Medical Coding Auditor, Retired Physical Therapist
Resume:
Karen Durniak, MS, CPC, CRC
Providence Forge, Virginia 23140
********@*****.***
Career Summary
Experienced Physical Therapist who has transitioned to Risk Adjustment Medical Coding and Auditing. Interest in this area was a result of my experience as QI Director of a Medicare CORF. Following a Medicare Intermediary Audit requiring 100% concurrent review, I was instrumental in the successful resumption of Medicare reimbursement within 3 months. Managed the PT/ Rehab Department for an In-patient Rehab Facility (IRF) and Skilled Nursing Facilities (SNF). Worked as a staff PT in a variety of clinical settings including acute care, outpatient, in-patient rehab, home health/hospice and SNFs.
Education
Master of Science in Physical Therapy and Bachelor of Science in Health Science, Long Island University, Brooklyn, NY, Oct 1986
Bachelor of Arts in Biology, State University of New York, Potsdam, NY, May 1983 Licensure/Certification
CRC through AAPC, Aug 2018
CPC through AAPC, Aug 2016
Board Certified Specialist in Geriatric Physical Therapy, Apr 1999 to Apr 2009 Virginia Licensure in Physical Therapy, Aug 1989 to Dec 2018 Professional Experience and Accomplishments
Coding Auditor, Signify Health, Nov 2016 to present Perform audits of in-house HCC coded Health Risk Assessments for Medicare, Medicaid and Commercial Managed Care Health Plans. Assist in appeals of Health Plan audits of in-house coded Health Risk Assessments.
Field Reviewer, Altegra Health, Marietta, Georgia, June 2016 to Sep 2016 Reviewed and collected identified chart audit materials from various medical practices/facilities as required for IPAs for Medicare and Medicaid.
Staff Physical Therapist, Home Health and Hospice
• Personal Touch Home Care, Newport News, VA, Nov 2015 to Jan 2017
• Care South Home Health, Colonial Heights, VA, Sep 2015 to Nov 2015
• Riverside Home Care, Gloucester, VA, Oct 2013 to Sep 2015
• Home Health Contract Position, Comp Health, Colonial Heights, VA, June 2013 to Sep 2013
• American Senior Care/Encompass Home Health, Williamsburg, VA, July 2012 to Mar 2013
• Amedisys Home Health Services, Chesterfield and New Kent, VA, May 2009 to Dec 2012
• Bon Secours Home Health, Providence Forge and Richmond, VA, Jan 2007 to June 2007.
• Personal Touch Home Care, Newport News, VA, Sep 2004 to May 2009
• Rehab Care Group, Inc., Newport News, VA, Oct 1998 to July 2007 Director of Rehab, Bayside Convalescent Center, Poquoson, VA, June 1997 to Oct 1998 Supervised and reviewed rehab staff including Physical Therapist Assistant, Occupational Therapist, Speech-Language Pathologist and Respiratory Therapists at a 60 bed SNF. Director, Quality Improvement, Professional Therapy Services, Inc., Yorktown, VA, July 1995 to Mar 1997
Created the Quality Improvement Department for a Medicare Certified Outpatient Rehab Facility
(CORF). Working with Billing personnel, developed policies and procedures for documentation and correct Diagnosis/CPT codes for PT, OT and SLP services, assisting in their implementation and monitoring to meet state and federal regulations. Supervised a staff of 10 people overseeing the weekly and month-end review of therapy documentation in multiple clinical settings, performed retrospective chart audit, and staff training.
Rehab Supervisor, Professional Therapy Services, Inc., Yorktown, VA, Jan 1995 to June 1995 Supervised rehab and clerical staff in two SNFs, directing the daily flow of referrals, scheduling, screenings, team/facility meetings, evaluations and treatment of geriatric adult population. Staff Physical Therapist
• Community Home Health Services, Williamsburg, VA, Jan 1992 to Aug 1996
• Riverside Home Health Agency, Newport News, VA, Mar 1994 to Feb 1995
• Novacare, Inc., Virginia Beach, VA, Nov 1992 to June 1993 Director, Physical Therapy, Riverside Rehabilitation Institute, Newport News, VA, Jan 1990 to Dec 1991
Managed the daily operations of the Physical Therapy department of a 75-bed freestanding IRF; supervised and reviewed approximately 20 people of senior and staff physical therapists, assistants, aides, clerical/secretarial staff, and volunteers; recruited, oriented and trained staff; developed departmental budget and updated policies and procedures, oversaw student clinical education programs; provided in-services within the facility and health system; reported to facility administrator and interacted with facility and health system management. Oversaw successful re-accreditation process for JCAHO and CARF, including In-Patient Brain Injury Program.
Developed and implemented physical therapy component for successful CARF accreditation of the Work Hardening Program.
Continuing Professional Development
Member, AAPC, 2015 to present
Member, Virginia Physical Therapy Association, 1989 to 2018 Member, American Physical Therapy Association, 1984 to 2018
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