Medical Project Manager
Resume:
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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