Yolanda Fogle, RHIA

**** ******** **. *** ***, Jacksonville, FL 32246 Mobile: 904-***-****

SUMMARY

• 9 years of experience in medical billing and medical record policies and procedures in a variety of clinical settings.

• 5 years experience as a Medical Coder.

• Proficient in inpatient, acute care coding, outpatient, physician and ED coding.

• Experience with the Revenue Cycle, Medicare, Medicaid, HMOs, PPOs

• Assisted with projects involving HIPAA 4010/5010; ICD-10 training and mapping.

• Experience using several ICD-10 mapping tools, including ICD-10-CM/PCS GEMS, CodeItRightOline mapping tool, 3M ICD-10 Code Translation tool and AAPC’s code translation tool.

• Tested STAR Financial and STAR Patient Care STI’s and worked with IT personnel to resolve system issues.

• Conducted EHR implementation assessments; analyzed the goals of the organization and helped developed budget and technical needs.

• Tested billing and claim load edit parameters with McKesson Star for accurate billing processes in Claims Administrator.

• Oversaw two project implementations assisting with project objectives, requirements, and schedules.

• Analyzed workflows, including patient registration, billing and coding. Assisted with refining processes to develop a more efficient process leading to reduced rework.

• Conducted A/R assessments to help develop a plan to reduce high A/R, which included redefining workstations that were causing claims to get lost in the follow-up process.

• Analyzed billing denials and assisted with developing a denials management program, which helped to uncover incorrectly denied claims and appeals, coding and billing issues.

EDUCATION & CERTIFICATIONS

Florida A&M University, Tallahassee, FL, BS, Health Informatics

Louisiana Tech University, Ruston, LA, MS in Health Informatics

Registered Health Information Administrator (RHIA) AHIMA

AHIMA Approved ICD-10-CM/PCS Trainer

SYSTEM & SOFTWARE EXPERIENCE

Claims Administrator, AllscriptsPM, AllegianceMD, McKesson, &Cerner, Microsoft Office

3M Encoder and Ingenix Encoder Pro

EXPERIENCE

Health Informatics Associates November 2011 to September 2012

Healthcare Consultant

• Performed impact and process improvement assessments; conducted workflow analysis.

• Consulted with hospitals providing coding expertise and evaluated clinical documentation to insure it will support ICD-10 coding.

• Forward and backwards mapping between ICD-9 and ICD-10-CM/PCS.

• ICD-9-CM and ICD-10-CM/PCS coding for acute care, outpatient and ED settings.

• Provided education to various users including, IT personnel and medical staff on ICD-10-CM/PCS and ICD-9-CM, including the format of code sets.

DOC’s Billing, Jacksonville, FL July 2011 to October 2011

Health Information Management Consultant

• ICD-9-CM and ICD-10-CM/PCS coding for inpatient acute care, outpatient and ED settings.

• Forward and backwards mapping between ICD-9 and ICD-10-CM/PCS.

• Worked with various staff members providing system support with AllscriptsPM.

• Acted as a liaison between patient accounting departments, clinical and professional staff to ensure accurate billing and coding.

Personal Injury Physicians, Jacksonville, FL March 2010 to August 2011

Medical Office Administrator

• Assigned ICD-9-CM and CPT codes to physician office encounters.

• Audited medical records monthly for compliance to practice and documentation standards.

• Developed training curriculum for medical coders, billers and medical staff to ensure compliance with office procedures.

• Managed 4 to 6 employees, including off-site transcriptionist; oversaw daily operations of the medical front office, including patient flow, scheduling, referral management, collections, medical billing and coding.

• Trained medical coders on ICD-10-CM/PCS, including benefits and the effects on users and day to day operations.

• Forward and backwards mapping between ICD-9 and ICD-10-CM/PCS.

• Oversaw software implementation; trained medical billers and office staff on Allegiance MD system.

• Conducted educational programs on claim denials pertaining to coding, billing and medical necessity issues.

• Educated coders, medical staff and IT personnel about the differences between the classification of diseases and procedures in ICD-10, including the format of code sets.

• Collected funds in excess of $150k through a self-initiated medical coding and billing audit.

Tallahassee Memorial Hospital, Tallahassee, FL

July 2005 to March 2010

McKesson STAR Applications Analyst 2008 – 2010

Medical Coder 2005– 2008

• Reviewed medical record documentation to select and sequence the appropriate ICD-9-CM diagnosis and procedure codes.

• Coded inpatient, emergency room, observation and same day surgery records.

• Initiated physician queries in compliance with company policy where appropriate.

• Tested billing and claim load edit parameters with McKesson Star.

• Worked the payback report and all aspects of Claims Administrator.

• Participated in revenue cycle enhancement projects to improve processes and ensure system optimization.

• Tested STAR Financial and STAR Patient Care STI’s and worked with IT personnel to resolve system issues.

• Provided system support for all aspects of McKesson’s STAR products, including patient access, Accounts Receivable Workstation and Claims Administrator.

• Reviewed payer contracts, fee schedules and provided prior authorizations support.

• Performed medical billing using Claims Administrator.

• Conducted training classes for McKesson Star and Claims Administrator.

• Educated non-clinical users and clinical users, IT personnel and medical staff about the differences between the classification of diseases and procedures in ICD-10-CM/PCS, including the format of code sets.

ACS Healthcare Solutions, Tallahassee, FL August 2003 to May 2005

Customer Care Supervisor 2004 – 2005

Lead Medical Coder 2003 – 2004 .

• Coded for acute care, ED and outpatient encounters assigning ICD-9 and CPT codes.

• Reviewed medical record documentation to select and sequence the appropriate ICD-9-CM diagnosis and procedure codes.

• Initiated physician queries in compliance with company policy where appropriate.

• Managed 40-50 employees; oversaw call center operations, claims processing, and prior authorizations.

• Assisted the Project Manager with the Department of Energy project by coordinating project management activities with appropriate sponsors and stakeholders.

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