Andrea Giesecke
San Juan Bautista,CA
Summary
I am seeking the role of Revenue and Education Supervisor within Stanford Medicine Partners. I have 12 years of experience in professional fee coding, auditing, education, reimbursement, revenue cycle, and compliance. During this time I have developed in depth knowledge of coding practices, guidelines, and regulations across multiple specialties. I have experience in leading an education team and building policies and procedures that were critical in ensuring coding accuracy and upholding the integrity of the organization. I am passionate about the coding profession. I believe that educating clinicians plays a critical role in minimizing risk, maximizing opportunity, in addition to providing a high level of patient care. I also feel that creating strong relationships with clinicians and leaders is key in moving forward organizational goals and initiatives successfully.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Compliance Auditor, Professional Services Billing
Stanford Healthcare
07.2020 - Current
- Lead auditor and educator for 18 pediatric medical specialties at Stanford Medicine Children's Health
- Plan and conduct internal audits of medical documentation supporting claims billed to third parties to ensure billing is done in accordance with the appropriate third-party regulations and/or standards
- Evaluate the appropriateness of the services, procedures, and diagnoses billed based on the supporting documentation and in accordance with coding guidelines
- Conduct training for physicians, advanced practice providers, fellows, residents, and billing staff to support compliance with third-party documentation and billing standards
- Prepare written reports of the findings and recommendations of audits and present the results to management, division chiefs, chairs, providers, and billing staff
- Perform corrective action, as well as document and maintain records of all monitoring activity
- Establish and maintain excellent interdepartmental relationships with clinical and business administration department heads to facilitate cooperation and compliance
- Respond to questions from physicians and billing staff regarding billing, coding, and documentation
- Stay current on trends and developments in the field of medical coding compliance, including regulatory changes from the Center for Medicare and Medicaid Services
- Work on joint projects with multi-departmental staff to resolve billing and documentation issues. Attend project or committee meetings as assigned
- Complete extensive research to assist in the launching of new services to ensure all coding guidelines and requirements are being upheld
- Collaborate with cross-functional teams to ensure timely implementation of corrective actions, mitigating potential compliance issues
National Manager Chargemaster
CommonSpirit Health
04.2020 - 07.2020
- Served as the primary point person responsible for the overall management and maintenance of the chargemaster for both Dignity Health and Catholic Health Initiatives
- Monitored weekly Medicare transmittals to ensure compliance with regulations and communicated changes to relevant stakeholders
- Provided daily updates to National Director on quickly evolving landscape of allowances and sub-regulatory changes related to the Public Health Emergency during COVID-19 Pandemic
- Maintained a daily resource which comprised all CMS, Medicaid, and major commercial payers changing guidelines and allowances during the PHE for California and Arizona
- Developed comprehensive billing guidance for facility based providers delivering of all types of telemedicine services during the pandemic
- Developed relationships with Conifer Health Solutions and other third party vendors contracted to perform charge capture and denial management tasks to ensure performance goals were being met
- Worked on pricing transparency project to meet CMS requirements for all facilities to display costs for all services for Dignity Health entities
Risk Adjustment Training Consultant
Anthem Inc./CareMore Health
10.2019 - 04.2020
- Managed all northern California CareMore network providers and contracted provider groups
- Identified opportunities to improve documentation integrity for accurate coding and documentation impact
- Facilitated provider education sessions to assist in medical record documentation improvement and optimization of accurate disease burden depiction
- Partnered with market leadership to develop and implement action plans to address opportunities identified through data analysis
- Provided oversight, guidance, and training to employed and contracted providers related to CMS guidelines and Risk Adjustment best practices
- Developed training programs and tools related to coding documentation guidelines for provider use
- Ensured market leadership was kept abreast of coding initiatives, RAF reports, overarching coding guidelines updates, Patient Health Assessment Form progress, and any potential RAF impact to their market
Coding Quality And Education Manager
Sutter Health/Sutter Bay Medical Foundation
10.2018 - 09.2019
- Responsible for the integrity of coding documentation practices and processes for the Sutter Bay Medical Foundation (3,000+ providers and 60 coding analysts)
- Developed policy and procedure for annual, new provider, and ad-hoc audits focusing on areas of identified risk, high volume code reporting, and usage frequency
