Business Analyst

Emily McLaughlin, MSHI, BS, AS, RHIA, CPC, CEMC

Virginia

**.************@*****.***

Entry Level Business Analyst

I am an entry-level data analyst with over 10 years of experience in health information management roles, implementing HIPAA standards, proactively identifying vulnerable data processes and process improvement areas, and analyzing customer needs. Exceptional skills in identifying documentation accuracy, data analysis, and extrapolating healthcare documentation to accurately code visit notes. Strong commitment to building a solid analytical foundation to drive organizational goals and process improvement.

KEY QUALIFICATIONS

Data analysis

Data modeling

Electronic health record management

Process improvement

Requirements gathering

Documentation

Workflow analysis

Problem-solving

Critical thinking

Communication

Time management

Attention to detail

Adaptability

Tableau (beginning level)

SQL (beginning level)

Pivot table experience

Interest in data visualization

RELEVANT PROFESSIONAL EXPERIENCE

SAIC (Science Applications International Corporation), Reston, Virginia

Medical Coder III - Remote Full time 07/2024- 5/2025

Advanced knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM), and Procedural Coding System (PCS); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT).

Advanced knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS).

Advanced knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.

Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services and revenue cycle management concepts.

Practical knowledge and understanding of Government rules and regulations regarding medical coding, reimbursement guidelines, and healthcare fraud; commercial reimbursement guidelines and policies; coding audit principles and concepts, and potential areas of risk for fraud and abuse. Includes, but is not limited to: The Federal Register, Center for Medicare, and Medicaid Services (CMS) Local Coverage Determinations and National Coverage Determinations (LCD and NCD), National Correct Coding Initiative (NCCI) guidance, manual, and edits, Internet-Only Manuals (IOMs), and HHS-OIG publications and reports.

Practical knowledge of revenue cycle management, project management concepts, business analysis, training methods, clinical documentation improvement, and continuous process improvement processes.

Pediatrix Medical Group, Sunrise, Florida

Coding Specialist 04/2023- 05/2024

Reviews pertinent medical records for diagnosis and procedures performed and documented while maintaining strict adherence to Pediatrix compliance program guidelines.

Timely and appropriate coding of Neonatal and Pediatric services, Pediatric Cardiology, Perinatology, and Developmental and Pediatric surgery services as required to meet production needs.

Participates in OBR (Online Billing and Registration) and NextGen EPM process; entering and/or verifying all valid diagnoses, procedure codes, and modifiers discovered upon medical review of records via Claims Manager reports.

Communicates to physicians all discrepancies in coding based on the medical record reviewed.

Review and educate physicians, neonatal nurse practitioners, and other staff as necessary on documentation requirements and coding guidelines.

Communicates to Coding management any Claims Manager updates as needed.

Review claim denials from Patient Accounts through the EEC process.

Omega Healthcare Management Services, Boca Raton, Florida

Physician Coder- Remote, Part-time 5/2022 – April 2023

Understand the client requirements for certified medical coders and the specifications of the project and code the charts accordingly

Meet the productivity targets of clients within the stipulated time

Ensure that the deliverables to the client adhere to the quality standards

Exceeds productivity expectations with a score of almost 200% and over 95% accuracy

Emergent Billing LLC, Holyoke, MA

Medical Coder – Remote, Part-Time 6/2015 – 05/2022

Abstracts pertinent information from patient records. Accurately assigns appropriate ICD-9 CM/ICD-10-CM, HCPCS, and CPT codes to emergency physician services

Query providers when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes

Knowledge of and adherence to the payer coding guidelines (Medicare Part B and CCI edits), State and Federal laws, and regulatory bodies as it pertains to proper coding

Perform audits of provider services and procedures

DaVita Integrated Kidney Care Denver, CO

Medical Records Technician- Remote, Part-Time 5/2020-8/2020

Outreaches to a multitude of medical groups, specialists, and hospitals to procure medical record documentation

Serves as a key contact for clinical providers regarding medical record procurement, including timely collection and distribution of requests for medical records

Reviews medical documentation, ensuring compliance with established standards and regulatory requirements

Understands regulatory guidelines and operates within the guidelines to mitigate risk to the business

Effectively drives projects and tasks to completion

nThrive Alpharetta, GA

Coding Specialist – Remote, Part-Time 2/2019- 8/2019

Level one Trauma/ Teaching hospital experience

Selects and sequences ICD-10, and/or CPT/HCPCS codes for designated patient types including but not limited to Ancillary (Diagnostic)/ Recurring; Hospital, Clinic; Physician Pro Fee; Technical Fee, or Evaluation and Management.

Reviews and analyzes clinical records to ensure that APC assignments accurately reflect the diagnoses/procedures documented in the clinical record.

Abstract clinical data from the record after documentation review to ensure that it is adequate and appropriate to support diagnoses, procedures, and discharge disposition selected.

Act as a resource with client staff for data integrity, clarification, and assistance in understanding and determining appropriate and compliant coding practices including provider queries.

Maintain strict patient and provider confidentiality in compliance with federal, state, and hospital laws and guidelines regarding information release.

EDUCATION & PROFESSIONAL AFFILIATIONS

Temple University Philadelphia, PA

Master of Public Health in Health Informatics 5/2022

California Coast University, Santa Ana, CA

Bachelor of Science in Business Administration 8/2014

Keiser University, Daytona Beach, FL

Associate of Science in Diagnostic Medical Sonography 5/2008

Certified Professional Coder (CPC) Member #: 01344473 – American Academy of Professional Coders (AAPC) 2015– Member in Good Standing

Registered Health Information Administrator (RHIA) Member #: 2916775 - American Health Information Management Association 12/2022– Member in Good Standing

Certified Evaluation and Management Coder (CEMC) Member #: 01344473 – American Academy of Professional Coders (AAPC) 2025 – Member in Good Standing

VOLUNTEER EXPERIENCE

Torrance Memorial Medical Center Jan. 2009- Apr. 2009

Newborn Photographer

American Health Information Management Association Time 2023 – Current

Scholarship Reviewer

Respond to communications promptly.

Establish a level of involvement and attend the kickoff meeting/conference call.

Review and rank applications based on multiple criteria, ex. essay questions, high level of achievements and academic success, etc.

Evaluates solely on data presented in the application rather than the names or institutions.

Prepare to participate in a survey email to enhance the program for next year.

Contact this candidate