Provides Opinion & Testimony In:
HEDIS, Patient Safety, Education, Policies, Procedures, Hospital Setting, Legal Nurse Consultant, Malpractice, Personal Injury, Wrongful Death, Standard Of Care, SOC, Damages, Evaluations, Patient Discharge, Nursing Diagnosis, Patient Care Plans, Health Education Training, Post Operative, Assessments
Expert No. 3803
Conscientious Medical Records Specialist/Auditor has high ability to maintain confidentiality. Has both a strong understanding of HIPPA requirements as well as excellent organizational skills. Strong understanding of compliance and regulatory guidelines. Looking for remote positions only.
- Expertise of medical terminology, anatomy and physiology, treatment protocols, compliance and regulatory guidelines.
- Interpret and analyze medical record documentation, research, and extrapolate pertinent health information; verification of component parts of inpatient and outpatient medical record.
- Determine all final diagnoses and procedures, collects data from all charts, paper and EMR, using pre-defined sets of measures and accurately enter data directly into an electronic health record data collection database.
- Excellent ability to research diseases and injury diagnoses, acuity of care, and procedures.
- Microsoft Word, PowerPoint, Microsoft Excel 2010 and Microsoft Access, Microsoft office.
- Planned and helped coordinate measures for patient safety and care on safety committee in hospital setting.
- Experienced in various software applications, paper and electronic medical records to include: Cerner, Epic, Meditech, McKesson, Clinicomp, Citrix, Inovalon, Chart access, e Clinical Works, ODIS, Verisk, QHSR, Navigator, MRCS, KDJ.
- CPT, ICD-9CM, ICD-10 CM, ICD-10 PCS, HCPCS II codes.
- 5+ years ‘experience in performing HEDIS medical record reviews, review audits, clinical documentation improvement and IRR over reads using multiple data programs.
- Team player, reliable, good interpersonal skills, flexible and responsive.
- Excellent verbal, written and interpersonal communication skills.
- Client and detail oriented, analytical, ability to work independently in a time-oriented environment.
- Researches all available resources on missing, conflicting or ambiguous information in the medical record
- Excellent critical thinking and problem-solving skills.
- Fourteen years in hospital setting on various units to include, ICU, telemetry, medical surgical, rehabilitation, Psychiatric, step down and cardiac care units.
- Audited medical records in a hospital setting for discrepancies in the documentation for core measures.
July 2016- Present 2016 PRN Medical Records Specialist/HEDIS auditor (Apixio)
Intergroup- Remote project based HIM services. San Antonio, Texas
Conducts research of medical records using data collection, methods, and health statistics. Imports data into their application system to validate and analyze data for a data base system they are creating for a client.
January 2016-May 2016 (HEDIS) Medical Records Specialist/Auditor (Anthem/Amerigroup)
Care National – Remote San Antonio, Texas
Conducting reviews of medical records for compliancy of data and completeness of medical records. Abstracting and auditing medical data utilizing MRCS 4.0 and KDJ.
October 2015- January 2016 (Pre HEDIS) Remote (Anthem/Amerigroup)
Care National – San Antonio, Texas
Conducting medical record abstraction using MRDB with Medicare accounts using hybrid measures for pre HEDIS season.
January 2016- May 2016 Medical Records Specialist /HEDIS/Quality Assurance (Molina Healthcare)
Insight Global – Remote San Antonio, Texas
Conducting reviews of medical records for accuracy and documentation completeness, and abstracting data utilizing CMCM.
January 2015 – May 2015 Quality Management 3/ HEDIS (Aetna)
Managed Staffing – Remote San Antonio, Texas
January 2013- May 2015 Medical Record Abstractor/ HEDIS (Aetna)
Managed Staffing – Remote San Antonio, Texas
January 2013- May 2015 Medical Record Abstractor/ HEDIS (Cigna)
Mind lance Inc. – Remote San Antonio, Texas
Medical record abstraction, accurately and efficiently conducted medical record review for HEDIS measures. Scheduled on-site visits with provider offices, clinics and other clinical facilities. Participated in required training for the company, communicated effectively and professionally with provider offices, clinics and other clinical facilities. The ability to multitask and troubleshoot problems independently. Traveled to medical facilities in specified area of regions to complete chart reviews. Review medical claims for compliance for national account services. Reviewed medical claims for compliance for national account services.
- 2016 Studying for the Risk Adjustment; HCC /CRC coding certification with OS2 healthcare for the CRC exam with AAPC.
- 2016 Certification as Certified Professional Medical Auditor (CPMA) with AAPC
- 2015 Certification Proficiency in ICD-10 CM with AAPC
- 2015 Certification Clinical Documentation Issues with AHIMA
- 2011 Bachelor of Science degree in Nursing/ Healthcare, Grand Canyon University, Phoenix, Arizona
- 2007 Registered Nurse CA
- American Health Information Management Association (AHIMA)
- Association of Health Care Auditors and Educators (AHCAE)
- American Association of Medical Audit Specialists (AAMAS)
- American Association of Professional Coding (AAPC)
- Association of Clinical Documentation Improvement Specialists (ACDIS)