- Implemented coder accuracy monitoring program and coordinated education initiatives based on findings, to ensure a high level of code assignment accuracy and clear understanding of documentation requirements and guidelines
- Designed and developed and all coding education materials for both coder and provider utilization
- Developed a communication process to effectively disseminate all changes to coding requirements, new codes, coding updates, and educational documents to appropriate stakeholders
- Partnered with enterprise and foundation level Compliance to coordinate all corrective action plan steps such as clinician/coder education, regulatory refunds, charge corrections, and assist with clinical operations workflow processes
- Collaborated and strategized with medical group and physician leadership to ensure any new coding initiatives were carried out thoughtfully
- Coordinated with Compliance to ensure curriculum was clear and consistent across both operating units in addition to developing effective dissemination processes
- Developed staff in communication processes, presentation building, and coding skill accuracy
Practice Manager
Shahin Fazilat, M.D., FACS
06.2018 - 10.2018
- Developed policies and procedures for effective practice management
- Provided high level of support to clinical and administrative staff which improved workflow and boosted efficiency
- Supervised team of 3 administrative personnel and performed all HR related activities
- Addressed all patient concerns and provided resolution in a timely fashion
- Ensured compliance with OSHA and HIPAA regulations
- Consulted with practice owner on various business decisions and strategies such as product and software implementation
- Maintained a high level of patient satisfaction by ensuring surgical experience was seamless from initial consult through post operative care
- Trained newly hired team members on all in-office procedures, EHR, and surgery scheduling processes
Project Manager I - Reimbursement
Sutter Health/Sutter Bay Medical Foundation
05.2017 - 05.2018
- Performed reimbursement analysis to ensure proper billing, pricing, and contractual obligations were being met
- Analyzed problematic billing denial areas related to coding and proposed recommendations to improve functionality of clinical and revenue cycle processes
- Worked closely with coding management and their teams to review denials and improve reimbursement by following payor specific coding/billing guidelines
- Performed pricing analysis and comprised pricing recommendations for new procedures, programs, technologies, drugs, and DME based on organization's standard methodologies
- Prepared presentation materials for meetings, briefed with senior management and/or other personnel to inform them of trends and requirements, translated complicated data into useable information
- Maintained strong knowledge of reimbursement policies and payor contracts
- Created system edits, rules, and logic within Epic to ensure claims were routed to appropriate work queues when special billing circumstances applied
- Worked to resolve issues with payment denials quickly and collect maximum amount of reimbursement
Coding Analyst III/ Trainer
Palo Alto Medical Foundation/ Sutter Bay Medical Foundation
10.2015 - 05.2017
- Responsible for coding education of all Bay Area providers (2,500 + providers), in addition to Coding and Reimbursement staff
- Developed coding curriculum for all specialties such as presentations, coding guideline advisories, educational documents, and 1-Point Lessons
- Assisted with creation and delivery of coding education training program for new coders and providers
- Provided annual audit feedback and training to providers to ensure understanding of coding concepts and to uphold compliance standards
- Coordinated and performed tasks for all newly acquired physicians and practices including audits, feedback, training, presentations, and education plan creation
- Partnered with Compliance and provided education to ensure corrective action was taken on any audit issue identified
- Performed quality analysis of work performed by coding staff and auditors, provided feedback and recommendations
- Maintained consistent communication with providers via staff messaging, emails, and meetings to assist with coding concerns
- Worked with Service Line Directors and Department Chairs to standardize workflows within their departments
- Acted as a reference to coding analysts within department daily
- Maintained up to date coding knowledge by performing extensive research, reviewing government and payer coding advisories, and attending webinars on coding changes
Coding and Reimbursement Coding Analyst II
Palo Alto Medical Foundation
09.2014 - 10.2015
- Analyzed charge review edits to ensure accuracy in accordance with coding guidelines for procedure, E&M, diagnosis codes, as well as modifier usage
- Helped resolve denials by ensuring proper coding in accordance with payer guidelines
- Participated in On-Boarding Program for PAMF physicians including floor support, audits, and extensive communication and training on specialty specific coding guidelines
- Maintained daily communication with physicians and obtained clarification of conflicting, ambiguous, or non-specific documentation
- Worked in collaboration with training team by assisting with research to ensure compliance with coding guidelines for Plastic Surgery Department
