Beth Helsel RN, CPC, CRC
Claysburg,PA
Summary
Experienced and proven HCC Risk Adjustment Team Lead/Auditor prepared with 9+ years of HCC Risk Adjustment experience and RN clinical background. Efficiency-driven and proactive with hardworking nature, organized, with strong attention to detail. Team player with high ethical standards. Knowledge and experience with accessing various EMR systems. Proficient with utilizing Microsoft Office Products in a remote work setting. Ready to contribute and add value to the organization.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Lead, Risk Adjustment Quality Team
UPMC Health Plan Insurance Division
08.2021 - Current
- Management of team members, which includes work assignments, individual 1:1 meetings, scheduling, accepting time off requests, time approval, and yearly reviews
- Participate with new-hiring process that includes resume review, interviewing, new-hire training and completing required employee reviews
- Assist manager with overseeing internal, focused audits, by setting up and attending meetings, educating team members, answering questions, and summarizing findings for upper-level management
- Create spreadsheets for internal audits, utilizing EXCEL and applying knowledge of random selection and/or pivot tables, as needed
- Assist manager with overseeing ACA, MA, and IPM audits by attending meetings and providing audit status updates, reviewing findings to ensure all opportunities for HCC capture have been explored, answer team questions, and accurately apply specific guidance for each line of business
- Pull and interpret feedback reports from both IVA and CMS, then relay results to manager and team members
- Attend meetings with IVA team to review outcomes and coordinate meetings with IVA coding manager to discuss any disagreements
- Create a slide deck to present audit findings at quarterly team meetings
Clinical Auditor/Analyst (Risk Adjustment)
UPMC Health Plan Insurance Division
05.2019 - 08.2021
- Performed variety of internal audits, with focus being on coding and documentation
- Assisted manager with overseeing ACA and MA RADV audits by attending meetings, answering team questions, and applying specific guidance for each line of business
- Utilized EXCEL and WORD to create review guides specific to individual audits
- Coordinated training for new team members as well as any additional training needed for Risk Adjustment Quality Team
- Assisted with development of new audits, processes, and relaying review results
- Assisted manager with overseeing internal audits by attending meetings, educating, and summarizing findings for upper-level management
Coding Specialist I (Risk Adjustment)
UPMC Health Plan Insurance Division
08.2017 - 05.2019
- Reviewed medical records for groups of selected members
- Accepted or rejected ICD-10 diagnosis codes suggested by coding program
- Responded to results from Quality Assurance Review
- Identified when provider education was needed
- Worked independently from home and met productivity expectations
Physician Educator (Risk Adjustment)
UPMC Health Plan Insurance Division
03.2013 - 08.2017
- Provided HCC Education to staff and providers at various physician offices
- Delivered HCC reports and discussed with physician office managers
- Audited records for accuracy and diagnosis removals
- Assisted with education of new hires within department
- Created own weekly schedule for offices visited each week
- Worked independently from home
- Taught private and public coding classes
Clinical Document Auditor
Blair Medical Associates
08.2011 - 03.2013
- Audited new physician and mid-level visits for 90 days for proper E/M documentation and ICD-9 coding
- Performed documentation and coding audits for various providers, including specialties
- Provided documentation/coding education when necessary
- Created power point presentations
- Educated large groups of physicians and mid-level providers
- Prepared and distributed quarterly trending reports to physicians
- Fulfilled record requests for various health plans
Education
Bachelor of Arts - Degree in Nursing
Luther College
Decorah, IA05.1999
Skills
- Team Lead
- ACA RADV Audits
- MA RADV Audits
- IPM Medicare Audits
- Internal Focused Audits
- HCC Coding/Hierarchies/Mapping
- CMS Coding Guidelines
- ICD-10 Coding Guidelines
- Utilization of Coding Clinics
Certification
Certified Professional Coder (CPC) July 2013
Certified Risk Adjustment Coder (CRC) April 2016
References
References available upon request
Timeline
Lead, Risk Adjustment Quality Team
UPMC Health Plan Insurance Division
08.2021 - Current
Clinical Auditor/Analyst (Risk Adjustment)
UPMC Health Plan Insurance Division
05.2019 - 08.2021
Coding Specialist I (Risk Adjustment)
UPMC Health Plan Insurance Division
08.2017 - 05.2019
Physician Educator (Risk Adjustment)
UPMC Health Plan Insurance Division
03.2013 - 08.2017
Clinical Document Auditor
Blair Medical Associates
08.2011 - 03.2013
Bachelor of Arts - Degree in Nursing
Luther College
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