AKHIL PATHAN
CHICAGO,IL
Summary
Healthcare professional with over 10 years of diverse experience in the medical field, seeking an opportunity with a dynamic organization.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Clinical Documentation Improvement Specialist
Insight Hospital & Medical Center
02.2023 - Current
- Conducted initial -concurrent and retrospective reviews and document findings.
- Responsible for reviewing medical records to ensure the accurate representation of the severity of illness and improving the quality.
- Documented reviews to ensure clarification has been recorded in the patient's chart.
- Completed documentation to measure and report physician and hospital outcomes and treatment settings.
- Collaborated with physicians, case managers, and Health Information Management Coders to identify areas for improved physician documentation
- Reviewed clinical issues with coding staff, nurses, and others to ensure appropriate inpatient technical diagnosis.
- Formulated clinically credible queries to notify physicians and healthcare providers of chart deficiencies requiring clarification
Clinical Documentation Specialist
Xtend Healthcare-Mt. Sinai Hospital
01.2019 - 02.2023
- Review inpatient medical records for identified payer populations (i.e., Medicare, Medicaid, Managed Care etc.) as directed on admission and throughout hospitalization, analyzing clinical status of patient, current treatment plan and past medical history and identifies potential gaps in physician documentation
- Assesses all patient medical documents to ensure accuracy
- Completing initial reviews of patient records for a specified patient population to: (a) evaluate documentation to assign the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate DRG assignment, risk of mortality, and severity of illness
- Conducting follow-up reviews of patients to support and assign a working or final DRG assignment upon patient discharge
- Querying physicians regarding missing, unclear, or conflicting health record documentation by requesting and obtaining additional documentation within the health record when appropriate
- Educating physicians and key healthcare providers regarding clinical documentation improvement and the need for accurate and complete documentation in the health record
- Conducted follow-up of posted queries to ensure that queries have been answered and physician responses have been appropriately documented
- Applies knowledge of medical terminology and medical procedures to properly evaluate clinical documents
- Ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine a working and final DRG, severity of illness, and/or risk of mortality
- Communicating with physicians via query process to ensure all diagnoses are supported and to obtain and support Complication & Comorbidities (CC) and Major Complications & Comorbidities (MCC).
Clinical Documentation Specialist
Xerox Corp./Conduent
01.2011 - 01.2019
- Reviewed medical records and claims on behalf of health insurance providers to identify any gaps and discrepancies in documentation
- Review inpatient medical records on a daily basis, concurrent with patient stay, to identify opportunities to clarify missing or incomplete documentation, lab results, diagnostic information, and treatment plans
- Create and implement training and development for nursing staff, physicians and mid-level practitioners that addresses documentation issues & variances
- Interacts with coding team to resolve documentation and coding issues and ensure proper DRG assignment
- Following ACDIS code of ethics, and familiarity with ICD-9, ICD-10 and DRG guidelines and regulations
- Ensure that clinical documentation reflects the level of service rendered to patients in complete, accurate and compliant with the regulations of the Center for Medicare and Medicaid Services.
Education
Doctor of Medicine -
Windsor School of Medicine
Frankfort, IL06.2011
Bachelor of Science in Biology & Biophysics -
St. John's University
Jamaica, NY06.2006
Skills
- Project Planning
- Problem Solving
- Physician Education
- Medical Resource
- HIPAA, Medicare, Medicaid regulations
- Team Work
- Data Analysis
- 3M
- Midas
- Cerner
- Coding
- Clinical Data Review
- Quality Review
- Meeting Management
- Microsoft Office Suite including Excel, PowerPoint, Word
- Documentation Management
- Expert Problem Solving
- Multitasking
- Relationship Building
- Team building
City
CHICAGO
Certification
- CDIP AHIMA 01/2022
Timeline
Clinical Documentation Improvement Specialist
Insight Hospital & Medical Center
02.2023 - Current
Clinical Documentation Specialist
Xtend Healthcare-Mt. Sinai Hospital
01.2019 - 02.2023
Clinical Documentation Specialist
Xerox Corp./Conduent
01.2011 - 01.2019
Bachelor of Science in Biology & Biophysics -
St. John's University
- CDIP AHIMA 01/2022
Doctor of Medicine -
Windsor School of Medicine
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