Mataline Kay Potter

**** ****** ***** **** **********, SC 29492

(Cell) 843-***-****

Professional Summary

A dynamic, quality-focused professional that plays an integral role for delivering quality health care through quality information. Experienced Manager working as a team player to ensure compliance in regard to internal reporting and regulatory requirements with experience in:

•Physician Practice Management

•OIG Audit Process

•Physician Practice Coding and Compliance Consultant

•Physician Practice Revenue Analysis

•Physician Practice Budgets

•VA -Recruits, retains, and develops HIMS talent to achieve high quality standards.

•Improved Accuracy and Quality of the VA Providers Clinical Documentation - 30% quality improvement.

•Health Insurance Portability and Accountability Act

•Revenue Cycle Analysis

•Physician Practice Electronic Medical Record Implementation

•Teach ICD-10, CPT, and HCPCS Coding

•Hospital Inpatient Coding - DRG's

•Accounts Receivable Recovery

•Coding Denial Appeal Experience

•Over 25 years’ experience in the Health Information Management industry.

Professional Experience

Ralph H. Johnson VA Medical Center. Charleston. South Carolina 29401 12/2018 to present.

Chief of Health Information Management Services

Responsible for the management and direction of the health information management program for the Ralph H. Johnson VA Medical Center. Responsible for the oversite of national HIM program policies and procedure, guidelines, references, and training on a local level at the Charleston VA Facility. Ralph H. Johnson Veterans Affairs Medical Center in Charleston, SC is a general medical and surgical facility. It is a teaching hospital. Chief is directly responsible for the Coding Metrics to maintain VA Standard of 95%and above for the Coding Quality and Productivity of the facility located in VISN 7. Reports to Chief of Health Administrative Service.

Medical University of South Carolina-Physicians• Charleston, South Carolina 29425 • 11/2005 to 11/2018.

University Medical Associates, the 600 plus physician group of the MUSC Medical Center, provides services ranging from prevention and wellness to highly specialized care at outpatient clinics and facilities both on the MUSC campus and extending into the community. UMA has the widest range of specialty care available at any medical center in South Carolina.

UMA Compliance Manager

Monitor data integrity through audits to ensure compliance regarding internal and external reporting and regulatory requirements. Work on the Revenue Cycle Team to conduct back-end health system compliance audits. Responsible for maintaining the Policy and Procedure Manuel for assigned departments/divisions.

This includes the development of specialty specific policies providing guidance on billing and documentation issues as well as dissemination of Corporate Compliance Policies per Compliance Guidelines. Instruct and supervise staff and physicians in proper coding guidelines, insurance carrier regulations, medical records, and documentation requirements.

MedCare Express • Mount Pleasant, South Carolina • 29464 • 03/2008 to 09/2008 (Contracted PRN Position) Responsible for designing and managing the billing department for two Urgent Care Treatment Facilities. Managed the daily operations of charge entry, coding, billing, accounts receivables and the overall appeal process.

Responsible for management of department's revenue cycle. Responsible for tracking, trending AIR denials,

implementing an appeal process for denials.

Director of Billing

Managed departmental billing operations which included: front desk collections, insurance verification, coding, charge posting, payment posting, and daily close out, monthly close out, and reducing AIR. Responsible for reimbursement recovery, ensure timely and accurate claims submission.

Achievements:

•Reduced AIR by 40% from 03/08 until 08/08.

•Redesigned collection process to improve employee productivity.

•Effectively implemented billing software to improve clean claim submission

■Wrote facility HIPPA Manual

•Audited 30 medical records per month

•Hired and trained billing department staff

Lowcountry Medical Associates • Charleston South 29425 • 2005 to 2008

Lowcountry Medical Associates, a 65 primary care & pediatric physicians’ group with 26 practices, an integral part of the Roper/Saint Francis Hospital Affiliations.

Practice Analyst

Monitor data integrity through audits to ensure compliance in regard to internal and external reporting and regulatory requirements. Work on the Revenue Cycle Team to conduct back-end health system compliance

audits. Responsible for maintaining the Policy and Procedure Manual for assigned departments/divisions. This includes the development of specialty specific policies providing guidance on billing and

documentation issues as well as dissemination of UMA Corporate Compliance Policies per Compliance Guidelines. Instruct and supervise staff and physicians in proper coding guidelines, insurance carrier regulations, medical records and documentation requirements.

