Jordan Shah
Saint John,IN
Summary
Certified professional coder 15 years of management experience talented at assigning, correcting and resubmitting claims. Offers background in reviewing, analyzing and managing medical record information to obtain prior authorizations from insurance companies and ensure payment.
Overview
17
17
years of professional experience
Work History
Manager
Auditors| Franciscan Alliance
Dyer, IN
04.2020 - Current
- Manages day-to-day operations for team of 35 employees
- Built high-performing teams through effective recruitment, onboarding, and talent development initiatives.
- Established performance goals for employees and provided feedback on methods for reaching those milestones.
- Developed strong company culture focused on employee engagement, collaboration, and continuous learning opportunities.
- Provides oversight of encounter data submissions and guidance for risk adjustment coding department regarding activity, status, trends, and coordination
- Trained personnel in equipment maintenance and enforced participation in exercises focused on developing key skills.
- Coordinates strategic planning with preferred provider groups along with network and quality teams
- Served on several committees including Immunization Improvement Team, Process Improvement Team, Collection Policy Process Improvement Team, Integra Implementation Team, as well as Office Activity Committee
- Manages all aspects of retrospective review process including oversight of third party contracted vendor, chart abstraction projects, and compliance oversight
- Manages all aspects of prospective risk adjustment process including growing program with all value-based provider groups
- Provides oversight of all provider reporting as it relates to Risk Adjustment including but not limited to capture rate reporting, prospective reporting, projections, submission gap reporting, and overall performance
- Engages with provider network in each region regarding specific provider initiatives, clinical meetings, and education
- Creates and executes Risk Adjustment calendar which is centered around submission deadlines.
- Assisted in organizing and overseeing assignments to drive operational excellence.
- Implemented innovative marketing campaigns that boosted provider education on risk adjustment.
HCC Coder/ Prior Authorization Representative
GEBBS HEALTHCARE
San Francisco, CA
11.2021 - 05.2024
- Reviewed medical documentation to accurately assign diagnosis codes and procedure codes.
- Performed on-site coding audits to determine accuracy and compliance with coding guidelines.
- Reduced claim denials for insurance reimbursement by meticulously verifying coding accuracy before submission.
- Communicated with insurance companies to research and resolved coding discrepancies.
- Managed high volume of medical records efficiently while maintaining exceptional attention to detail during coding process.
- Provided mentorship and guidance to junior coders entering field, sharing expertise on best practices for accurate and efficient coding assignments.
- Make sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations
- Maintain Monthly Accuracy Rate of 95% or higher
- Verified accuracy of patient information in medical records.
- Created and maintained up-to-date patient medical records to enable tracking history and preserve consistent information.
- Researched and resolved medical record discrepancies.
- Contributed to revenue optimization by identifying opportunities for capturing additional reimbursements through accurate HCC code assignment.
- Stayed current with evolving industry standards, attending professional development seminars and workshops related to HCC coding advancements.
- Increased interdepartmental communication by collaborating closely with physicians, nurses, and other healthcare professionals to ensure accurate documentation and coding.
- Maintained strict compliance with HIPAA regulations, ensuring privacy and security of patient information during coding process.
- Generated reports to identify coding trends and discrepancies.
Office Supervisor- Medical Clinic
Cardiology, Community Care Network
Munster , Indiana
07.2012 - 05.2021
- Ensured compliance with federal regulations regarding labor laws, taxes, payroll processing while maintaining accurate records.
- Optimized organizational systems for payment collections, AP/AR, deposits, and recordkeeping
- Oversaw daily, operations, managed 7 office locations, 32 employees, and 15 providers.
- Evaluated employee records and productivity and submitted evaluation reports
- Managed recruitment, performance management and training/development of specialty practices
- Streamlined office operations by implementing efficient filing systems and workflow processes.
- Evaluated current office procedures, identifying areas for improvement, and implemented necessary changes to optimize workflow efficiency.
- Assists in physician credentialing, license renewal, and annual privilege reappointment
- Facilitated smooth communication between departments, promoting collaboration and problem-solving efforts.
