AYESHA JABEEN
Richmond,TX
Summary
Dynamic Clinical Documentation Specialist and experienced, foreign-trained physician with ECFMG certification. Proven expertise in clinical documentation, auditing, and provider education to optimize revenue cycle outcomes. Extensive background in acute care and ICU settings, providing a deep clinical foundation for complex chart reviews, inpatient documentation, and severity of illness (SOI) accuracy. Certified in CDIP, CCS, CPC, and CRC, with a track record of enhancing coding accuracy and compliance. Proficient in EPIC and NLP tools, effectively streamlining workflows while leveraging years of clinical experience to drive improvements in documentation and healthcare outcomes.
Overview
22
22
years of professional experience
1
1
Certification
Work History
CDI Specialist/Risk Adjustment Auditor
United Health Group - Optum
Phoenix, USA
10.2022 - Current
- Audited over 6,000 charts across 21 providers in the Colorado region, strengthening clinical documentation quality and accurate HCC capture using MEAT criteria; identified new HCC suspects through lab results and inpatient documentation, contributing to substantial improvements in provider RAF performance.
- Trained and mentored coders on audit workflows, documentation standards, and HCC validation practices, supporting consistency, accuracy, and quality across team reviews.
- Conducted tailored education sessions for providers, enhancing their proficiency in documentation standards, and risk adjustment methodologies.
- Leveraged EPIC EHR to execute concurrent and retrospective audits, ensuring alignment with organizational standards, and payer compliance.
- Performed concurrent and retrospective chart reviews to enhance the completeness and accuracy of clinical documentation.
- Applied ICD-10 and related materials to investigate coding discrepancies, and produced accurate, compliant results.
- Facilitated daily follow-up communications with providers to obtain documentation specificity through clarifications.
- Collaborated with Care Coordination, Quality, and other interfacing departments to align documentation practices with organizational goals.
- Conducted routine data analyses to identify trends and improve operational efficiencies.
Risk Adjustment Auditor
Change Healthcare
, USA
10.2018 - 09.2022
- Executed inpatient and outpatient audits for Medicare and Medicaid patients using EPIC EHR and Health Fidelity NLP tools.
- Designed and delivered educational programs to empower providers with improved documentation practices.
- Maintained 95%+ QA review accuracy while consistently exceeding productivity benchmarks.
- Audited clinical documentation to validate compliance with payer-specific guidelines, optimizing reimbursement outcomes.
Inpatient Documentation Auditor/Reviewer
Weller HIT
, USA
04.2022 - 08.2022
- Performed detailed inpatient documentation reviews using EPIC EHR and NLP tools.
- Captured accurate MS-DRG assignments to ensure compliance and optimized reimbursement.
- Educated providers on improving inpatient documentation quality.
- Advanced to a Quality Assurance role in recognition of exceptional performance.
Clinical Research Coordinator
A1 Clinical Research
Houston, Texas
10.2017 - 09.2018
- Monitored adherence to standards across data collection, research protocols, and regulatory guidelines.
Identified potential research participants by assessing patient records and checking referrals.
- Acquired informed consent from research subjects or their guardians as required. Entered patients' medical histories, vital statistics, and test results into electronic records.
- Evaluated patient care requirements to prioritize treatments and streamline patient flow.
Clinical Observer
Providers Group
Houston, Texas
04.2015 - 05.2017
- Evaluated patient care needs to prioritize treatment and maintain patient flow.
- Gained deep understanding of diagnosis and management through relevant questioning.
- Attended examinations and procedures to maximize learning opportunities.
- Provided counseling on healthy lifestyle information for patients and families.
- Obtained vital signs and performed phlebotomy on adult patients.
- Counseled patients on medication compliance, recovery strategies, and community resources.
Registered Medical Officer
Ashfaq Memorial Hospital
Karachi, Pakistan
01.2004 - 08.2006
- Performed medical assessments and developed individualized treatment plans for critically ill ICU patients.
Executed medical procedures while diligently monitoring patient progress.
Ensured clear and concise documentation, contributing to clinical improvement initiatives.
Optimized healthcare outcomes and reimbursement processes with thorough record maintenance.
Education
M.D. - Medicine
Dow University of Health Sciences
Skills
- Concurrent and retrospective chart reviews
- Coaching and mentoring
- Clinical documentation improvement (CDI)
- ICD-10 CM, PCS
- CPT & HCPC coding
- HCC coding and risk adjustment analysis
- MS-DRG and APR-DRG methodologies
- CDI trends and Medicare regulations knowledge
- Provider education, communication, and clarification follow-ups
- Clinical pathophysiology and pharmacology expertise
- Epic EHR proficiency
- Compliance with HIPAA and coding guidelines
- CAC tools (eg, Health Fidelity NLP, HCC Coder)
- Microsoft Word, Excel, PowerPoint
- HIPAA compliance standards
Certification
- Certified Documentation Improvement Practitioner (CDIP), AHIMA
- Certified Coding Specialist (CCS), AHIMA
- Certified Professional Coder (CPC), AAPC
- Certified Risk Adjustment Coder (CRC), AAPC
- Educational Commission for Foreign Medical Graduates (ECFMG)
Timeline
CDI Specialist/Risk Adjustment Auditor
United Health Group - Optum
10.2022 - Current
Inpatient Documentation Auditor/Reviewer
Weller HIT
04.2022 - 08.2022
Risk Adjustment Auditor
Change Healthcare
10.2018 - 09.2022
Clinical Research Coordinator
A1 Clinical Research
10.2017 - 09.2018
Clinical Observer
Providers Group
04.2015 - 05.2017
Registered Medical Officer
Ashfaq Memorial Hospital
01.2004 - 08.2006
M.D. - Medicine
Dow University of Health Sciences