Jason McAlhaney
Aiken,South Carolina
Summary
Focused compliance officer with extensive regulatory compliance experience. Excellent history of compliance auditing and risk assessment at Physician Practice Solutions. Demonstrated leadership by optimizing revenue through successful insurance negotiations. Skilled in project management and data analytics, driving operational excellence, and regulatory adherence.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Compliance Officer
Physician Practice Solutions
08.2012 - Current
- Monitored adherence to regulatory standards, including HIPAA, HITECH, and OSHA.
- Conducted internal audits to identify compliance issues and facilitated corrective actions with management.
- Executed external audits to identify compliance gaps in practice operations and recommended actionable solutions.
- Collaborated with clinical teams to ensure adherence to local, state, and federal regulations, enhancing overall compliance.
- Implemented ICD-10 education and training sessions for staff members.
- Educated practice administrators on best practices to address insurance denials.
- Performed financial analysis of insurance reimbursements to optimize revenue.
- Negotiated reimbursement rates successfully with commercial insurance carriers.
Coding Consultant
Lexicode Corporation
08.2011 - 08.2012
- Executed inpatient and outpatient coding with ICD-9, CPT, and HCPCS codes to ensure accurate billing.
- Maintained DRG assignment accuracy above 96% by adhering to hospital-specific production standards.
- Collaborated with physicians to clarify diagnoses affecting DRG assignments, enhancing coding accuracy.
- Conducted concurrent quality analyses to ensure coding accuracy through detailed reviews.
- Trained on McKesson, Cerner, GE, Meditech, Epic, Eclipsys, and 3M systems for comprehensive coding proficiency.
- Enhanced coding knowledge through ongoing education and updates on Coding Clinic changes.
- Identified and communicated efficiency improvements in coding processes to contracted facilities, streamlining workflows.
HEDIS Medical Record Abstraction Consultant
QMARK
01.2011 - 06.2012
- Documented patient data using established methods, enhancing data integrity for HEDIS compliance.
- Scheduled on-site appointments with office managers for comprehensive reviews.
- Compiled and delivered member lists to office managers, supporting accurate and timely record-keeping. to office managers and confirmed receipt.
- Provided operational advice on business development initiatives and organizational changes.
Summer Intern
University Hospital Information Services
05.2010 - 08.2010
- Analyzed health information records to ensure compliance with quality standards.
- Validated entries for Master Patient Index to maintain accuracy of data.
- Assisted with coding of inpatient and outpatient medical records, ensuring comprehensive documentation.
- Revised hospital procedures and policies, streamlining medical record administration.
- Evaluated auditing contract proposals for compliance and quality assurance. for annual coding audit to ensure thorough evaluation.
- Prepared, scanned, filed, and retrieved patient medical records efficiently.
Information Services Summer Intern
MCG Health Inc.
05.2008 - 08.2008
- Investigated and optimized diagnostic orders prebuilt in Cerner for Computer Physician Order Entry 'Go-Live' project.
- Coordinated and streamlined ordering workflow for diagnostic tests with MCG department heads.
- Collaborated with staff to enhance clinical workflow processes.
- Presented recommended records management changes to MCG Physicians Executive Team.
- Created Quick Tips fold-out to enhance usability during initial 'Go-Live' phase.
- Prepared and organized materials for training sessions and meetings.
Education
Health Information Administration Certification -
Medical College of Georgia
Augusta, GA08.2010
Master of Health Informatics -
Medical College of Georgia
Augusta, GA05.2009
Bachelor of Science - Exercise Science
University of South Carolina
Columbia, SC05.2007
Skills
- Project management
- Compliance auditing
- Risk assessment
- Quality assurance
- Team leadership
- Financial analysis
- ICD-10 and CPT compliance
- Data analytics
- Denial resolution
- Legal research
Affiliations
- SC Health Information Management Association
- American Health Information Management Association (AHIMA)
- American Academy of Professional Coders (AAPC)
Certification
- Registered Health Information Administrator (AHIMA)
- Certified Professional Coder (AAPC)
- Certified Medical Compliance Officer (AIHC)
Accomplishments
- SCHIMA Board of Directors
- Fermata Club Board of Directors
- SCHIMA Distinguished Member Award 2023
- South Carolina HOPE Scholarship Recipient
- Letterman, University of South Carolina Tennis
- Southeastern Conference Athlete All-Academic Team
- Medical College of Georgia Dean's List
Timeline
Compliance Officer
Physician Practice Solutions
08.2012 - Current
Coding Consultant
Lexicode Corporation
08.2011 - 08.2012
HEDIS Medical Record Abstraction Consultant
QMARK
01.2011 - 06.2012
Summer Intern
University Hospital Information Services
05.2010 - 08.2010
Information Services Summer Intern
MCG Health Inc.
05.2008 - 08.2008
Health Information Administration Certification -
Medical College of Georgia
Master of Health Informatics -
Medical College of Georgia
Bachelor of Science - Exercise Science
University of South Carolina