KRISTI HAYES, CFE, CPC, CPC-I, CEMC
**** ******** **. **** *********, OH 43162 · 740-***-****
adnb11@r.postjobfree.com · Linkedin.com/IN/HAYES-KRISTI
Certified Fraud Examiner and Coder looking for a position to utilize my audit and compliance expertise along with my strong verbal and written communication skills.
EXPERIENCE
4/2017 – PRESENT
SR. ANALYST ETHICS & COMPLIANCE INVESTIGATIONS, ohiohealth
Assist with drafting and/or revising policies and procedures, compliance program policies as well as departmental procedures; Assist with documenting the annual compliance risk analysis; Assist in the completion of the annual compliance effectiveness review; Develop compliance communications; Oversee the compliance exit interview processes; Assist in the management of the OhioHealth Hotline, the Ethics and Compliance Hotlink to include assigning reported matters and preparing all related reports; Assist subject matter experts with the review and revision of general and specialized training and education, Initial Compliance Education as well as Annual Compliance Education modules. Ethics and Compliance Senior Leadership Committee. Prepare reports for senior management as well as providing overall support to the Ethics and Compliance Senior Leadership Committee Board, to include preparing committee meeting materials, minutes, and other reports, as appropriate. Provide monthly Compliance education to new providers. Respond to detected offenses; managing internal monitoring and auditing activities; and assist with the enforcement of disciplinary standards.
CODING SUPERVISOR, ohiohealth
Lead a professional coding team to meet and exceed department productivity standards. Track and monitor department Key Performance Indicator measures to help facilitate process improvement with other departments within Revenue Cycle. Monitor attendance and performance for corrective action when needed. Worked on the team that facilitated updating edit rules for data driven rules in the Optum system to work along with Epic edits. Moved to Supervisor over the education and quality assurance team. Created productivity standards for the team, attended meetings and education sessions with providers. Worked closely with educators to create training track and binders for coders and failed claims associates based on teams and specialties. Created training track and binders for Supervisors, coders and educators as well.
10/2011 – 4/2017
COMPLIANCE SPECIALIST, OSU physicians
Provided training and education on coding, documentation and other compliance issues to physicians, advanced practice providers and their staff on an ongoing basis. Provided individual educational sessions with providers to discuss audit results and provide recommendations where warranted. Respond to third party inquiries regarding level of service coding, evaluate denied claims and file appeals when necessary. Certified Coder 10/11-5/13-Reviewed patient charts to determine accurate CPT, HCPCS and ICD-10 codes for billing based on documentation by providers.
12/09 – 10/11
AUTHORIZATION UNIT ASSISTANT, compmanagement health systems
Verify treatment plan authorization, CPT codes and related data/documentation. Review medical and billed CPT codes to determine if appropriate for payment. Research and identify issues related to C9 processing and determination. Worked closely with Authorization Assurance Unit Nurses. Customer Service 12/09-7/10.
2/01 – 7/09
SERVICE REPRESENTATIVE, osmA Insurance Agency
Performed prescreening / underwriting of new insurance business. Renew business and service issues. Prepare and process new business cases and annual plan changes. Liaison between insurance agents and insurance companies.
EDUCATION
JUNE 2008
CERTIFIED PROFESSIONAL CODER, AAPC
SEPTEMBER 2018
CERTIFIED EVALUATION AND MANAGEMENT CODER, AAPC
JUNE 2019
CERTIFIED PROFESSIONAL CODER INSTRUCTOR, AAPC
APRIL 2021
CURRENTLY ENROLLED AT COLUMBUS STATE AND ACTIVELY WORKING TOWARDS ASSOCIATES DEGREE IN HEALTHCARE MANAGEMENT
JUNE 2021
CERTIFIED FRAUD EXAMINER, ACFE
SKILLS
Communication—Verbal and Written
Multitasking
Prioritizing
Proficient in all Microsoft Applications
Interpersonal skills
Organization and attention to detail
Dependability
ACTIVITIES
2017 Treasurer for Columbus AAPC Chapter
2016 Education Officer for Columbus AAPC Chapter