Brandi Taylor

Company Overview: (64 Bed) Short term General Hospital

• Direct application of CPT, ICD-10-CM, ICD-10- PCS, and HCPCS codes for the following areas;
• Same Day Surgery (General surgery, Orthopedic, Podiatry, Pain management, Gastroenterology, Gynecology, Dermatology) (5 per hour)
• - Observation (2 per hour)
• - Emergency Services (10 per hour)
• - Laboratory Services (30 per hour)
• - Wound Care (12 per hour)
• - Inpatient Care (2 per hour)
• - Ambulatory Care (5 per hour)
• Performed medical record review for Clinical Documentation Improvement, Physician queries, and coding accuracy; increasing facility Case Mix Index.
• Contributed to overall revenue growth through diligent attention to detail in code assignment, DRG assignment, and meeting coding accuracy rate of 95%. Results included; revenue optimization, fewer denials and clean claim submission.
• Met national and departmental coding productivity standards (see above), optimizing revenue cycle and preventing any delays in claim submission.

Company Overview: Governance, Risk, and Compliance; Healthcare business management consulting.

• Evaluated client needs and expectations, establishing clear goals for each consulting engagement.
• Managed client relationships through regular check-ins and updates on project progress.
• Assisted clients in navigating complex industry challenges with strategic recommendations.
• Identified areas of improvement for clients'' operations, implementing targeted solutions to increase productivity.
• Analyzed denial trends, providing education and coding guidance to third party billing service.

• Conducted routine monitoring and retrospective auditing of physician coding. Preventing claim denials, increasing coding accuracy scores to greater than 90% and achieving clinical documentation improvement.
• Provided follow up one-on-one audit review and education with clinical team.
• Provided service line of support for billing and coding as subject matter expert.
• Monitored appropriate charge capture during routine audits; increasing facility revenue.
• Collaboration with H.I.M staff on identifying denial trends, finding resolution and improving revenue cycle.
• Communicated weekly coding guidance based on trends, improving coding accuracy and compliance.
• Created educational coding guides for additional physician coding support.
• Researched and communicated new compliance and regulatory guidelines, as well as new potential revenue to stakeholders.
• Provided 100% audit review and provided education for Medicare Targeted Probe and Educate. Resulting in facility passing Medicare review.
• Collaborated with IT department in EMR adjustments, optimizing use for clinical staff.
• Developed strong rapport with colleagues and staff members, promoting teamwork and improved communication within the workplace environment.
• Improved dialogue with clinical and financial departments to meet strategic goals, values, mission and improve overall patient experience.

• Verified accuracy of coordination of benefits, patient identifiers, and CMS 1500-line items
• Examined ICD-10, and CPT codes for accuracy, reducing denials, and clean claim submission
• Mentored junior examiners on best practices for conducting thorough evaluations while adhering to established guidelines.
• Identified potential risks and fraud through meticulous review of documentation.
• Managed high volume work que, prioritizing tasks to meet strict deadlines while maintaining attention to detail.
• Ensured compliance with relevant laws, policies, and procedures throughout the process.

• Corrected denied and rejected CMS-1500 claims.
• Resubmission of CMS 1500 claim forms
• Communication with third party payers, resulting in reimbursement of services provided.
• Performed first level of appeal for claim denials
• Timely resubmission of denied claims, for expedited reimbursement.
• Provided customer service for payment, billing inquiries, updates to demographic information and explanation of benefits, while maintaining patient satisfaction.
• Communication with Third Party Payers for claim status and reprocessing of claims.