Achievements:

•Effectively educated and trained all new providers on coding and the documentation guidelines.

•Audited 100% of all New Provider charges within 30 day.

•Managed all compliance regulations for All Primary Care and Pediatric Practices..

•Instruct and supervise staff and physicians in proper coding guidelines, insurance carrier regulations, medical records and documentation requirements.

•Board Member of the PPCA Local Coders Association

•American Academy of Professional Coders Active Member

•American Health Information Management Association Active Member

•Guest Speaker at PPCA Coder's Association Fall Seminar

•Registered Health Information Technician, April 1983

•Certified Professional Coder, March 1999

•Certified Professional Coder-Instructor, December 2001

•Physician Coding Specialist, March 2007

Southeastern Spine Institute, Mount Pleasant. South Carolina 29466, 02/2012 to present (Contracted Position)

The Southeastern Spine Institute is the largest medical practice in South Carolina specializing in spine only care.

Compliance Officer

Monitor and oversee operations to ensure compliance with audit control system procedures and policy, that they comply with legal requirements and meet all regulatory standards. Conduct regular audits to identify operational and audit control problems. Identify and correct problems, develop and implement programs. Provide Physician and Physician Assistant education for corrective actions needed.

Achievements:

Develop, recommend, and implement programs, systems and procedures to ensure that compliance policies are followed.

•Provide ongoing coaching and training and manage and resolve or ensure resolution of compliance problems up to and including research, investigations, and resolutions of on compliant complaints.

•Monitor and maintain Compliance Hot-line complaints.

•Identify and correct problems, develop and implement programs.

Coastal Cardiology, P.A.• Charleston. South Carolina 29425 •05/ 2002 to 10/2005

Private board-certified cardiologist practice with locations in Charleston, West Ashley, and East Cooper, Physicians with privileges at Roper/Saint Francis Hospital and East Cooper Medical Center.

Practice Administrator

Responsible for managing clinic and business operations of a fast paced, high volume cardiology practice. Managed and held staff accountable for providing professional and reliable quality service in a positive manner. Investigated and researched physician practice growth opportunities. Managed account payables and account receivables. Reported to managing partners.

Achievements:

•Monitored and maintained net collection rate of 95% of collectable charges.

•Updated and revised practice fee schedule to reflect industry standard.

•Wrote practice HIPPA manual, employee handbook, practice policy and procedure manual.

•Researched and provided managing partners with information on employee benefits, medical insurance, retirement benefits, and paid time off benefits.

•Managed the physician's schedule for hospital meetings and committee membership responsibilities.

Good Samaritan Hospital, Lexington. Kentucky 40508. 08/1995 to 08/1997

A 150-bed acute care hospital located in Lexington Kentucky that is one of the affiants of the University of Kentucky Medical Center.

Associate Director of Medical Records

Responsible for the day-to-day operation of the Health Information Management Department. Directly managed and held staff accountable for chart analysis, inpatient, outpatient, and ER coding, scanning, chart filing, Master Patient Indexing, and Birth & Death Certificates. Monitored and oversee applied Health Information Guidelines (coding guidelines, CMS, facility, regional best practices, federal and state regulations). Applied healthcare standards, (Joint Commission).

Maintained the integrity and ensured the quality of medical records by verifying their completeness, accuracy, and proper entry into computer systems. I also used computer applications to assemble and analyze patient data for the purpose of improving patient care or controlling costs. I personally coded, monitored, and maintained diagnostic coding and procedures in patient records for reimbursement and research. Audited content and completion of the legal health record, which validated the document content. Educated clinicians on documentation and content to support the DRG's.

EDUCATION

Health Information Management Degree, 1982

Eastern Kentucky University Richmond, Kentucky

Licensure: Certified Professional Coder Registered Health Information

Technician

Certified Professional Coder Instructor

Physician Coding Specialist

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