- Served as mentor to colleagues regarding guidelines specific to Dermatology, Plastic Surgery and Dermatopathology
- Performed focused audits on newly acquired physicians with constant feedback to providers
- Acquired most up to date knowledge on assigned specialties by performing constant research
- Participated in RPIW and helped to train other department members on methodologies utilized within this workshop
- Knowledge of Epic, MD Audit, Microsoft Word, Excel
- Comprehension of 1995 & 1997 documentation guidelines
- Broad understanding of multidisciplinary specialties, with emphasis on Dermatology and Plastic Surgery
- Ability to prepare and perform presentations, as well as educate and teach information to individuals of varying levels
Coding Analyst I
Palo Alto Medical Foundation
07.2012 - 09.2014
- Performed coding analysis and support for Dermatology, Plastic Surgery, Otolaryngology, Audiology, Allergy, and Pathology
- Processed claims edits for accuracy as well as coding compliance
- Communicated with physicians and provided knowledge of correct coding practices, as well as code updates
- Reviewed medical documentation and consulted with healthcare providers when documentation was inadequate/unclear for coding purposes
- Maximized reimbursement by ensuring accurate ICD-9-CM and CPT coding
- Conducted regular audits of providers' charges and provided feedback
- Worked collaboratively with patient account department (SPS) to ensure accurate billing and resolve claim denials
Medical Assistant
Palo Alto Medical Foundation
06.2011 - 07.2012
- Back office medical assistant with responsibilities such as rooming patients, obtaining vitals, chief complaint, and medical history
- Assisted with in-office cosmetic and surgical procedures
- Maintained a strong line of communication with physician to keep busy surgical practice running smoothly and efficiently
- Surgery scheduling which involved selecting appropriate diagnostic and procedural codes for each patient
- Started insurance prior authorization and processed all necessary paperwork
- Informed patients of necessary pre-op instructions, ensuring patients had appropriate pre-operative testing and clearance
- Assisted with insurance appeals for patients whose surgeries were denied
- Responded to high volume of patient phone calls, supplied them with information regarding procedures
- Scheduled appointments, edited provider's schedule, ordered supplies, stocked rooms, sterilized instruments, processed specimens, used electronic health records (EPIC)
Medical Assistant
Khuu Dermatology
08.2010 - 05.2011
- Performed front office procedures such as greeting patients, answering multi-line phone, scheduling, confirming appointments, creating patient files, verifying insurance, scanning, and filing
- Accurately entered payments into patient accounts
- Researched and resolved patient billing issues, collected outstanding debts with strong and consistent communication with coding department
- Performed back-office procedures including rooming patients, obtaining chief compliant, and medical history
- Assisted with various medical, surgical, and cosmetic procedures
- Acted as scribe for doctor, completed office notes for patient visits
- Coded all services and sent information to billing department for physician
- Trained all new staff on front and back-office procedures, as well as coding practices
- Processed, packaged, and sent specimens out to labs stocked supplies, used sterilization techniques (autoclaving)
- Called in prescriptions, acquired prior authorization for office visits
- Acquired and contracted new insurances for practice
Education
Bachelor of Science -
San Jose State University
San Jose, CA05.2009
Medical Assistant Certificate -
Carrington College
San Jose, CA09.2010
Skills
- Teaching experience
- Public speaking
- Process implementation
- Exceptional attention to detail
- Data analysis
- Project management
- Team leadership
- Comprehensive knowledge of CPT, HCPCS, and & ICD 9/10 codes
- Extensive knowledge of coding regulations and guidelines
- Superior verbal and written communication skills
- Analytical thinker
- Complex problem solving skills
- Training program design
- Presentation design
Certification
CPC - Certified Professional Coder
CPCD - Certified Professional Coder of Dermatology
References
REFERENCES Available upon request
Timeline
Compliance Auditor, Professional Services Billing
Stanford Healthcare
07.2020 - Current
National Manager Chargemaster
CommonSpirit Health
04.2020 - 07.2020
Risk Adjustment Training Consultant
Anthem Inc./CareMore Health
10.2019 - 04.2020
Coding Quality And Education Manager
Sutter Health/Sutter Bay Medical Foundation
10.2018 - 09.2019
Practice Manager
Shahin Fazilat, M.D., FACS
06.2018 - 10.2018
Project Manager I - Reimbursement
Sutter Health/Sutter Bay Medical Foundation
05.2017 - 05.2018
Coding Analyst III/ Trainer
Palo Alto Medical Foundation/ Sutter Bay Medical Foundation
10.2015 - 05.2017
Coding and Reimbursement Coding Analyst II
Palo Alto Medical Foundation
09.2014 - 10.2015
Coding Analyst I
Palo Alto Medical Foundation
07.2012 - 09.2014
Medical Assistant
Palo Alto Medical Foundation
06.2011 - 07.2012
Medical Assistant
Khuu Dermatology
08.2010 - 05.2011
Bachelor of Science -
San Jose State University
Medical Assistant Certificate -
Carrington College
CPC - Certified Professional Coder
CPCD - Certified Professional Coder of Dermatology