Josie Johnson
Waverly,Illinois
Summary
Results-oriented professional bringing expertise in health information data management and administration. Successful at overseeing all areas of daily operations and making effective policy decisions to positively impact business direction and bottom line profits.
Overview
12
12
years of professional experience
Work History
DRG Validator/Auditor
AMN Healthcare
, TX
09.2024 - Current
- Trained new staff members on validation protocols and best practices.
- Investigated potential fraud cases involving invalid data or inconsistencies in records.
- Ensured that all validations were completed within established timelines.
- Interpreted complex regulations and ensured compliance with applicable laws and standards.
- Generated reports summarizing validation activities for management review.
- Assisted with audits by providing relevant documentation as needed.
- Identified errors in reports which could compromise patient care.
- Documented entire validation process and recorded all changes.
Director of HIM/Privacy-Compliance Officer
Lincoln Prairie Behavioral Health Center
Springfield, IL
06.2022 - 08.2024
- Plans, directs, and coordinates all aspects of the Health Information Department
- Collaborates with all departments regarding medical record standards and practices and state and federal regulations and laws
- Develops and participates in management of health information policies
- Provides education to employees and providers in areas of health information and compliance
- Monitors timeliness and delinquencies in health records
- Provides oversight of coding responsibilities
- Compile data for use in state reporting, analytics, and performance improvement projects
- Initiates annual performance evaluations and provides feedback to staff
- Advocate for patient quality and safety measures
- Delegate tasks to staff to ensure cohesive functioning of the unit and within other departments
- Monitors health information management systems and sets the healthcare system’s standards for data quality and ethical practice
- Serves as a resource on health information management issues including release of information, confidentiality, information security, information storage and retrieval, and record retention as well as authorship and authentication of health record documentation, standardization of medical vocabularies, and use of classification systems
- Maintain master patient index and census data
- Audit monthly and quarterly data for quality reporting
- Chair committees within Health Information, Compliance, and Patient Advocacy
- Approves and monitors access requests through healthcare applications
- Process, approve, or decline medical records requests (ensure timely response to records request with regards to HIPAA and OCR)
- Investigate compliance hotline reports and initiate corrective action plans based on the findings
- Review facility contracts to ensure compliance with HIPAA laws.
- Recruited, trained, supervised, evaluated and mentored staff members.
- Assessed employee performance against established benchmarks or targets.
- Cultivated strong relationships with customers by responding promptly to inquiries or complaints.
- Investigated potential violations of applicable rules and regulations.
- Assessed the effectiveness of existing processes and procedures related to compliance.
Coding Supervisor
Springfield Clinic
Springfield, IL
03.2021 - 06.2022
- Oversees and monitors medical coding staff to ensure accurate assignment of CPT, HCPCS, and ICD-10-CM codes
- Serves as a resource for other department managers, staff, physicians, and administration
- Reviews claims denials and rejections pertaining to coding
- Identifies denial trends and disseminates coding guidance, regulations, and policies
- Review and make recommendations on programs, policies, and practices to ensure that the organization complies with federal, state, and local regulatory requirements, as well as other third-party payers
- Review evaluation and management services and surgical procedures and address documentation and coding related issues
- Review and approve bi-weekly timecard and PTO/Vacation/Sick benefits prior to payroll processing
- Oversee the performance of 18 remote lead and medical coders and ensure adherence of all department and company policies and procedures
- Evaluate and recommend changes in the revenue cycle process per changing healthcare trends and statistical analysis
- Review the medical record for health record integrity and compliance with federal and state regulations and policies.
