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Blue Cross and Blue Shield of MinnesotaRisk Adjustment Clinical Doc Improv Spec
Sep. 2021Eagan, Minnesota, United StatesDevelops and implements documentation training programs for Blue Cross Blue Shield of Minnesota’s contracted Medicare, Medicaid, and Commercial division providers. Presents education regarding clinical documentation and coding in a variety of settings. Leads the development and execution of physician education strategies, resulting in improved completeness and accuracy of clinical documentation and coding. Provides timely feedback to providers regarding clinical documentation and coding opportunities for improvement. Provides expert-level review of clinical records; identifies gaps in clinical documentation that need clarification for accurate code assignment to ensure the documentation and coding accurately reflects the severity of the condition(s) and acuity of care provided. Builds relationships, programs, and processes alongside providers that will result in more accurate documentation and coding of diagnoses. Conducts 1:1 educational sessions with physicians and providers to review the integrity of clinical documentation and coding and identify areas for improvement. Develops strategies to support knowledge transfer and testing to determine the outcome and success of training. Presents reports to Leadership and recommends training improvement plans for providers, as needed. Regularly reviews the literature to identify enhancements to medical documentation and coding requirements. Actively engages with the Provider Education Program Manager to continually evaluate and spearhead clinical documentation and coding improvement opportunities.
Specialties in General Surgery Ltd.Supervisor Coding & Billing
Mar. 2021 - Sep. 2021Maple Grove, Minnesota, United States
Rose InternationalCOVID-19 Investigation Branch - Case Investigator | Minnesota Department of Health
Jun. 2020 - Mar. 2021Minnesota, United StatesUse a web-based client resource management (CRM) platform to contact individuals with a positive COVID-19 test result to provide the information and answer questions, ascertain their contacts and information to reach contacts, and begin the process to monitor symptoms. Follow all scripts, policies, and procedures provided by the State of Minnesota. Identify individuals who have come in contact with the High Risk or infected person and gather contact information. Discuss the implications of the positive diagnoses Explain isolation recommendations Take initial information for any essential services needed to follow isolation recommendations and refer appropriately. Answer questions and assure protocols are followed for completion of case report information
Fairview Health ServicesOutpatient Coding Analyst
Nov. 2014 - Jun. 2019Greater Minneapolis-St. Paul AreaOutpatient Medical Coding Analyst November 2014 - June 2019 Fairview, Minneapolis, MN • Coded and abstracted clinical and demographic data using standardized coding regulations, abstracting rules, and CMS and Fairview guidelines • Identified and resolved clinical documentation errors to ensure integrity of data reported. • Educated multidisciplinary team members, including physicians, about frequently changing mandated regulations and guidelines to ensure compliant claims • Provided effective service by adjusting approach to reflect developmental level and cultural differences of populations served
HealthEastMedical Coder II - Multi-Specialties
Nov. 2006 - Oct. 2014Saint PaulI abstracted multi-specialties as Rheumatology, Allergy, ENT, Audiology, Neurology/Sleep Medicine, and Podiatry surgeries to mention some. I am Responsible for a variety of technical functions within the coding department that requires critical thinking and problem solving skills. Functions include: -Review Evaluation and management (E/M) for clinician services to assure appropriate billing and reimbursement. -Assigns diagnostic (ICD-9-CM and/or procedural codes (CPT and HCPCS) on all medical record types at an advanced level to ensure proper reimbursement and accurate data base information. -Interacts with clinician and other clinic/corporate departments to ensure compliance and appropriate billing practices. -Work rejections and denials in a timely manner
NorthPoint Health & Wellness CenterMedical Coder/Billing Specialist/Translator
Sep. 2005 - Nov. 2006Greater Minneapolis-St. Paul Area• Processed billings to patients and third-party reimbursement claims • Maintained supporting documentation including patient statements, keyed data, posted transactions and verified accuracy of input to reports generated • Researched and responded to patient inquiries regarding billing issues and problems • Followed up on submitted claims; monitored unpaid claims, initiated tracers • Received and receipt cash items and third-party reimbursements, posted and reconciled payments to patient ledgers • Balanced daily batches and reports as well as maintained patient demographic information and data collection systems
United HospitalData/Coder Coordinator
Jan. 2000 - Jun. 2005Saint Paul, MN• Create and implement production reports for hospitalist services, utilizing spreadsheet software. • Coordinate a database file system to update physician census in daily bases. • Work closely with physicians as a resource for accurate documentation for medical billing and denials on Third Millennium. • Coordinate the daily operations of the clinic, develop procedure, train staff, and monitor workflow. • Research new information, audit physician charts and process routine coding daily.
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