SENIOR LEVEL CONSULTANT | OUTPATIENT & PHYSICIAN CODING | CHARGE CAPTURE
Medical coding and auditing professional with proven ability as an independent problem solver and self-starter with a high level of accountability. Strong knowledge of coding guidelines including Charge Capture, CPT-4, E/M 95 and 97 professional guidelines Facility and Physician, HCPCS, Modifiers, ICD-10, and Revenue Integrity Management/Project Management. Extensive experience coding EMR remotely in addition to claims review, and compliance review in hospitals and multi-specialty settings including knowledge of numerous managed care contracts and government contracts.

CORE COMPETENCIES
 Charge Capture  Charge Master  Pharmacy/Supply HCPCS Codes  E/M Reviews  ICD-10
 Professional E/M Charges facility  Medicare & Medicaid  Compliance/Billing Coding
 Outpatient & Multi-specialty Coding  Project Management
 Medicare & Medicaid Litigation Auditing

PROFESSIONAL EXPERIENCE

Vitalware, Yakima Washington 2017 to 2019                                                                                                                                                                                                                                  Chargemaster Solutions, Senior Revenue Integrity Consultant

Vitalware chargemaster solutions make the business of healthcare easier through intuitive cloud-based technologies and advanced knowledge sharing.
Provide a thorough internal assessment to identify if you are in compliance with your own internal charging practices, using Medicare rules as a default. Identify corrective actions to promote complete and correct charging as well as compliance.
Achieve compliant billing and charge capture processes at the foundation of the revenue cycle, the CDM. Focus on major hospital clinical departments providing outpatient services.
Standardizing multiple CDM facilities, consolidate, review and create a cross-reference of current individual hospital CDM charge items for a new Enterprise CDM.
Consultation and support help to manage and maintain a compliant chargemaster to optimize reimbursement while reducing the risk of improper billing practices.
Audit records and claims to minimize compliance risk along with: Optimize revenue reimbursement opportunities, improve clinical documentation practices, ensure appropriate capture of severity of illness (SOI) and risk of mortality (ROM), survey and rapidly reduce risk of improper claims rejections, underpayment, overpayments, audits, fines, and penalties, identify regulatory changes that impact services and delivery

FTI Consulting, Washington D.C. 2015 to 2017
Independent global business advisory firm dedicated to helping organizations manage change, mitigate risk and resolve disputes within multiple industries including healthcare.
Senior Consultant
Focused on implementing a process whereby there is a clear connection between clinical services and billable events while utilizing the client’s IT capabilities to generate automated coding and billing information. Proper charge capture, coding, Coding analyst, and final claims reporting with importance on the clinical documentation requirements.
• Assist Litigation Consulting practice providing compliance investigations, an audit of E/M Physician Professional records to ensure correct medical billing with thorough reporting and documentation to legal counsel; Reviewing contracts for fraud, breach of contract, business interruption, and lost profits
• Professional Physician coding audits E/M focused for Emergency Room, Critical Care, Oncology, Consultations, ICD-10, and Midlevel Providers resulting in education for opportunity and process design
• Hospital UB-04 and physician 1500 claims reporting analysis coding to account follow up; Implement a workflow of resources that will impact proper revenue outcome and potential reduction of force. E/M focused engagements for physician education.
• Charge capture coding audit for multiple clinics including facility procedures and non-billable coding education; Utilizing IT capabilities to generate automated coding and billing information with accuracy.
Independent Consultant 2013 to 2015
Healthcare Coding Consultant Independent Contractor
Contracted with a Software Consulting firm for Chargemaster maintenance with revenue cycle efficiency analysis, charge capture process evaluation and re-design, coding and billing compliance, and achieving appropriate third-party reimbursement. Restructured ED levels for the facility customizing the charge capture process. Provided coding audits for ED levels along with CPT procedural coding.
Contracted with a healthcare system for Professional Physician Coding Audits for specialized outpatient office and surgery procedure claims to ensure consistent documentation, coding, and claim payment data.
Other Key Client Engagements:
• Professional Physician E/M Coding and Auditing for freestanding Clinics along with ED and Critical Care
• Emergency Department coding as well as technical and professional E/M codes to patient charts, ICD-10, and entering data and maintaining logs. Education to the staff and nurses regarding injection, infusion and other clinical documentation compliance.
• Resolving CCI edits reviewing medical records. Conducting ongoing billing audits. Utilized CMS, NCD, LCD policies to ensure proper billing and coding with integrating new policies to staff.
• Provided inpatient and outpatient coding backup during schedules/unscheduled employee absence for facilities.

