Utilization Review Medical Records
Resume:
Wanda B. Tucker, RHIT
Apache Junction, AZ. 85120
PH: 615-***-****
Education
American Health Information Management Association
Medical Record Technician Coursework
Accredited, 1977 (#14722)
Certification Examination, Certified Professional in Health Care Quality, November 1994
Volunteer State College
Gallatin, TN.
1 semester CPT Coding classes
University of Southern California
Tumor Registry Training Program, 1980
San Bernardino Valley College
Data Processing/Computer Science Courses
(1985 through 1987)
Various courses in the Microsoft Office Suite of software programs, including Work, Excel, Powerpoint, Visio etc.
Professional memberships
Member in good standing of the American Health Information Association
Track Leader for the National User’s Group of Shared Medical Systems in the area of Medical Records and Performance Improvement, 1995 and 1996
Work experience
Arizona Spine & Joint Hospital
4620 E. Baseline Rd.
Mesa, As. 851206
Manager, HIM
October 2012 – May, 2014
Responsible for all facets of the HIM department in this specialty hospital.
Calculated all statistics and presented to various committees/medical staff. Handled all requests for copies of medical records.
Retired from this position in May of 2014.
Yavapai Regional Medical Center
1003 Willow Creek Road
Prescott, AZ. 86301
Director, HIM
Oct. 2011-Oct. 2012
Interim Director/Director HIM
July 2011 – October 2013
Direction of a staff of approximately a staff of 50 employees including coding, transcription, release of information as well as all daily functions of monitoring timely completion of electronic records.
Worked very closely with the Informatics team in order to efficiently implement electronic records and procedures within the facility. (A total of 59 modules successfully went live on the same day.
Other duties included hiring and when necessary, disciplining of employees. Preparation of annual budget and monitoring monthly budge reports t to insure department was in line with finalized budget.
VMG Coding & Charge Entry
719 Thompson Lane
One Hundred Oaks
Nashville, TN. 37204
Coding Specialist I
11/06 to 6/2910
Duties involve coding of the professional charges for inpatient and outpatient services for the Psychiatric Hospital at Vanderbilt as well as inpatient coding for Vanderbilt Stallworth Rehabilitation Hospital. Utilize CPT and ICD-9-CM coding classifications to assign codes for billing purposes for these services.
Betty Ford Center
Rancho Mirage, CA.
Manager, Health Information Management
05/04 to 10/06 and 9/01 thru 02/03
The Betty Ford Center is an 80-bed inpatient treatment center for the treatment of chemical dependency. The center also provides Outpatient treatment as well as a “Residential Day Care” Program. Each of these treatment areas creates their own medical records for their patients.
Responsible for the day to day supervision and direction of medical record staff and processing all requests from patients regarding any requests for medical records or other issues.
St. Bernardine Medical Center
2101 Waterman Ave.
San Bernardino, CA. 92404
Assistant Director, Medical Records
03/03 to 05/04
St. Bernardine Medical Center is a 300+ bed acute care facility. It is one of the leading diagnostic cardiac centers in the “Inland Empire” as well as one of the most active emergency departments in the area.
Coordinate calendars and schedule various hospital wide meetings as required for Department Director. Provide clerical support for Department Director. Create PowerPoint presentations as needed for these meetings.
Insure that multiple tasks throughout the department were completed in a timely manner, including release of information, transcription, processing of ED charts, as well as all “chart room” functions.
Monitor productivity of staff, prepare work performance evaluations and participate in disciplinary action if necessary.
Arrowhead Regional Medical Center
Colton, CA. 92324
Asst. Manager, Medical Records
8/97 to 8/01 and 6/82 to 11/89
Arrowhead Regional Medical Center (formerly San Bernardino County Medical Center) is a 286-bed acute care facility with an 86 inpatient psychiatric unit. In addition, the Center also includes multi-specialty outpatient clinics and satellite Family Health Centers. The center is a teaching facility formerly associated with the University of California at Irvine. The medical center is a Level II trauma center as well as one of two burn centers in Southern California.
Duties included direct supervision of all coding/abstracting staff, release of information, must insure confidentiality of medical information with respect to release of information etc. particularly those associated with psychiatric patients, birth and death certificate processing, Cancer Registry, and transcription distribution. Must assure timely coding of all inpatient, outpatient clinic, Family Health Center, emergency department, and ambulatory surgery records using ICD-9 and CPT coding classifications. Coding and abstracting of inpatient medical records to insure timely submission of all billing documents.
Develop and implement data collection mechanisms to capture data for OSPHD and Maryland Hospital Association data in preparation for ORYX reporting requirements. Developed procedure for monitoring Clinical Completeness and reporting of it to Medical Record Committee and respective departments.
Provide various reports to hospital staff relating to specific areas of focus for studies/monitors throughout the organization, including collecting, analyzing and presentation of data. Review and analyze various types of data related to coding issues as requested by administration, i.e., Completed review of all Medicare patients who are discharged with a primary diagnosis of pneumonia due to governmental interest in fraud issues
Desert Valley Hospital
Victorville, Ca.
DIRECTOR, MEDICAL RECORDS
2/97 to 8/97
Desert Valley Hospital is a 50-bed acute care facility. This facility was physician owned during my employment, but was sold to a medical corporation.
I was responsible for the direction and supervision of the medical record department staff. Assist in the various functions of the department as necessary in order to eliminate “backlog” in coding, abstracting, record analysis etc. Developed systems to assure all coding was completed in a timely manner in order to decrease cash flow issues.
Act as resource to medical staff and administration with regard to medical record licensing requirements and similar issues.
San Bernardino County Medical Center
San Bernardino, Ca.
MANAGER, PERFORMANCE IMPROVEMENT.
2/94 through 2/97
Responsible for design and implementation of various systems and reports to obtain data necessary for performance improvement activities related to appropriateness of services and outcomes of service. Coordinate activities with other departments/programs involved in data collection and analysis; direct supervision of nursing staff assigned to the Performance Improvement Department. Present findings, recommendations of various studies to administrative/medical staff committees. Analyze and interpret pertinent legislation, federal and state licensing and accreditation standards and advise appropriate individuals.
Responsible for the complete direction of Medical Records (inpatient and outpatient), Medical Transcription and Utilization Review Departments.
MANAGER, MEDICAL RECORDS & UTILIZATION REVIEW
11/89 through 2/94
Duties include evaluation and coordination of functions in all areas. Responsible for developing and implementing policies and procedures related to all aspects of the department. Responsible for medical record content, insuring confidentiality of medical information; establishing goals and objectives, and providing continuing education for all staff members.
Oversee the concurrent chart review process performed by the Utilization Review Department to monitor medical necessity as required by third party payers. Coordinate the review process for the on site Medi-Cal reviewer to insure appropriate reimbursement for the facility.
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