Belkys Herrera-Coronado, RHIT, CCS
New York,NY
Summary
A detail-oriented, self driven and passionate Health information professional with over 10 years of expertise in Inpatient coding, DRG Validation and Appeals.
Overview
18
18
years of professional experience
2
2
Certification
Work History
DRG Validation Consultant
NYCHSRO/MeReview
09.2022 - Current
- Meticulously audit ICD-10-CM/PCS to identify inconsistencies/deficiencies/ discrepancies in medical documentation.
- Query Doctors when clinical documentation is not clearly and consistently supporting diagnoses/procedures.
- Review/process Medicare, Medicaid, Commercial insurance coding/clinical denials/hospital appeals.
- Maintain updated knowledge of coding requirements, through continuing education/certification renewal.
DRG Validation
NYCHSRO/MedReview
10.2009 - 09.2022
- Analyze and audit inpatient claims for various Health Insurance throughout New York States following Official Coding and Reporting Guidelines to validate reported ICD-10-CM/PCS codes to ensure proper DRG assignment for payment integrity.
- Initiates MD query to clarify if provided diagnostic codes are clinically supported by available documentation.
- Deny hospital claims not meeting UHDDS and Coding guidelines. Generate detailed rationale supporting findings.
- Trained and assisted staff in validation techniques, methods and testing processes.
- Skilled at working independently and collaboratively in team environment.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Acted as team leader in group projects, delegating tasks and providing feedback.
- Perform other duties related to review process as deemed necessary
DRG Specialist/HIM Manager
Pocono Medical Center
06.2006 - 03.2009
- Conducted concurrent chart reviews for documentation improvement.
Monitor Hospitalist and address Physicians to clarify documentation. - Attend weekly Interdisciplinary Team meetings on patient floors.
- Developed and implemented monthly Documentation/DRG Initiative report to track physicians clinical documentation performance.
- Created and delivered presentations to internal stakeholders to showcase optimal documentation outcome.
- Developed strong client relationships through consistent communication and attentive service.
- Assisted/maintained all functions of coding/abstracting of 30 employees.
- Served as Taskforce Manager for Clinical Documentation Program.
- Monitor and manage transcription services within hospital for quality, turn around times and medical staff satisfaction.
- Develop and implement ongoing (monthly) coder education in accordance with accepted coding practices & annual updates.
- Mentored junior staff members on proper modeling techniques, fostering professional development within team.
- Worked well in team setting, providing support and guidance.
- Exercised leadership capabilities by successfully motivating and inspiring others.
- Evaluated staff performance and provided coaching to address inefficiencies.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
Skills
- ICD-10 (International Classification of Disease Systems)
- DRG/APC Methodology
- Inpatient records coding/Auditing proficiency
- Excellent problem solver
- Close attention to detail
- Excellent knowledge of 3M and WebStrat
- Patient chart auditing ability
- Excellent knowledge using McKesson (HPF), EPIC and many more home grown systems
- Resourceful and reliable worker
- Data Integrity Validation
- Relationship Building
- Problem-solving abilities
- Analytical Skills
Education
Associate of Science - Health Information Management
Borough of Manhattan Community College of The City University of New York
New York, NY09.1989
Certification
- Registered Health Information Technician (RHIT), September 1989.
- Certified Coding Specialist - Hospital Based(CCS), June 2004.
- AHIMA approved ICD-10-CM/PCS Trainer, October 2011.
Timeline
DRG Validation Consultant
NYCHSRO/MeReview
09.2022 - Current
DRG Validation
NYCHSRO/MedReview
10.2009 - 09.2022
DRG Specialist/HIM Manager
Pocono Medical Center
06.2006 - 03.2009
Associate of Science - Health Information Management
Borough of Manhattan Community College of The City University of New York
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