Alison Gibson
HIM Leader
Macungie,PA
Summary
Health Information Management leadership professional skilled in driving payment integrity standards throughout the organization with proven medical costs savings from an innovative fraud, waste, error, and abuse concept portfolio. Excellent interpersonal skills and comprehensive knowledge of organizational stakeholders, adept at limiting provider abrasion and risk when implementing concept solutions. Revenue cycle, medical coding, and value-based quality program subject matter expert, passionate about making the healthcare system better for everyone.
Overview
15
15
years of professional experience
Work History
Associate Director
OPTUM
Minneapolis, MN
2019 - Current
- Identifies innovative solutions for medical cost savings opportunities, including data mining, medical record review, fraud investigation, claims edits, new policies, and targeted provider education
- Achieve team goal of $450 million in annual medical cost savings across all lines of business for client
- Analyzes impacts of regulatory and coding changes on operations and develops mitigation plans to limit fraud, waste, error, and abuse
- Performs in depth data analysis to determine viability of concepts
- Creates and presents highly complex concepts that translate to variety of audiences to gain client alignment for implementation
- Guides data analysts by defining parameters and criteria for concept research
- Company thought leader and functional payment integrity subject matter expert
- Leads large, multifaceted projects to achieve key business goals and large savings targets
- Influences senior leadership to adopt new ideas, products, and/or approaches
- Member of UnitedHealth Group corporate Coding Escalation and Resolution Team (CERT)
- Member of Optum Culture Ambassadors, Innovation Advocates, Relationship Builders, and Optum Payment Integrity Social Responsibility Team
HIM Clinical Language Intelligence Lead Product Consultant/Computer Assisted Coding Development
OPTUM360
San Diego, California
2017 - 2019
- Worked with linguists to develop and refine existing and new ICD-10-CM, CPT, HCPCS and CPT II codes in Professional and Enterprise computer assisted coding module
- Lead for HEDIS, HCC, MACRA, MIPS and APM related development opportunities
- Development HIM SME for all proof of concept and implemented innovation projects
- Acting HIM team lead for all NLP Clinical Intelligence Innovation products integrating alternate code sets (SNOMED, LOINC, RxNorm) and new uses for NLP technology into existing and new products
- Responsible for evaluating and determining diagnosis risk for ICD-10-CM yearly updates, in conjunction with medical decision-making component for evaluation and management services
- Organized and prepared quarterly group education for co-workers relevant to professional evaluation and management services, government and insurer quality programs, and clinical ontologies
- Participated in Optum360 NLP Innovation Summit 2018 as Development HIM subject matter expert
- Completed Leadership 101 training for emerging leaders in organization
Value Based Project Supervisor/EHR Consultant/Auditor
St. Luke's Physicians Group
Bethlehem, PA
2013 - 2017
- Supervised cross-functional team of quality analysts and physician practice employees
- Coordinated all centralized projects relating to payer quality measures within physician group (PQRS/MIPS, PCMH, PCSP, CPC+, HCC coding, gap closure)
- Created and maintained dashboard views in EHR based on payer quality metrics; used by practices to close care gaps at time of service and to view overall metric score performance
- Provided support and training to providers and practice staff on how to meet quality metrics utilizing discrete EHR documentation
- Integral member of EHR transition team (Allscripts to EPIC Ambulatory)
- Tracked all noteform/template requests for change from practices, analyzed changes for each specialty, built note templates and noteforms, tested functionality and implemented changes
- Maintained dictionaries in EHR: orderable items, ICD-10 and CPT codes, care guides, charge modules, etc
- Met with providers to review requests regarding noteform or templates and recommended ways to improve functionality of EHR; with specific regards to specialty, coding and compliance, and ability to meet quality measures with documentation
- Lead of quality projects using data pulled from EHR with manual research as needed
- Performed maintenance audits (E/M and procedure) on all providers in all specialties within network; meeting and providing feedback, education, and additional training as necessary based on provider's audit score, performing ongoing focused audits as needed
- Reviewed coding and documentation for Medicare prepayment audit requests
- Organized, coordinated, and presented monthly coding and documentation classes for new and existing providers
Certified Professional Coder, Clinical Integration
INTERMOUNTAIN MEDICAL GROUP, COMMONWEALTH HEALTH
Plains, PA
2010 - 2013
- Worked one-on-one with existing and newly hired providers to educate on proper documentation and coding guidelines, including audits after education, and retraining if necessary
- Conducted group training workshops for all providers on quarterly basis
- Developed and maintained templates in electronic health record to focus on ease-of-use and compliance with proper documentation for services rendered and meaningful use core measures, tailoring per specialty/provider
- Assisted billing staff with any coding/compliance questions and/or claim denials
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures
Admissions Coordinator
WILKES-BARRE GENERAL HOSPITAL COMMONWEALTH HEALTH
Wilkes-Barre, PA
2007 - 2010
- Obtained and verified complete patient registration information and accurately entered computer system in fast-paced emergency room and outpatient department
- Provided appropriate accommodations for elective, urgent and emergency patients based on diagnosis and availability of beds
- Worked with physicians and hospital supervisors to coordinate direct admissions, prioritize admissions, assign beds, and process transfers
- Worked with physician's office staff to obtain necessary pre-certifications as required by insurance companies for patient testing, outpatient surgeries, and observation and inpatient admissions
Education
Bachelor of Science - Health Information Management
Western Governors University
Salt Lake City, UTMaster of Health Leadership -
Western Governors University
Salt Lake City, UTSkills
Certified Professional Coder, AAPC
Affiliations
American Academy of Professional Coders (AAPC), Member
American Health Information Management Association (AHIMA), Member
Pennsylvania Health Information Management Association (PHIMA), Member
National Healthcare Anti-fraud Association (NHCAA), Member
Additional Information
- Excellence Award, Western Governors University – Integrated Health Leadership
- Excellence Award, Western Governors University – Collaborative Leadership
Timeline
Associate Director
OPTUM
2019 - Current
HIM Clinical Language Intelligence Lead Product Consultant/Computer Assisted Coding Development
OPTUM360
2017 - 2019
Value Based Project Supervisor/EHR Consultant/Auditor
St. Luke's Physicians Group
2013 - 2017
Certified Professional Coder, Clinical Integration
INTERMOUNTAIN MEDICAL GROUP, COMMONWEALTH HEALTH
2010 - 2013
Admissions Coordinator
WILKES-BARRE GENERAL HOSPITAL COMMONWEALTH HEALTH
2007 - 2010
Bachelor of Science - Health Information Management
Western Governors University
Master of Health Leadership -
Western Governors University