Health Care Medical Records

DINA ELRAZKY CPC, CPMA, CRC, CPB, BA, BS *** ***- 9088 ********@*****.***

Professional Profile: Accomplished Certified Outpatient Professional Compliance Educator, Coder, and HCC auditor with more than 14 years' experience for various specialties' but not limited to outpatient, inpatient, observation, hospitalist, HCC, CDI, and working with charge capture and revenue cycle. Expert with risk adjustment, HEIDS measurements, ancillary services, and performing EKG Interpretation nephrology, emergency room, and urgent care.

Core Competencies:

●Demonstrates thorough understanding of documentation rules and ability to audit ICD10, CPT procedures from medical records according to coding guidelines.

●Strong leadership experience with Clinical Documentation Improvement (CDI), physician fee schedules, and payment accuracy initiatives.

●Expert with Clinical Documentation Improvement as it relates to HCC and HEDIS Measurements.

●Expert with Risk Adjustment Analysis based on Medicare, Medicaid, and Market Place guidelines.

●Proficient with various Computer Skills and Applications such as Epic, CAC, Encoder Pro, 3M, McKesson and Cerner, Excel, Power Point, Outlook and Microsoft Word.

Optum/United Health Care (formerly known as Episource).

Medical Auditor II. (June 2023-Present)

Conducts audit reviews related to Coding Compliance initiatives and communicates/collaborates with Manager and other teams regarding audit outcomes and educational areas of opportunity.

Prepares written reports of audit findings from coders and presents them to Managers and Physicians.

Audit and/or abstract code medical record backlog for proper assignment of diagnoses specificity (including HCC/risk adjustment concepts) procedure codes, units, sites, modifiers, drugs, supplies.

Work with Management to develop coding, /documentation educational approach, presentations, and Audit Team scope of review for Provider educational purposes

Maxim Health Staffing: (Client Cognizing, Optum).

Senior Medical Auditor for HCC Coding (August 2023-June2024) .

Responsible for verifying medical documentation based on ICD10 guidelines.

Abstracted HCC Medical Records based on provider documentation.

Maintained 100 % audit for medical coders Level I and Level II.

Strategic Solution Staffing: (Client Trinity Health Care Systems).

Medical Auditor for the revenue cycle for Trinity Health Care (May 2023-July2023)

Represented leadership staff at meetings in their absence. Ensured expectations are developed, controlled, and executed in a timely manner.

Maintained 100 % compliance for several Department by making sure that procedures and EM leveling are coded appropriately using RAT-STAT analysis, and random sample auditing specifically for Teaching hospitals.

Compiled and presented reports on findings to the CEO Major for quarterly audits done on several practices.

Randstad Technologies.

Medical Auditor and Coder for CVS Health Care (November 2022-March 2023)

Developed and implemented risk assessment for ICD-10 diagnosis and provided new CPT guidelines based on the AMA and CMS regulations.

Audited records by coders and developed solutions to assist in the identification and mitigation of compliance risks and strengthen any deficiencies which they might have.

Tracked and managed corrective action plans to address identified compliance risks and deficiencies.

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Professional Experience: Based on Short- & Long-Term Contracts.

Trust HCS Company, now known as Corrohealth.

Remote Medical Coder/HCC November 2018-March 2023.

Responsible for auditing and abstracting ICD-10, and CPT procedures for maximizing revenues.

Attended weekly meetings to review any problems or clinical deficiencies that arise.

provided continual coding and payer updates to the billers, coders, and management team.

Harmony Healthcare, TAMPA BAY- FLORIDA July 2018 –July2019

Medical Remote Lead educator/auditor

Performed medical record reviews and used coding principles to code to the highest specificity by complying with CMS and NCQA regulations as well as company goals and policies.

Performed Quantitative and Qualitative analysis of paper and electronic medical records for completeness, consistency, and accuracy.

Performed risk adjustment data validations using AHA coding guidelines.

Interacted with coders to communicate value added information such as missing diagnosis and CPT procedures and made improvements to implement policies and procedures for

Reventrics/Omega Health Care

Project Auditor for the Emergency Department for Coding and billing. (July 2022-November2022)

Assisted with the management team on developing policies and procedures for the new EM guidelines for 2023.

Audited new coders on a weekly basis by making sure that all documentation is captured and coded accurately.

Reviewed the productivity report daily for coders and establish new guidelines for training new coders on board.

Communicated with Department/Director regarding areas of risk as related to EM leveling (under or over coding) based on time or Medical Decision Making.

US Medical Management: Troy. Michigan

Medical auditor for HCC (June 2020 -Jun2022)

Audited and reviewed retrospective and concurrent coding for PACE (Programs of All-Inclusive Care for the Elderly) Dual participants with regards to HCC diagnosis coding for Medicaid and MarketplacInsurance.

Continually identified new edits to drive incrementalsavings from the CMS website.

Researched and referenced various documents to support billing processes and support organizational compliance efforts.

Conducted audits and participated in provider education programs to ensure compliance with CMS diagnosis and procedure coding guidelines.

Communicated with Department/Director regarding areas of risk related to HCC coding based on medical documentation .

Henry Ford Health Care Systems Detroit MI TEACHING HOSPITAL LEVEL I TRAUMA

Complex Medical Coder/ September 2017-September 2022

Conducted practice backlog for coding and billing and assigned different assignments for the team to work on.

Assisted physicians in determining appropriate issues of coding for maximizing reimbursement for physicians. Educated coders for establishing policies and procedures for CCI edits with complex procedures, and global services.

Analyzed complex medical records and identified missed billable services (such as EKG and lab services)

Audited coder’s charts to ensure medical documentation based on ICD-10 and CMS guidelines are documented correctly.

Communicated with physicians missed revenue due to lack of documentation.

Education:

American Academy of Professional Coders (AAPC) - 00080623

Certified Professional Coder (CPC) 2003

Certified Professional Medical Auditor, (CPMA) 2016

Certified Risk Adjuster Auditor, (CRC) 2020

Certified Professional Biller, (CPB) 2021

Eastern Michigan University, Ypsilanti, MI Bachelor of Arts, (BA) 1996 Major: Health Administration. Michigan State University, East Lansing, MI. Bachelor of Science (BS) 2003. Major: Nutrition and Dietitians with focus on Anatomy and Physiology and Pharmacology.

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