- Implements corporate and departmental policies, and procedures
- Manages employees' schedules and payroll Develops, and strengthens patient/provider relationships through managing community development programs
- Manages finances and resource profitably
- Drafts monthly financial/ growth reports for senior management
- Oversees all location finances including cash flow, payroll, charge entry, co-payments, and accounts payable services
- Responsible for analyzing/ modifying individual provider fiscal year budgets
- Coordinated special projects and managed schedules.
- Built highly-efficient administrative team through ongoing coaching and professional development opportunities.
- Scheduled surgeries, managed pre-certifications work ques, and verified patient insurance coverage daily
- Served as liaison between healthcare providers and hospital Utilization Management Department to ensure proper CPT code us
- Ensured compliance with federal regulations regarding labor laws, taxes, payroll processing while maintaining accurate records.
Supervisor- Risk Adjustment Team
Franciscan Alliance
Dyer , IN
05.2018 - 04.2021
- Oversaw daily operations of 53 department employees, ensuring smooth workflow and timely completion of tasks.
- Increased Department productivity by 15%
- Monitored workflow to improve employee time management and increase productivity.
- Presented data findings and solutions to providers, staff, and management in timely manner to support efficient identification of trends and facilitate actio
- Resolved conflicts among team members promptly, maintaining harmonious working environment conducive to productivity.
- Developed staff skills through targeted training programs, resulting in improved performance and career growth opportunities.
- Worked with quality committee to strategically plan initiatives annually
- Supervised direct reports and manages performance of individuals through ongoing coaching, feedback, and development to motivate, engage and drive high performing team
- Built and maintained relationships with other practices and departments
- Created and sustained culture in practice that reflected Franciscan Mission and Values
- Assisted staff through regular audits; validation audits, evaluate medical record documentation and ensure documentation accurately reflects and supports relevant coding
- Ensured regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of coding standards and EPIC
- Conducted performance evaluations for staff members, identifying areas of improvement and guiding professional development plans.
- Reduced employee turnover by fostering positive work environment and providing ongoing feedback to staff members.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
Practice Coder/Health Insurance Specialist
Community Care Network
Munster , Indiana
06.2007 - 07.2018
- Collected, posted, and managed patient account payments
- Performed various duties related to coding, including patient record review, and accurately assigning ICD-10-CM/ CPT codes for both in and outpatient services
- Scanned and uploaded medical records into electronic medical records system.
- Trained and mentored junior coders to support growth and development and apply high-quality coding practices.
- Reconciled clinical notes, patient encounter form, and health information for compliance with HIPPA rules and JCAHO standards
- Maintained 97% or above accuracy rate
- Responded to staff and client inquiries regarding CPT and ICD-10 coding
- Resourcefully used various coding books, procedure manuals, and on-line encoders.
- Provided coding and documentation advice to clinical and professional staff
- Streamlined codebase maintenance with thorough documentation, commenting, and version control practices.
- Examined patient encounter forms to verify diagnosis codes, and reconcile codes against services rendered
- Facilitated knowledge sharing within team by conducting regular code reviews, training sessions, and workshops on relevant topics.
- Reviewed EOB's for various insurance carriers and completed necessary appeals needed for denials received
- Verified signatures and checked medical charts for accuracy and completion.
- Followed up on past due invoices and delinquent accounts
- Conducted routine medical record audits to comply with insurance company requirements
- Monitored changes in coding regulations to provide recommendations for compliance.
Skills
- Skills & Abilities
- Team building
- Analytical Thinking
- Professionalism
- Financial Management
- Project management abilities
- Process Improvement
- Accuracy and punctuality
- Technical knowledge
- Employee Coaching and Mentoring
- Hiring and Training
Accomplishments
- Certifications:
- Indiana Public Notary – November 2018
- AAPC CPC Certification – February 2017
- AAPC CRC Certification – September 2018
Timeline
HCC Coder/ Prior Authorization Representative
GEBBS HEALTHCARE
11.2021 - 05.2024
Manager
Auditors| Franciscan Alliance
04.2020 - Current
Supervisor- Risk Adjustment Team
Franciscan Alliance
05.2018 - 04.2021
Office Supervisor- Medical Clinic
Cardiology, Community Care Network
07.2012 - 05.2021
Practice Coder/Health Insurance Specialist
Community Care Network
06.2007 - 07.2018