support all remote Coders

(CAC) Computer Assisted Coding Validators and the CDI Team with system issues as well as all HIM Vendors and Contractors with both technical and software issues. Enter HIM departmental Helpdesk Tickets for issues beyond my security profile and enter Helpdesk Tickets in the OPTUM Enterprise Computer-Assisted Coding (CAC) for all software related issues. In addition to statistical reporting, other responsibilities include training for the Vendors, Contractors and Physician Office Staff in their practice settings. Daily duties also consist of addressing system issues, providing technical support for all HIM System Applications and issues with VMWARE platform for remote users while working closely with IT, Leadership and the Management Teams to offer speedy resolutions. My duties include the optimization of workflow for the Health Information Management Departments(HIM); HIM Coding, CDI, Transcription, ROI, Prepping, Scanning, Indexing, Birth Registry, RAC Analyst, Deficiency Analyst while communicating all findings with those users affected by the change. Facilitate and Host Lunch & Learn, Webinars and Learning Seminars. I maintain my HIPAA knowledge by attending Compliance Forums, compliance web based training sessions, publications and briefing from HHS, OCR, OIG, HITECH and other compliance newsletters.

*54 FTE’s

Certified HIPAA Security Professional CHSP

Certified FairWarning Professional

Certified FormFast Designer

Certified Electronic Health Record Trainer July 2011- April 2013 EPIC Software System ADT-Registration / Prelude/ HIM Identity Computer Services Dept / Pelican Project

LSU Health Science Center 1501 Kings Hwy., Shreveport, Louisiana Tested, analyzed, and updated all training material as well as the creation of Workflow Activities for the end users. I troubleshoot issues received from the Computer Help Desk by the end users: working closely with clinicians and non-clinical staff and other EHR Trainers to maximize the utilization of the Electronic Health Record System features.

ADT-Registration, HIM Identity (Medical Records), Patient Access Departments, Financial Services, Patient Info Desk, Labor and Delivery Nurses, Compliance Dept, Pastoral Care, Environmental Service, ED Registration, Auth-Cert, Bed Planning Staff, Unit Clerks and the Admissions Departments. I also, work closely with the ADT Analysts, ADT Report Writer and other Training Coordinators as well as the EPIC Support Team in order to assure a smooth transition in testing scripts and workflow activities while offering continuous support to the end users before, after each implementation and each EPIC GO-LIVE.

LSU Health Science Center, Shreveport La ** Go-Live November 2011 Medical Center of New Orleans (ILH), New Orleans La ** Go-Live July 2012 Huey P Long Medical Center, Pineville La ** Go-Live November 2012 E.A Conway Hospital, Monroe La ** Go-Live Nov 2012 Lallie Kemp Hospital, Independence La ** Go-Live May 2013 Financial Counselor / Denial Specialist Aug 2006 – July 2011 HIM Specialist / EMR Trainer and System Support

Ochsner Medical Center, New Orleans, Louisiana

As a Financial Coordinator at Ochsner my main focus was on the needs of the patients, physicians, and other medical personnel. My main duty involved researching the patient accounts to determine the final disposition of all inquiries and performed the appropriate system tasks to provide correct balance on the account prior to billing a patient. I also, was responsible for researching patient accounts, ensuring accurate account proration, batching patient and insurance payments, and posting manual patient and insurance payments and contractual allowances bought while bringing a swift resolutions to account balances identifying the patient’s eligibility for financial assistance; and interpret percentages in order to accurately communicate patient responsibility and quote deposits. My role as Denial Specialist consisted of reviewing denial reports, development letters, aged reports, special denial projects, and all other requests for denial review to evaluate and research reasons for non- payment and determine front-end solutions to denial issues. Review charge data elements for appropriateness and compliance with regulations and policies and procedures. Evaluate use of code linkage to support medical necessity. Determine appropriateness of codes and modifiers originally submitted for the service rendered and I made changes as necessary using electronic chart information and paper chart information as the guide. I also, recommended amendments and obtained clarifications from practice managers when necessary. Submit corrected claims when appropriate, assigning ICD-9-CM, CPT, HCPCS, and/or service codes when necessary. Communicated findings, made recommendations, and compliance issues to appropriate areas according to policies, procedures, and regulations so that denial termination efforts are efficient and within compliance guidelines. Researched the patient accounts to determine the final disposition of all inquiries. Investigated and verified requests for refunds to Medicare and/or non-Medicare insurance companies. Researched patient refund request, analyzed patient account for billings and claim filings. Processed the necessary adjustments to bring patient accounts balances to a current and collectible status. I served as a Department Representative on the Billing Accountability Team (BAT Team). My role as the HIM Specialist / EHR Trainer was to maintain the electronic medical record. Responsibilities included physician and user access, security and password control, development and updating of record views and record view groups, development and updating of workflow groups and workflow activities, maintaining physician codes and groups, and resolving all items in error queues. Communicate with HIM management and staff, ancillary department IS systems administrators and IS team regarding the electronic medical record issues and assists with resolution of issues. Maintained all external request for system access. Responsible for analyzing, compiling, calculating and reporting on all statistical data for the clinic operations in an electronic format. While interacting with Information Technology Team, keeping them updated with system maintenance and needed upgrades. In addition to statistical reporting, other responsibilities include training in the physician practice setting, addressing system problems, providing technical support, assisting providers, support staff and processing and working all error rejection reports: work closely with the Management Team to solve problems and meet deadlines. Essential Job Duties

