Brandi Monks

Performs retrospective chart reviews to ensure accurate risk adjustment reporting, verifying and ensuring the accuracy, completeness, specificity and appropriateness of provider reported diagnosis codes based on medical record documentation. Reviews medical records to identify complete and accurate ICD-10 codes based on CMS and HHS HCC categories. Identifies trends in provider coding and documentation. Supports and actively participates in process and quality improvement initiatives. Monitors, interprets regulatory changes as well as maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with ICD-10 coding guidelines and government requirements. Serves as a mentor for Risk Adjustment Auditor I staff. Services with special, ad-hoc projects as needed. Services as a SME regarding the risk adjustment process and ICD-10 coding for risk adjustment.

• Provided audit support for BY 2022 HHS RADV
• Supported management decision making with accurate audit results and insights from audit findings

Oversaw vendor management for the coding audit processes for Medicare, Medicaid and Commerical lines of business as well as for IHA vendors, conducted quality audits on vendor coding results, packaged and processed audit results for major sweep projects for distribution to internal stakeholders which supported HCC/CDPS capture for supplemental data submissions as well as claim resubmission projects. Established the manual processes for quality audits and distribution of audit results. Established and managed project timelines to assist the team in meeting government submission deadlines.

Collaborated with coding partners and department leadership in RADV audit chart review and submission support. Collaborated with coding partners and internal stakeholders in drafting and updating coding guidelines to reflect organizational coding approach in accordance with official coding guidelines, AHA coding clinic advices and quarterly/yearly updates. Acted as a coding SME, keeping up to date with coding guideline changes, regulatory requirements, OIG areas of concern as well as assisting in other coding related projects as needed.

• Identified and corrected significant coding error trends in OBGYN and inpatient coding, increasing HCC capture rate
• Implemented new coding vendor and developed processes for coding audit
• Ensured quality of coding results and claims re-bill requests to CHC partners, helping to maintain good CHC partnership
• Participated in BY 2021 HHS RADV process by validating charts supporting HCCs under audit, helping to achieve passing rate of 97.5%

Performed comprehensive, prospective chart reviews in Epic to locate chronic conditions yet to be addressed by the physician for the current calendar year. Provided supporting documentation to providers of unaddressed chronic conditions along with coding support to improve clinical documentation quality and HCC recapture rates. Supported providers in ICD-10 coding guidelines, AHA coding clinic advices as well as ICD-10 code selection to the highest specificity to improve documentation and ICD-10 coding quality.

Performed comprehensive chart reviews in response to payer data of open gaps for any conditions that may no longer be presenting requiring gap closure on the payers end. Collaborated with team members and leadership for process improvement, provider engagement and maintaining regulatory compliance.

• Lead work distribution for team, providing analytical and reporting support to distribute office visits to be prepped weekly
• Collaborated with analytics for ongoing process and workflow improvements

Managed accounts receivable for multi-specialty physician group including denials to resolve claims issues. Obtained payment from insurance carriers and government payers. Resolved claim edits to ensure clean claims. Resolved patient billing issues by phone and in person. Resolved EHR build issues with recently implemented billing system for clean claims. Closely collaborated with management on department policies and procedures. Submitted appeals as necessary to obtain payment for services.

• Collaboration with internal stake holders to correct EHR build challenges reduced rejected claims and outstanding A/R by millions
• Maintained over 95% success rate for complex appeals
• Managed A/R for physicians in 9 rural health clinics

Audited charges for CPT, HCPCS and ICD-10 coding accuracy while utilizing knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives and Medically Unlikely Edits (MUEs) to ensure accurate submission for charge capture and clean claims for multi-specialty physician group. Resolved claim edits to ensure clean claims and accurate billing. Prepared and submitted daily deposit. Resolved patient billing issues by phone and in person. On site subject matter expert in coding, billing and insurance for patients, clinic staff and physicians. Worked directly with front desk staff with registration issues. Maintained good communication between clinic staff, physicians and back office revenue cycle to ensure prompt resolution of patient billing issues as well accurate physician coding and documentation.

• Increased patient satisfaction with complex billing and coding issues
• Increased provider revenue by finding and applying CPT codes for missed charges
• Consistently maintained quality scores of over 95%
• Lead onboarding, training and coaching for new employees
• Cultivated and maintained relationships with providers and clinical staff to improve documentation, coding and revenue collection quality

Submitted monthly billing to all payers for two skilled nursing facilities. Answered resident billing questions. Maintained facility systems to ensure clean claims. Utilized 3 point claim review process to check accuracy of claims before submission. Maintained proper formatting of resident accounts. Maintained daily census information. Entered monthly invoices from vendors for monthly billing. Followed up on outstanding claims.

• Solved complex resident billing issues
• Developed and mapped processes for more efficient billing
• Established in house claims submission

Processed specialty billing and conducted follow up with specialty programs for full services facilities. Ensured facilities were paid timely. Processed adjustments for all necessary programs under program guidelines

Collaborated closely with facilities to ensure accurate and timely handling of facility program accounts. Identified and drafted processes as necessary for specialty billing and follow up.

• Managed AR for 18 facilities.
• Received award for service excellence, 2010
• Participated in Epic go-live for multiple facilities
• Mapped and documented processes and procedures for facility specialty programs
• Collaborated with training department in development of training documents, leading presentations for onboarding classes

Managed hospital A/R for commercial insurance plans, including Regence BCBS and non-contracted insurance plans. Assessed for accounts w/out response for over 30 days to determine if claims was received and sent for claims resubmission as necessary. Routed accounts to appropriate departments for next steps based on billing errors, or patient service issues.

• Managed AR for 18 facilities.
• Assisted with additional ad hoc projects as needed
• Acted as leader in team setting, providing support and guidance

Processed insurance changes from Health Services account system CUBS back into client facilities host systems, STAR and Meditech in order to maintain accurate information between systems and generate new claim for billing as necessary, or forward to next appropriate work group for billing. Assisted with developing and drafting processes as needed. Participated in integration of two new hospital accounts and developed processes for transferring of insurance information. Collaborated with managers of hospital client accounts to ensure effective and accurate reporting of hospital-based programs revenue.

• Processed over 100 insurance changes and claim reorders daily.
• Collaborated with leadership on process improvement, increasing quality and efficiency of data entry
• Acted as leader in team setting, providing support and guidance

Answered patient phone calls in call center setting and answered questions about patient facility-based billing. Processed payments for self-pay accounts. Processed intake of patient correspondence and facilitated routing account issues to appropriate departments for investigation and resolution.

• Managed over 100 incoming and outgoing calls daily
• Maintained patient satisfaction with efficient and effective resolution strategies for billing and self pay concerns.