Coding Specialist
Resume:
Donna Irons, CCS, CHTS-IM
Los Angeles, CA *****
*****.*****@*********.***
Professional Summary:
Candidate is an AHIMA certified Coding Specialist who specializes in CMS HCC/RADV Medicare Risk Adjustment Coding, HEDIS review, Charge Code Capture, Home Health, E&M Coding, Clinical Documentation Improvement (CDI), Long Term Care, Workers Comp, Professional and Facility Based Coding. Code complex medical records utilizing ICD-9-CM, CPT, HCPCS and coding conventions. Audit medical records to ensure specificity of diagnoses and procedures to ensure appropriate and optimal third party reimbursement. Work closely with physicians and educate them and other personnel on coding practices and conventions to provide detailed coding information or gather additional documentation. Thorough knowledge of clinical documentation requirements as they relate to the classification systems, MS-DRG assignment, and clinical conditions and treatment needs of the patient population. Experience in chart assembly, abstracting, analysis, MPI cleanup, release of information, etc. Successful completion of an academic curriculum in medical records science at an AHIMA accredited school. Detailed, organized, and analytical with professional communication skills. ICD-10 Proficiency Certification.
Technical Summary:
Experienced with various encoders and abstracting software, Word, Windows, Access, Internet, Power Point, Excel, Outlook, Epic, HealthConnect, Quantum, Ingenix, 3M, various EMR/EHR softwares, various billing software, claims, etc.
Education:
Cypress College - Completed HIT Workforce Implementation Manager Program & HIT Workforce Trainer - March 2011. Passed HIT Pro Implementation Manager Exam 8/31/2011.
East Los Angeles Community College - Completed AHIMA Approved Coding Specialist Program - May 2002
Detailed Work Experience:
Aids Healthcare Foundation, Hollywood, CA. Risk Adjustment Coding Analyst. 9/2016 – Present.
Performs Risk Adjustment Coding, medial record reviews (Risk Adjustment & HEDIS reviews) and abstraction of codes effectively from medical records for the purpose of ensuring quality and timely care of the Health Plan’s members as well as correct reimbursement. Collecting, assessing, monitoring and documenting claims and encounter coding information as it pertains to Hierarchical Condition Category Codes, verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on the documentation of services rendered.
In addition to review and abstraction responsibilities, the RACA collaborates with the Medical Director in the development and presentation of provider educational sessions and/or individual provider consultation(s) on clinical documentation, medical coding, CMS/State requirements and revenue cycle processes; collaborates with the department manager in designing and implementation of risk assessment tools to enhance the identification of chronic medical conditions among the Plan member population
Wilshire Valley Therapy Center, Encino, CA. Billing Consultant 2016 – 2021. Billing, coding, credentialing, collections, insurance verifications, referrals, authorizations, bookkeeping, EOBs, denials, appeals, etc..
COSC, Beverly Hills, CA. Coding & Billing Consultant 7/2012 – 12/17. Same day surgery and outpatient coding and billing. Provide expert witness testimony on workers compensation cases. Workers Comp bill review – billing, collections, and coding. Conduct documentation and compliance issues review. Provider education.
Environment: Same day surgeries and outpatient.
Altegra Health, Los Angeles, CA, Blue Shield. Senior Compliance Auditor 12/11 - 7/2012. (Contract Temporary Position)
Responsible to ensure complete timely and accurate reporting to CMS regarding ICD-9-CM/MS-DRG/HCC validation audits. Conduct audits of departments involved in delivery of administration of Blue Shield Medicare Advantage Plans for compliance with CMS and Blue Shield standards. Prepare analysis/reports based on audit results, including recommendations for corrective action. Maintain records of audits and follow-up of corrective actions. Manage Medicare compliance initiatives and other projects as delegated by the Manager.
Environment: HCC/RADV coding, compliance, and education
Healthcare Scouts Winter Park, FL, Scan Health Plan - Long Beach, CA. CMS/RADV Lead Coding Consultant 1/11-12/11. (Contract Temporary Position)
Medicare Risk Coding Audit (HCC) consisting of abstracting diagnoses from provider documentation, compliance, and provider education. Identified training needs for team members. Provided coaching and guidance in an effort to increase overall work productivity and accuracy. Evaluated the accuracy and consistency of coded clinical data quality results and reports on the accuracy and consistency of the data in accordance with accepted and established standards. Provided expertise in the use and application of coding classifications and record documentation to ensure compliance in the collection of diagnosis and services.