WEISERMAZARS, New York City, NY 2012 to 2013
A boutique healthcare consulting firm Revenue cycle transformation, Health Information Technology Solutions, and reimbursement methodologies in managed care. Provides clients with chargemaster management to optimize reimbursement, and assist in lost revenue.
Senior Associate
Directing clients through the charge capture redesign and implementation of improved business and coding processes and the integration of new technology by assessments, productivity models, and monitoring new processes, and customizing the facility their full reimbursement potential.
• Provided chargemaster reviews, order entry reviews, supply chain, and pharmacy reviews. Presenting staff education on coding and documentation requirements. Assisted clients with the development of policies and procedures related to chargemaster maintenance and medical necessity requirements.
• Coding Analyst and streamline billing workflows through concentrated clean-up of UB and 1500 edits in the claims scrubber application. Performed a comparison of medical records to determine the appropriateness of the provider’s medical/clinical documentation to substantiate and support charges, and compliance with CMS guidelines.
• Demonstrate a high level of communication, coordination, and integration of the project work with all areas affected, including vendors. Travel 20% to 50%.
CRANEWARE, INC, Atlanta, GA 2009 to 2012
A leading supplier of revenue cycle software that provides clients with chargemaster management products to optimize reimbursement, assist in lost revenue, pricing, and revenue cycle workflow.
Business Solutions Consultant
Implementation of 6 Revenue Cycle software products including charge capture ensuring claim accuracy, reducing compliance risks, regulatory resources, chargemaster management processes, and standardization and management of corporate chargemaster. Assisting inaccuracy with the patient financial system data.
• Implemented Corporate Bill Analyzer charge capture product for 6 hospitals; engaged in special projects such as Routine Supplies, Pharmacy Self-Administered drugs, Radiology Best Practice and Respiratory
• Therapy Documentation Education.
• Provide chargemaster reviews in cooperation with Revenue Integrity, Health Information Management, Billing, Ancillary Department heads, Finance and Administration for every outpatient department in a
hospital for compliance, intent of service, Medicare regulatory requirements, additional revenue opportunity.
• Billing/Coding reviews of claims identifying billing edits for potential revenue opportunity, CCI edits, Diagnosis, compliance issues, system edits, and documentation requirements.
• Team of the Year Award for 2011
• Travel 45% to 75% nationwide
3M Health Information Management/Consulting Services, Atlanta, GA 2002 to 2009
A worldwide healthcare information company specializing in consulting services to help healthcare organizations capture, classify and manage accurate healthcare data. A provider of consulting with advanced software tools, coding audits, revenue management, educational seminars, and assistance with implementation.
Outpatient Consultant
Chargemaster services include staff education, process improvement, and assistance with implementation. OPPS training for each department within a hospital on CPT-4 coding issues, regulatory compliance, and pricing methodology for each department. Review UB-04, medical records, and last remittance advice to identify problems and recommend corrective actions in compliance with relevant laws and regulations. Implementing and maintaining a live charge master tool in various facilities providing the client with on-going technical and consulting support.
• Successfully implemented startups of a chargemaster live tool in 4 rural hospitals independently within 2 months.

APC Assurance reviews consist of a Coding Validation, charge process review, and revenue management. Evaluates charges for accurate structure in the APC payment environment. Improves delayed payments and prevents denials. Streamline revenue performance with efficient documentation, charge capture, and accurate coding.
• Billing/Coding audits for outpatient special procedures. Recognize coding errors, items failing Medicare’s Outpatient Code Editor, and use of modifier reporting. Assess individual line items of the hospital’s itemized statement, order entry system, Medicare record documentation, and UB-04s.
• Detailed reports to hospital’s coding/billing staff for all consulting services of unbilled services, data entry errors, and proper bundling of charges. Recommendations for appropriate use of revenue codes, modifiers, and E/M levels based on the hospital’s general practice is provided.
• Served on the litigation team for audit and compliance of the medical documentation.
• Travel 25% to 75% nationwide.

PREVIOUS RELEVANT EXPERIENCE
INGENIX/ST. Anthony/Publishing – Data and Advisory Healthcare Consultant
Impact Healthcare Services, Inc. – Assistant CDM Compliance Director
Dynamic Imaging – Billing Manager
Orlando Regional Healthcare Systems/MD Anderson Cancer Center – Referral Specialist
Orlando Regional Health Affiliates – Office Assistant II
Orlando Regional Medical Center – Outpatient Analyst

Bachelor of Science, Health Services Administration – University of Central Florida, Orlando FL
CPC, Certified Professional Coder