Coding Compliance Specialist
Orthopedic Center of Illinois
Springfield, IL
10.2019 - 03.2021
- Audit medical records to ensure compliance with the organization's coding procedures and standards
- Reviews insurance payments and denials and recommend billing corrections
- Educate providers and clinical staff on the coding and documentation process
- Collaborate with the reimbursement supervisor and the Finance Director to ensure proper documentation and claims submissions
- Review and make recommendations on programs, policies, and practices to ensure that the organization complies with federal, state, and local regulatory requirements, as well as other third-party payers
- Review and respond to coding related denial questions for the Reimbursement team or/and follow-up with clinical staff for correct assignment of CPT/HCPCS, ICD-10-CM diagnoses, and modifier usage
- Audit evaluation and management services and surgical procedures
- Communicate upcoming changes in CPT-4, ICD-10-CM, and HCPCS coding methodologies and payer policy requirements
- Evaluate and recommend changes in the revenue cycle process per changing healthcare trends and statistical analysis
- Review the medical record for health record integrity and compliance with federal and state regulations and policies
- Coordinate and collaborate with administration on improvements in the health information processes
- Prepare information/training materials for staff as needed and provide training on frequently denied claims
- Maintain an electronic record of query transactions.
Revenue Cycle Analyst
HSHS Medical Group
Springfield, IL
03.2019 - 10.2019
- Analyze incoming and outgoing claims during the revenue cycle
- Coordinate activities of coding staff to facilitate charge capture and maximum reimbursement
- Identify reimbursement trends in claims denials and coding errors
- Assist and/or advise in revenue projects
- Act as a liaison for the coding department
- Provides support to cost accounting in the maintenance and review of the charge description master file to ensure compliant billing, coding, and reporting of charges as outlined by the federal government
- Provides feedback to the coders as recommended from regulatory/governing resources and other applicable credible sources
- Compiles and reports coder productivity reports
- Investigates and resolves issues which affect the revenue cycle process
- These issues may arise from the charge description master file; billing; coding; or reporting of charges
- Performs audit review of coded charts (includes E&M and Surgical procedures)
- Analyze revenue cycle performance and metrics including but not limited to patient access, charge input and reconciliation, denials, and days in accounts receivable
- Develops and implements policies, procedures, and practices with all revenue cycle areas that facilitate timely, accurate, and efficient charging, coding, billing, and collection activities
- Act with authority to examine and change standard policies, procedures, and practices in revenue cycle areas when options reviewed and warranted
- Disseminate metrics, denials information, and other analytical reports to the managers
- Coordinates and prepares clinical charge audits include charge capture, policy compliance, and charge description master file accuracy
- Serves as a resource to leadership on revenue cycle measurement, charge capture procedures, third party billing, and coding guidelines
- Provides effective oral and written support to all affiliate managers in reference to the revenue cycle
- Provides analytical support to the budget team for annual charge increase data used for budget projections
- Assists in determining aggregate increase, targeted increases by charge code/service line, and quantification of identified increases
- Evaluate the record for documentation consistency and adequacy
- Ensure that the final diagnosis accurately reflects the care and treatment rendered
- Verify work is performed in accordance with the rules, regulations, and coding conventions as established by the American Medical Association, ICD-10, and CMS
- Assign ICD-10 CM diagnosis codes per documentation, physician order, and through the physician query process
- Use of HPF Content Management and Paragon EMR (McKesson)
- Variety of coding includes Inpatient facility, ER facility, OP Diagnostic & Therapeutic services, and OP Lab Services
- Utilize performance improvement techniques via Lean Six Sigma initiatives (White Belt training w/ Certification)
- Served on two Green Belt project teams to “reduce denials” and “improve pre-authorization processes”
- Assign ICD-10 CM codes to outpatient diagnostic and clinical services and ER services according to guidelines and policies set forth by the American Medical Association, Centers for Medicare and Medicaid Services, AHIMA, AAPC, Coding Clinics, and other regulatory/governing resources
- Review of the medical record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered
- Abide by the Ethical Standards of coding and practice guidelines
- Maintain adequacy and accuracy set forth by hospital policy
- Review documentation, CPT codes, and assigned ICD-10 CM codes by following up on claims inquiries and errors
- Ensure patient, employee, and visitor privacy standards in accordance with HIPAA rules
- Follow up on deficient orders, diagnosis, and documentation errors
- Report discrepancies to Director of Health Information Management.
