LISHA EVANS,CPC
Bronx,NY
Summary
Effective Compliance Specialist with commitment to excellence and more than 20 years of experience in Healthcare. Well- versed in comprehensive Reliable Medical Coder with a background in document oversight, data security procedures and resolving coding errors. Detail-oriented performer with medical terminology knowledge. Considered a team player with exemplary multitasking skills. Hardworking professional applies official coding conventions and rules established by American Medical Association and Centers for Medicare and Medicaid Services. Confident Compliance Specialist who adheres to data confidentiality and privacy rules in all workflows and promotes dynamic interpersonal skills.
Overview
20
20
years of professional experience
Work History
Compliance Specialist
Columbia University Department, Obstetrics and Gynecology
New York, NY
12.2017 - Current
- Compliance Education & Monitoring Activities:
- Performs monitoring activities on all assigned areas based on risk profiles of the department performing on average 100 monitoring activities per day.
- Notifies the Departmental Chair/Divisional Chief, Liasion Officer and Administrator of scheduled monitoring initiatives
- Meet with the Administrator and other appropriate staff to discuss specific processes and other information related to billing that is unique to the specialty
- Requests medical records and copies pertinent information as appropriate
- Analyze CPT Utilization Report for each physicians and select patients to be reviewed
- Perform chart abstraction either retrospectively or concurrently
- Presents reports to Departmental Chair/ Divisional chief and other staff as appropriate
- Prepare individual analysis report for all physicians monitored
- Meets with individual physicians to discuss analysis reports and findings
- Collaborates with Administrator or other appropriate personnel regarding refund process to third party payor as appropriate
- Performs special reviews of regulatory and external audit request received by FPA departments eg
- RAC,CMS/CERT, Managed Care Companies
- Conduct protocol reviews and preparation of appropriate CPT codes for grant research budgets.
Billing Compliance Assistant
Columbia University Department of Obstetrics & Gynecology
New York, NY
11.2004 - Current
- Compliance Education & Monitoring Activities:
- Performs monitoring activities on all assigned areas based on risk profiles of the department
- Notified Departmental Chair/Divisional Chief, Liasion Officer and Administrator of scheduled monitoring initiatives
- Meet with the Administrator and other appropriate staff to discuss specific processes and other information related to billing that is unique to the specialty
- Requests medical records and copies pertinent information as appropriate
- Analyze CPT Utilization Report for each physicians and select patients to be reviewed
- Perform chart abstraction either retrospectively or concurrently
- Presents reports to Departmental Chair/ Divisional chief and other staff as appropriate
- Prepare individual analysis report for all physicians monitored
- Meets with individual physicians to discuss analysis reports and findings
- Collaborates with Administrator or other appropriate personnel regarding refund process to third party payor as appropriate
- Performs special reviews of regulatory and external audit request received by FPA departments eg
- RAC,CMS/CERT, Managed Care Companies
- Conduct protocol reviews and preparation of appropriate CPT codes for grant research budgets.
Compliance Specialist
Columbia University Department of Pathology, Biology
New York, NY
06.2013 - 12.2017
- Compliance Education & Monitoring Activities:
- Performs monitoring activities on all assigned areas based on risk profiles of the department
- Notified Departmental Chair/Divisional Chief, Liasion Officer and Administrator of scheduled monitoring initiatives
- Meet with the Administrator and other appropriate staff to discuss specific processes and other information related to billing that is unique to the specialty
- Requests medical records and copies pertinent information as appropriate
- Analyze CPT Utilization Report for each physicians and select patients to be reviewed
- Perform chart abstraction either retrospectively or concurrently
- Presents reports to Departmental Chair/ Divisional chief and other staff as appropriate
- Prepare individual analysis report for all physicians monitored
- Meets with individual physicians to discuss analysis reports and findings
- Collaborates with Administrator or other appropriate personnel regarding refund process to third party payor as appropriate
- Performs special reviews of regulatory and external audit request received by FPA departments eg
- RAC,CMS/CERT, Managed Care Companies
- Conduct protocol reviews and preparation of appropriate CPT codes for grant research budgets.