Environment: HCC/RADV coding, compliance, and education
CodeMed, Los Angeles, CA, Rancho Los Amigos National Rehab & Acute Care Center. Coding Consultant 5/10-12/10. (Contract Temporary Position)
Coding of cases involving multiple body systems and co-morbidities, accurately selected principal diagnosis, sequenced diagnoses and procedures. Abstracted patient medical records. Ensured that all relevant medical documentation is included in patient medical records.
Environment: Same day surgery coding and outpatient specialties coding
The Coding Source, Los Angeles, CA, Cedars-Sinai Hospital, Riverside County Hospital, Various Medical Groups and Physician Offices. Coding Consultant/ Auditor 1/08-4/10. (Contract Temporary Position).
Medicare Risk Coding Audit (HCC) consisting of abstracting diagnoses from provider documentation and compliance. Audit health risk assessments for HCC coding compliance and to identify inaccurate diagnosis coding. Demonstrated knowledge of ICD-9-CM and CPT coding guidelines, medical terminology, anatomy, and physiology. Assures that all compliance standards are met. Coded outpatient specialties and abstraction of patient records.
Environment: HCC coding and outpatient specialties coding
Peak Health Solutions, San Diego, CA, Kaiser Permanente Los Angeles. Professional Services Coder 2007-2008. (Contract Temporary Position).
Hospital/Surgical coding with a variety of patient diagnoses, procedures and visit types (emergency room, inpatient, outpatient, same day surgeries, and ancillary services) including physician/professional fee based coding. Coding of all diagnostic and operative information from the medical record using ICD-9-CM, HCPCS, and CPT coding classification. Optimize hospital payment legitimately and ethically by utilizing approved coding guidelines and conventions. Verified and abstract all medical data from the record to complete a data abstract on each encounter.
Environment: Inpatient, outpatient, same day surgery, and emergency room
CodeMed, Los Angeles, CA, Kaiser Permanente Pasadena, West Los Angeles, and Los Angeles, and Centinela Hospital. Lead Coding Compliance Auditor/Consultant 2004-2007. (Contract Temporary Position)
Medicare Risk Coding Audit (HCC) consisting of abstracting diagnoses from provider documentation, provider queries, and provider education. Identified through focused audits operational and regulatory issues related to coding documentation and compliance requirements ensuring that appropriate documentation is maintained to comply with Federal and State requirements. Formulated recommendations for future training and areas of education and focused based findings. Used independent judgment and sensitivity, review with individual physicians their audit findings and make suggestions for coding improvements. Provided coding and abstraction of patient records. Coder training and supervision.
Environment: HCC coding. emergency room, same day surgery, ancillary, and outpatient specialties coding
Hospital Employee Labor Pool, Cypress, CA at Martin Luther King Hospital & USC Medical Center. Medical Records Coder 2002-2004. (Contract Temporary Position)
Provided coding and abstraction of patient records. Ensure compliance with local audit plan and act as communicator link regarding changes to Federal and State government billing and coding guidelines. Provide physician education on audit findings. Identify coding risk areas and ensuring that appropriate documentation is maintained to comply with Federal and State requirements.
Environment: Inpatient, outpatient specialties, emergency, and same day surgery coding
Associated Record Technician Services, Culver City, CA at Tri-City Medical Center, St. Joseph Medical Center, Irvine Medical Center, & Roybal Health Center. Coder and Medical Records Tech 1999-2002. (Temporary Contract Position)
Medical Records Technician - Supervised and trained clerical workers, directing and controlling activities of personnel in the medical records department. Process patient admission and discharge documents. Review records for completeness accuracy and compliance regulations. Plan, develop, maintain and operate a variety of health record indexes and storage and retrieval systems to collect, classify, store, and analyze information. Identify, compile, abstract, and code patient data using standard classification systems. Manage release of information in identifying the location of the components that define the legal medical record and designated record set to ensure the right information is released. Ensure policies and procedures on access, disclosure, and printing is implemented and maintained. Coder - Ensure the assignment of codes meet all legal, federal, and insurance regulations. Coding of cases involving multiple body systems and co-morbidities, accurately selected principal diagnosis, sequenced diagnoses and procedures. Provided physician education on audit findings.
Environment: Outpatient specialties coding, abstracting, assembly, analysis, ROI, provider education, etc.
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