Work with physician practice manager and support staff to gather information to implement scanning of documentation. Troubleshoot problems reported by users and follow up to ensure resolution or feedback to the user within 24 hours. Work closely with the IS and HIM management team to analyze and resolve recurring system issues. Attend various committee meetings and assist with the preparation of agenda and meetings. Perform research daily on all documents that are in the error queues and update documentation with correct information as appropriate for upload to the electronic medical record. Address, resolves and process all request that are sent to the HIM e-mail loop for clinic number changes, deletions or date changes. Identify trends in documents that error out and work with the owners of the source systems to resolve the issues. Process the duplicate number report by moving all electronic data to the correct medical record number. Refer document issues to HIM management team for follow up and resolution. Serve as resource to users for resolution of issues identified in the electronic medical record, including person-to-person review and training when necessary. Served as a resource for training internal as external staff on other systems as needed. Developed and maintained training materials for and user guides for systems supported by HIM. Provide support to internal staff and external departments on the operation of the chart tracking system. Medical Insurance Specialist October 2005 to January 2006 Advanced Dermatologic Surgery, Houston, Texas

Reason for leaving; came back to New Orleans to start rebuilding my home. Insurance verification -eligibility and benefits, posted charges and payments both manually and electronically, obtained pre certifications and referrals. File re-determinations, appeals and requested hearings on denials for reimbursement in order to establish the medical rational for services rendered to Medicare, Medicaid other Commercial Insurance Carriers. Followed Up on Insurance and Attorney claims. Determined appropriateness of codes and modifiers originally submitted for the service rendered and made changes as necessary using electronic chart information and paper chart information as the guide. Recommended amendments and obtained clarifications from practice managers when necessary. Submit corrected claims when appropriate, assigning ICD-9-CM, CPT, HCPCS, and / or service codes when necessary. Researched medical records and typed letters to Insurance carriers in order to establish medical necessity for surgeries performed, radiation treatment given and chemotherapy agents administered by doctors. Researched the patient accounts to determine the final disposition of all inquiries and performed the appropriate system tasks that balanced the accounts prior to billing the patient. Typed up consultation notices and estimated charge amount letters, I also held confidential patient meetings in which I went over their insurance policies as well as their estimated charge amounts and answered any other questions they had pertaining to their medical services. I also checked patients in and out of our office took in co-pays, scheduled appointments and consultation meetings for the physicians and nursing staff. Medicare Billing /Appeals Specialist June 1998 to September 2005 Liaison for Chemotherapy Drug Reimbursement

Hematology & Oncology Specialist, New Orleans Louisiana Reason for leaving; HURRICANE KATRINA

Review Claims for errors prior to submitting to Medicare such as: diagnosis, procedure codes, units billed, etc. Worked Drug Reimbursements, Chemotherapy Procedures and their Administration Charges. Assist monthly on-site at our other office locations assisting patients with insurance and billing issues. Researched the patient accounts to determine the final disposition of all inquiries and performed the appropriate system tasks to properly balance the account before billing a patient. Researched patient accounts to determine the final disposition for inquiries. Performed appropriate system tasks to properly balance the account before billing a patient ensuring accurate account proration, batching of insurance payments, and posted manual patient and insurance payments with contractual allowances bringing swift resolutions to account balances. Verified insurance, eligibility and benefits, posted charges and payments both manual and electronically, obtained pre certifications and referrals. Filed re- determinations, appeals and requested hearings on denials for reimbursement in order to establish the medical rational for services rendered to our patients. Followed Up on Medicare, Commercial Carriers, Workers Compensation and Attorney claims. Determined appropriateness of codes and modifiers originally submitted for the service rendered and made changes as necessary using electronic chart information and paper chart information as the guide. Recommended amendments and obtained clarifications from practice managers when necessary. Submit corrected claims when appropriate, assigning ICD-9-CM, CPT, HCPCS, and / or service codes when necessary. Researched medical records and typed letters to Insurance carriers in order to establish medical necessity for surgeries performed, radiation treatment given and chemotherapy agents administered by the Physicians.

As Liaison for Chemotherapy Drug Reimbursements, I worked on the denied, new and unlisted chemotherapy drugs by typing letters to establishing the medical rational for surgeries performed, radiation treatment given and chemotherapy agents administered by our Physicians. Filed re-determinations, appeals and requested hearings on denied claims. I had also worked with other Commercial Insurance Carriers; researching both underpayments and overpayments on patient accounts. Volunteered at our Chemo Radiation Clinics assisting patients with billing concerns. Past Employment

Physician Biller – New Orleans Anesthesia Group / Professional Radiology Services /Orthopedic and Nephrology Services

Insurance / Reimbursement Specialist – Vision Optique Medical Collector / Medical Insurance Biller / Insurance and Bad Debt Account Follow up – Gulf Coast Services

Collection Agency Office Manager – Southern Credit Recovery Medical Collector / Bad Debt Account Follow-up – Touro Infirmary Hospital Mail Clerk – US Postal Service, Air Mail Fields

Telephone Secretary – Continental Diversified

REFERENCES

Lakeysha Moore, MBA, RHIA

Corporate Director of Coding for Texas Health Resources Dallas, TX 859-***-****

Professional

Owen J. Dahl, MBA, LFACHE, CHBC

Consultant at Owen Dahl

adiveq@r.postjobfree.com

Professional

Russ Sinkler

Enterprise Client Manager, OPTUM

612-***-****

Professional

Kelley Huff, BSN, RN, CCM

Lead Clinical Documentation Specialist (CDI) West Jefferson Medical Center Marrero, La 504-***-****

Professional

Angelle White

Coding Auditor West Jefferson Medical Center Marrero, La 504-***-****

Professional

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