Compliance Coordinator
Columbia University Department of Medicine
New York, NY
12.2008 - 05.2013
- Compliance Education & Monitoring Activities:
- Performs monitoring activities on all assigned areas based on risk profiles of the department
- Notified Departmental Chair/Divisional Chief, Liasion Officer and Administrator of scheduled monitoring initiatives
- Meet with the Administrator and other appropriate staff to discuss specific processes and other information related to billing that is unique to the specialty
- Requests medical records and copies pertinent information as appropriate
- Analyze CPT Utilization Report for each physicians and select patients to be reviewed
- Perform chart abstraction either retrospectively or concurrently
- Presents reports to Departmental Chair/ Divisional chief and other staff as appropriate
- Prepare individual analysis report for all physicians monitored
- Meets with individual physicians to discuss analysis reports and findings
- Collaborates with Administrator or other appropriate personnel regarding refund process to third party payor as appropriate
- Performs special reviews of regulatory and external audit request received by FPA departments eg
- RAC,CMS/CERT, Managed Care Companies
- Conduct protocol reviews and preparation of appropriate CPT codes for grant research budgets.
Compliance Resource Specialist
Mount Sinai
NEW YORK, NY
11.2006 - 12.2008
- Compliance Education & Monitoring Activities:
- Performs monitoring activities on all assigned areas based on risk profiles of the department
- Notified Departmental Chair/Divisional Chief, Liasion Officer and Administrator of scheduled monitoring initiatives
- Meet with Administrator and other appropriate staff to discuss specific processes and other information related to billing that is unique to the specialty
- Requests medical records and copies pertinent information as appropriate
- Analyze CPT Utilization Report for each physicians and select patients to be reviewed
- Perform chart abstraction either retrospectively or concurrently
- Presents reports to Departmental Chair/ Divisional chief and other staff as appropriate
- Prepare individual analysis report for all physicians monitored
- Meets with individual physicians to discuss analysis reports and findings
- Collaborates with Administrator or other appropriate personnel regarding refund process to third party payor as appropriate
- Performs special reviews of regulatory and external audit request received by FPA departments eg
- RAC,CMS/CERT, Managed Care Companies
- Conduct protocol reviews and preparation of appropriate CPT codes for grant research budgets.
Education
Some College (No Degree) -
Adelphi University
Garden City, NYBachelor of Arts - Sociology
Hunter College/CUNY
12.2021
Clinical Documentation Specialist Training-DRG Coding -
Navigant Consulting- Mount Sinai
New York, NY01.2007
Certified Procedural Coder -
American Academy of Professional Coders
Salt Lake City, UT04.2000
CPT 4- Certificate w/Honors -
Roxbury Institute For Medical Management
Queens, NY01.2000
Medical Terminology- Certificate w/ Honors -
Roxbury Institute For Medical Management
Queens, NY01.2000
CPC Preparatory & ICD 9 CM Certificate -
Roxbury Institute For Medical Management
Queens, NY01.2000
Skills
- Compliance Reporting
- Audit Documentation
- Insurance Billing
- Certified Professional Coder
- Medical Billing Processing
- Epic Systems
- Verbal and Written Communication
- Attention to Detail
- ICD-10 Coding
- EMR Systems
- Coding Error Resolution
- Medical Terminology
- ICD-9 Coding
- Audit Coordination
Timeline
Compliance Specialist
Columbia University Department, Obstetrics and Gynecology
12.2017 - Current
Compliance Specialist
Columbia University Department of Pathology, Biology
06.2013 - 12.2017
Compliance Coordinator
Columbia University Department of Medicine
12.2008 - 05.2013
Compliance Resource Specialist
Mount Sinai
11.2006 - 12.2008
Billing Compliance Assistant
Columbia University Department of Obstetrics & Gynecology
11.2004 - Current
Some College (No Degree) -
Adelphi University
Bachelor of Arts - Sociology
Hunter College/CUNY
Clinical Documentation Specialist Training-DRG Coding -
Navigant Consulting- Mount Sinai
Certified Procedural Coder -
American Academy of Professional Coders
CPT 4- Certificate w/Honors -
Roxbury Institute For Medical Management
Medical Terminology- Certificate w/ Honors -
Roxbury Institute For Medical Management
CPC Preparatory & ICD 9 CM Certificate -
Roxbury Institute For Medical Management
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