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Work Background
Annova SolutionsAVP - Risk Adjustment and Coding Services
Feb. 2024Colorado, United StatesAs AVP of Risk Adjustment & Coding, I am responsible for overseeing expansion & execution of Annova's services in US Healthcare, including RA, HEDIS/Quality abstraction, SDOH capture, and other coding and Revenue Cycle activities.
ReveleerDirector Clinical Operations
Mar. 2023 - Jan. 2024United StatesDirected a team of over 150 in HEDIS and Risk Adjustment operations for major national and regional health plans with high levels of independence and minimal oversight.
• Created and implemented project plans which met demanding production milestones for Risk Adjustment and Quality.
. Directly managed multiple simultaneous projects under tight deadlines; successfully completed 40,000+ medical records reviewed and submitted within a three month window and on-deadline.
• Identified and solved for coding/abstraction reporting system errors (employee productivity and quality), which prevented up to nine employees from being inappropriately terminated due to wrongly data analysis.
• Educated platform-focused clients on in-house National Language Processing (NLP) system and Quality/Coding capture.
• Updated quality-related training materials in accordance with NCQA and other government regulation, including client-facing materials.
• Completed debrief material and conducted client-facing post-project meetings for Risk Adjustment and HEDIS/Quality projects.
Evolent HealthAssociate Director, Risk Adjustment Coding and Audit
Sep. 2018 - Feb. 2023Arlington, VADirector of coding and audit activity across multiple health plans and care delivery organizations administered or owned by Evolent Health in the arena of Risk Adjustment (Medicare Advantage, Part D, Medicaid (multiple states), and Affordable Care Act). Responsible for accuracy of all Risk Adjustment coding projects and HCC/CDPS diagnoses for submission to government agencies. SME for design and development of Risk Adjustment coding programs and in-house Natural Language Processing (NLP) coding platform. Designed and presented extensive educational materials in a variety of formats for medical providers, office staff, health plan executives, account managers/representatives, and other internal clients, with the particular goal of enhancing provider documentation and coding accuracy.
himagine solutions inc.Compliance and Quality Audit Manager
Sep. 2017 - Aug. 2018RemoteClient interface and management of a team of auditors to assess coder quality and provider documentation standards on behalf of care delivery organizations. Audit of all aspects/settings for coding (professional/facility, inpatient/outpatient/office). Created and presented post-audit reports and client education. Company-wide expert for Risk Adjustment/HCC audit projects and coding. Developed Risk Adjustment audit program from scratch, educating executive management and auditors.
Episource LLCDirector, Coding Services
Aug. 2010 - Aug. 2017La Palma, CASubject matter expert and educator for all aspects of medical coding, specializing in Risk Adjustment coding environments (Medicare, Medicaid, ACA). In seven years, I was a major force in award-winning organizational growth: medical records reviewed increased from 100,000 to 5 million (+5000%), and revenue multiplied 25x. Health Plan clients experienced an average 10x ROI on coding projects during this time. Episource moved from a niche provider to one of the major vendors in the Risk Adjustment space during my time as leader of coding activities, now counting 4 out of the largest 5 American health plans among its clients.
American Academy of Professional CodersLocal Chapter Secretary
Jan. 2010 - Dec. 2010
Carrington CollegeMedical Billing and Coding Instructor
Apr. 2009 - Apr. 2011On-ground college instructor in all aspects of medical billing and coding. Subjects include medical terminology, ICD-9-CM, CPT and HCPCS coding, medical office and records management, insurance plans and regulations, billing guidelines, government regulation and ethical considerations for healthcare professionals.
LovelaceLead Clinical Coder, Medicare Risk Adjustment
Mar. 2009 - Jul. 2010Coding team leader for New Mexico’s largest Medicare Advantage insurance plan. Designed and executed audits for CMS compliance and capture of Hierarchical Condition Categories (HCCs), with emphasis on audit methodologies and clinical correlations for efficient chart selection. Lead coder on team of professional medical auditors, advised and educated coding staff.
Maxim Healthcare ServicesRemote Coder
Jan. 2008 - Dec. 2008
The Coding SourceHCC Coder
Jan. 2007 - Dec. 2009Consultant for numerous client health care organizations, including auditing of records and preparation and presentation of findings for provider education. Chart review both on-site and remote, with emphasis on Medicare Advantage Risk Adjustment (HCCs).
Presbyterian Healthcare ServicesEWC Auditor
Jan. 2006 - Dec. 2007Physician educator and auditor across multiple specialties, inpatient and outpatient settings. Created and presented training materials for both providers and coders. Performed coding audits and presented specialized training for individual providers’ needs. Worked denied claims and corrected coding errors. Specialized experience in Emergency Medicine coding (professional and facility).
Precyse SolutionsCCE Consultant
Jan. 2005 - Dec. 2007Coding consultant at various client sites, for coding and auditing major hospital systems, with emphasis on inpatient and outpatient E/M. Duties include mentoring and instructing coders on-site, correcting coding errors, reporting audit results, and coordinating with client management. Strong ability to work independently. Full-time travel on major assignments, with remote coding between assignments.
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