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2009 - Current Providence Health Plans Beaverton, OR
Manager of the Special Investigations Unit
§ Manage
the day to day operations of the Special Investigations Unit auditors.
Conduct investigations to detect and prevent fraud, waste, and abuse. Work
with legal counsel to complete actions necessary for recoupment of monies or
assessment of punitive actions.
§
Consult with compliance and coding
administration to educate members, providers, and customers of Providence
Health Plan regarding accurate coding, billing and revenue cycle management.
2008 - 2009 RMC,
Inc. Portland, OR
Physician Coding Consultant
§ Support
RMC clients, this to include; on-site coding support, remote coding services,
auditing and review services, education and training. Conduct audit of CPT,
ICD-9-CM, HCPCS, and other codes by reviewing documentation and billing
documents. Apply coding and compliance guidelines and rules against
documentation. Compile audit findings by submitting notice of up-coding, down
coding or missed codes on RMC, Inc. forms. Provide summary of audit findings.
Seek continual education and stay abreast of payer and government policies
and guidelines. Provide educational talk points for client education. Create,
present and maintain coding and billing education for clients and RMC staff.
§
Practice Management Consulting – Support
clients seeking recommendations for best practices and better results with Business Operations, Financial Management,
Human Resource Management, Information Management, Organizational Governance,
Patient Care Systems, Quality Management, Risk Management
2005 - 2008 Sunset
Pediatrics, LLC Portland, OR
Clinic Administrator
§ Plan,
organize, and manage business operations and activities of the clinic
achieving efficient clinic operation and maximum service to ensure quality
patient care. Developed, revised, and promoted the annual goals. Reviewed and
negotiated contracts with third party payers, managed care organizations.
Oversaw the purchasing and payables of supplies and equipment. Maintained policies and procedures. Provided
financial and statistical information necessary to make informed decisions
regarding the business operation. This
included, but was not limited to, production numbers, collection rates,
patient encounter data, new patient data, and insurance types. Participated
in the development and implementation of plans and budgets; monitoring and
controlling facility expenditures within the budget. Monitored fees and
reimbursement for services and assisted in revising and implementing changes.
Responsible for the selection and termination of employees under supervision
of the physicians. Evaluated the
performance of staff being supervised and preparing and administering
disciplinary actions.
2004 - 2005 Providence
Health Plans Beaverton, OR
Fee Schedule & Coding Analyst
n Analyze
300+ provider claim inquiries per month. Code medical documentation,
determine rationale for clinical edits. Make the determination to uphold or
overturn claim denials. Create and implement payment policies. Educate
insurance and provider relations staff on correct coding rules and
billing/coding regulations. Advise contracting and finance staff on federal
and state healthcare regulations. Collaborate with medical directors on
determinations of payment reviews.
1998 - 2004 Oregon
Health & Sciences University Portland, OR
Manager of Professional Services Coding
n Manage
26 professional services coding staff for 56 different specialties in a
teaching setting. Design and implement policies and procedures. Reconcile and
manage complex multi-organizational department budget, administer payroll and
supplies. Coordinate billing and coding activities with specialty department
administration or clinic managers to ensure high quality coding and
reimbursement outcomes. Educate university personnel of contract or
Medicare/Medicaid billing regulations. Work closely with OHSUMG billing group
to ensure clean claims submission.
1990 -1998 The Portland Clinic, LLP Portland, OR
1997-1998Coding Specialist/Data Entry & Coding
Coordinator
1995-1997 Coding Specialist/Patient Communication
Coordinator
1994-1995 Coding Specialist
1993-1994 Registration Specialist
n Progressive
supervisory responsibilities over 5 years employment. Created centralized
coding department for 30 multi-specialty surgical and medical providers. Oversaw
operations of coding specialists and data entry staff. Consulted with
contracting and billing office to determine appropriate application of
insurance contracts and coding for clean claims. Worked complex patient
accounts to determine proper billing or claim appeals. Scheduled, hired and
trained 2 receptionist, 1 operator, 4 registration personnel, 2 coders and 5
data entry staff. Worked closely with clinic administrators to improve coding
and billing processes and effectively implement insurance contract changes.
1990-1992 Family Medical Center Tigard, OR
Front Office/Business office
n Scheduled
patient appointments, coordinated patient billing paperwork, answered
multi-line phone, multiple reception and registration duties. Performed data
entry and patient accounting functions.
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