Dinecqua L. Kornegay, CPC, CPMA
Hempstead,NY
Summary
Actively seeking a position with an organization in need of an individual knowledgeable in Coding Compliance duties accompanied with initiatives, multi-tasking abilities and drives to accomplish goals and objectives
Overview
16
16
years of professional experience
Work History
Certified Professional Coder – Auditor
UNITED HEATH GROUP/ OPTUM
01.2021 - Current
- Clinical Coding and Logic Workers’ Comp and Auto No-Fault, Identify appropriate assignment of ICD-10-CM and ICD-10-PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC/MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
- Complying with medical coding guidelines and policies
- Receiving and reviewing patients’ charts and documents for verification and accuracy
- Adhere to the ethical standards of coding as established by AAPC
- Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum360
- Implementing strategic procedures and choosing strategies and evaluation methods that provide correct results
- Maintain up-to-date Coding knowledge by reviewing materials disseminated/recommended by the QM Manager, Coding Operations Managers, and Director of Coding/Quality Management, etc
- Participate in coding department meetings and educational events
- Review and maintain a record of charts coded, held, and/or missing
Senior Lead - Physician Compliance Auditor/ Educator
CATHOLIC HEALTH SERVICES OF LONG ISLAND
02.2016 - 12.2020
- Maintains review schedule for Professional Fee Services in coordination with the other staff of this division by (1) doing preparatory work for the audit, (2) reviewing the documentation, (3) preparing reports, (4) doing necessary post audit training, (5) doing any necessary follow-up reviews and (6) ensuring that appropriate work papers are maintained
- Serves as a resource for the clients of the Compliance Office to answer compliance questions related to billing and coding for professional services across a broad spectrum of medical specialties that have diverse criteria for billing and coding
- Conducts research on and preparing analysis of coding and billing compliance issues
- Assist with the review and revision of existing compliance policies and procedures as well as drafting new policies and procedures as needed
- Code and abstract medical records of low to moderate complexity within the acute care facilities
- Knowledge of anatomy/physiology and disease process, medical terminology, coding guidelines (outpatient and ambulatory surgery), documentation requirements, familiarity with medications and reimbursement guidelines; and encoder experience
- Interacts with providers and management to review and/or implement codes and to update charge documents
- Conducts and assist with focused reviews as deemed necessary including assisting in determining the scope of the review, the necessary sample size based on the issue in question and the necessary documentation to obtain for the review
- Participates in the screening/interviewing process, making self- available to meet the candidates' needs to expedite the screening process
- Provides and/or oversees the training of newly appointed staff members (to the department)
- Attends coding conferences and workshops to receive updated coding information and changes in coding and/or regulations
- Coding
Coding Educator
ADFINITAS HEALTH
09.2013 - 01.2016
- Trains and coach providers in the latest coding guidelines and risk adjustments methodology; supports departmental auditing, data analysis, and reporting; and works on special documentation and coding projects as needed
- Continuously provides ICD-CM coding and documentation education and creates corrective action plans, as needed
- Provides continuing education and annual regulatory updates
- Identifies and develops best practices based on clinical analyses and providers’ documentation, coding, and reporting performances
- Assists with the development of education and training within specified area, which may include preparation of related specialties
- Meets with providers to reinforce diagnosis coding guidelines to ensure they achieve coding compliance
- Creates complex reports of audit findings for providers
- Keeps abreast of documentation and coding regulations and creates meaningful action plans and educational materials based on data analysis to help improve providers’ documentation and coding
- Assesses and identifies skills, competencies and areas of learning and instruction needed for new hires, staff and department management
- Develops and maintains an education calendar and individual continuing education and orientation record for each member of the assigned work group
- Develops and conducts programs with educational materials, procedures and exercises that are task/function specific using a variety of learning and evaluation strategies for all staff
- Coordinates and performs clinical pertinence and inter-disciplinary chart reviews, ensuring the reviews meet government and regulatory standards
- Performs ongoing research to ensure compliance with clinical documentation and/or regulatory guidelines and standards
- Works independently under general supervision and utilizes analytical and creative thinking skills, and influencing abilities
- Maintains a current knowledge relating to Health Information Management Systems by attending educational workshops/conferences, reviewing professional publications, establishing personal networks, and/or participating in professional societies
Coding and Reimbursement Coordinator
NORTHWELL HEALTH SYSTEM
06.2008 - 09.2013
- Audits medical record documentation to identify under-coded and over-coded services; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues
- Conducts chart reviews for proper diagnosis coding from physician and hospital outpatient records which required knowledge of HCC risk adjustment coding
- Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services
- Demonstrates the technical competence to use the facility encoder as it interfaces with the hospital mainframe and/or EMR in an on-site or remote setting
- Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation
- Interacts with providers and management to review and/or implement codes and to update charge documents
- Attends coding conferences and workshops to receive updated coding information and changes
Education
A.A.S -
NASSAU COMMUNITY COLLEGE
Garden City, NYCPC – Certified Professional Coder Certification, - CPMA - Certified Professional Medical Auditor
American Academy of Professional Coders
Skills
- Excellent Strategist - Provide solutions that boost productivity and efficiency across the organization Quickly identify problem areas and implement effective solutions to meet goals
- Exceptional organizational skills - Ability to prioritize tasks to accomplish maximum results, timely completion of projects, and ability to address organizational problems with innovative solutions
- Strong sense of responsibility - Solid professional standards; excellent track record of dependability Maintain focus on achieving results while implementing solutions to meet a diversity of needs
- Qualifications - Experience in HCC Medicare medical record review in an inpatient/outpatient (acute care, ambulatory surgery) setting, and eight years’ experience in ICD-10, CPT and HCPCS coding
- Computer Skills -Knowledgeable of computer programs to include MS Windows, Word, Excel, Web Connect, Stockamp, Medeconnect, Patient Keeper, Soarian Financials, GE Centricity Business, Northshore/LIJ IDX, MD Audit, EncoderPro, Codify, Allscripts, ProAuditor, Epic and 3M
Timeline
Certified Professional Coder – Auditor
UNITED HEATH GROUP/ OPTUM
01.2021 - Current
Senior Lead - Physician Compliance Auditor/ Educator
CATHOLIC HEALTH SERVICES OF LONG ISLAND
02.2016 - 12.2020
Coding Educator
ADFINITAS HEALTH
09.2013 - 01.2016
Coding and Reimbursement Coordinator
NORTHWELL HEALTH SYSTEM
06.2008 - 09.2013
A.A.S -
NASSAU COMMUNITY COLLEGE
CPC – Certified Professional Coder Certification, - CPMA - Certified Professional Medical Auditor
American Academy of Professional Coders
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