Eiesha McCoy
Summary
Dynamic HIMS Supervisor at Encompass Health Rehabilitation Hospital of Tustin, skilled in ICD coding and documentation compliance. Proven track record in enhancing physician training and developing educational materials, leading to improved accuracy in coding and billing processes. Adept at fostering collaboration among interdisciplinary teams to ensure regulatory adherence and optimal patient outcomes.
Overview
15
15
years of professional experience
Work History
HIMS Supervisor
Encompass Health Rehabilitation Hospital of Tustin
11.2012 - Current
- Review interdisciplinary clinical documentation and diagnostic data to accurately assign ICD 10 CM and ICD 10 PCS codes within the AHIMA Standards of Ethical Coding and the American Medical Association ICD-10 Guidelines for Coding and Reporting.
- Perform concurrent reviews on Case Mix Group assignments (the Inpatient Rehabilitation Facility analog of DRGs) to ensure that complications that can impact patient length of stay and reimbursement are accurately reflected.
- Create educational materials and conduct in-person training with physicians and staff geared toward improving documentation, and reinforcing the criteria required for admission to the Inpatient Rehabilitation Facility setting.
- Review records for consistency in documentation from all disciplines and mitigate any issues that are found through communication with the responsible parties.
- Review records for documentation errors and issues and educate providers and staff on how to correct any issues that are found.
- Query physicians and other staff to clarify any conflicting documentation and create education materials based on emerging trends.
- Keep abreast of coding changes, definitions and rules using resources such as the Coding Clinic and the OIG Wordplay.
- Coordinate with staff to complete documentation upon which timely billing is dependent to identify, troubleshoot and resolve issues in order to maintain 100 percent timely billing.
- Review records for clarity, completeness and compliance with State, federal and corporate regulations.
Specialty Analyst
HMS
Santa Ana, CA
11.2010 - 07.2012
- Evaluated and compared federal and state-specific edits to claim data Audited claims for medical necessity based on state and federal regulations.
- Referenced the Medicare and Medicaid National Correct Coding Initiative (NCCI), Local Coverage Determinations (LCD), and Relative Value Units (RVUs) rules to determine if appropriate CPT, HCPCS were used appropriately on a given claim.
- Made recommendations to clients regarding whether a medical claim should be paid, denied, recouped, or sent for further review based on federal and/or state regulations and created a client-specific database containing rules by which claims in their jurisdiction should be reviewed.
- Evaluated Medicare and State Medicaid manuals for rules and regulations for the billing and coding of services under the respective programs.
- Coordinated medical terminology, CPT, ICD-9 and 10, and HCPCS coding and medical billing principles training for our department.
- Acted as a team leader, and assisted members of my team and other teams with the location of codes and determining whether a certain rule would properly compare with medical claims data.
- Suggested new edits that would compare and track compliance with the federal regulations and those of several states, including California.
Education
Binghamton University
Binghamton, NYState University of New York Cobleskill
Cobleskill, NYSkills
- ICD coding
- Case mix group analysis
- Documentation compliance
- Educational material development
- Physician training and education
- Medical billing regulations
Timeline
HIMS Supervisor
Encompass Health Rehabilitation Hospital of Tustin
11.2012 - Current
Specialty Analyst
HMS
11.2010 - 07.2012
Binghamton University
State University of New York Cobleskill