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Work Background
IKS HealthVP Medical Coding Ops and Audit
Dec. 2024
IKS HealthVP Medical Coding and Audit Solutions
Dec. 2024
IKS HealthDirector
Nov. 2023 - Dec. 2024
Aquity SolutionsDirector of Coding Quality & Education
Oct. 2021 - Jul. 2024United States
Aquity SolutionsDirector of Medical Coding Quality and Education
Oct. 2020 - Aug. 2023North Carolina, United StatesResponsible for ensuring that healthcare providers, hospitals, and other medical facilities follow all coding regulations, policies, and procedures. This includes managing the training and education of coders, physicians, other healthcare providers, and billing staff on clinical documentation improvementand coding best practices; along with reviewing medical records and coding documentation for accuracy and ensuring that billing practices are per federal and state laws.• Collaborate with other departments and stakeholders to identify areas for improvement and implement best practices for coding and billing.
AtosManager Audit & Education
Jun. 2015 - Oct. 2020Texas, United StatesTrain and mentor new hires to the Inpatient/Outpatient Auditing Team.• Train and mentor new coders through audit and education process.• Work with client and internal coding management to resolve discrepancies found in coding and billing.• Work with new contract sites to Atos to build a platform/process for auditing, monitoring, educationand feedback for coders and auditors working within that specific hospital system.• Developed and implemented training tools and job aides to assist coders and auditors in properly utilizing hospital-specific programs for coding and auditing accuracy.• Develop and implement training material for Inpatient Auditors new to Atos Healthcare Solutions.• Provide ongoing mentoring for Auditors and Coders.
CGI Business ConsultingValidation Auditor
Jun. 2014 - May. 2015Ohio, United StatesInpatient Medicare RAC auditor
Upper Allegheny Health SystemCorporate Compliance Analyst/
Aug. 2011 - May. 2014New York, United StatesConducted compliance monitoring as assigned to verify compliance with established policies andprocedures and applicable regulations.• Conducted compliance assessment/review/audit of hospital inpatient and outpatient services todetermine if departments/functions are in compliance with Medicare, NYS Medicaid, and third partyinsurance, legal, accreditation and internal standards.• Prepared written reports of findings including recommendations for correction of deficiencies.• Presented recommendation to department management to insure thorough understanding ofcompliance requirements.• Investigated questions/concerns received by e-mail, voice-mail, "hotline, " drop-ins, etc., to determine specifics and provide recommendations for resolution.• Reviewed/implemented a wide variety of organization policies and procedures to ensure compliance with Medicare, NYS Medicaid, third-party insurance legal, accreditation, and internal standards.•. Maintained up-to-date job knowledge through professional reading, conference and seminar attendance.
The Arc Allegany-SteubenDirector of Residential Service
Jun. 1993 - Jan. 2010Supervised 140 Residential Staff and eight Management staff, trained new Residential Staff on HIPPAand documentation compliance for services and billing NYS Medicaid. Assisted Residential Managers withcorrective personnel action with staff as needed. Created staff reward system to reward quality serviceto consumers, compliant documentation, and least missed work days.• Supervised care for 75 consumers from ages nine to 92, with varying disabilities, Mental Retardation,Cerebral Palsy, Mental Health, Autism, Neurological impairment and/or medical issues. Developedindividualized program for young men with Autism transitioning from school to work. Developed end oflife care protocol for all consumers served. Screened all referrals for OMRDD eligibility and best placementopportunities within the program.• Performed Administrative duties of budget management for NYS Medicaid funded program, submitted grants and funding proposals to appropriate State, Federal and Private agencies. Performed quality assurance/Compliance audits on each Residential environment, staff care duties, consumer money management, documentation, service records and regulation compliance on a regular basis. Created,implemented and trained on policy and procedures relating to the program.• Served on the internal Corporate Compliance committee, wrote internal policy and procedures based on State/Federal regulations regarding program documentation compliance, billing, HIPPA, and corporate
compliance, and provided services.
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