Outpatient/Inpatient Coder
Passavant Memorial Hospital
Jacksonville, IL
11.2015 - 03.2019
- Code outpatient diagnostic medical records and evaluation and management services by utilizing ICD-9-CM, HCPCS, and CPT
- (Coding for approx
- 15 physicians at HRMG) Audit medical records to ensure specificity of diagnoses and procedures and to ensure appropriate and optimal third-party reimbursement
- Apply the appropriate diagnostic and procedural codes to individual patient health information for data retrieval, analysis, and claims processing
- Verify work is performed in accordance with the rules, regulations, and coding conventions as established by the American Medical Association, ICD9, and CMS
- Abide by the Standards of Ethical Coding and adhere to official coding guidelines
- Use of Allscripts EHR PM and EHR Clinical, Allscripts Sunrise, and Affinity
- Review of the medical record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered
- Evaluate the record for documentation consistency and adequacy
- Ensure that the final diagnosis accurately reflects the care and treatment rendered
- Review the medical record for compliance with established third party reimbursement agencies
- Analyze and audit provider documentation to assure the appropriate Evaluation & Management (E & M) levels are assigned using the correct CPT/HCPCS code
- Performs all duties according to established safety procedures
- Variety of coding specialties includes pediatrics, occupational medicine, family medicine, general surgery, internal medicine, cardiology, and acute care services
- Utilize hospital ER coding for abstracting and billing of professional and facility codes.
Certified Coder
Hannibal Regional Medical Group
Hannibal, MO
01.2015 - 11.2015
- Code outpatient diagnostic medical records and evaluation and management services by utilizing ICD-9-CM, HCPCS, and CPT
- Audit medical records to ensure specificity of diagnoses and procedures and to ensure appropriate and optimal third-party reimbursement
- Apply the appropriate diagnostic and procedural codes to individual patient health information for data retrieval, analysis, and claims processing
- Verify work is performed in accordance with the rules, regulations, and coding conventions as established by the American Medical Association, ICD9, and CMS
- Abide by the Standards of Ethical Coding and adhere to official coding guidelines
- Use of Allscripts EHR PM and EHR Clinical, Allscripts Sunrise, and Affinity
- Review of the medical record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered
- Evaluate the record for documentation consistency and adequacy
- Ensure that the final diagnosis accurately reflects the care and treatment rendered
- Review the medical record for compliance with established third party reimbursement agencies
- Analyze and audit provider documentation to assure the appropriate Evaluation & Management (E & M) levels are assigned using the correct CPT/HCPCS code.
Hospital Coder
Hannibal Clinic Operations, L.L.C.
Hannibal, MO
01.2013 - 12.2014
- Assign and sequence ICD-9-CM/CPT/HCPCS codes to diagnoses and procedures for documented information
- Assure the final diagnoses and operative procedures as stated by the physician are valid and complete
- Abstract all necessary information from health records to identify secondary complications and co-morbid conditions
- Educate providers on current policies and guidelines per payer
- Perform review of claims denials, research payer policies, and suggest appropriate action (such as contractual obligations, reimbursement policies, bundling, etc)
- Analyze and audit provider documentation to assure the appropriate Evaluation & Management (E & M) levels are assigned using the correct CPT code
- Abstract all necessary information and assign codes (ICD-9, CPT & HCPCS), which most accurately describe each documented diagnosis, surgical procedure and special therapy or procedure according to established guidelines
- Determine the final diagnoses and procedures stated by the physician or other health care providers are valid and complete
- Review of the medical record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered
- Evaluate the record for documentation consistency and adequacy
- Review the medical record for compliance with established third party reimbursement agencies.
Education
Master of Science - Healthcare Compliance
National Juris University/Crestpoint University
Phoenix, AZ01-2025
B.S. Health Information Administration -
Stephens College
12-2020
Medical Coding Certificate -
Spoon River College
05.2014
Masters of Arts in Legal Studies -
University of Illinois
Skills
- MS Word
- MS Excel
- MS PowerPoint
- Clintegrity
- Affinity EMR
- Allscripts
- Quickbooks
- Typing-40 to 45 wpm
- Intergy
- Paragon EMR
- HPF Content Management
- Epic EMR
- SRS EMR
- CPC
- COC
- CPMA
- RHIA
- Staff Management
- Project Management
- Staff Development
- Legal and Regulatory Compliance
- Company Guidelines
- Verbal and Written Communication
- Rules and Regulations
- Issues Resolution
Office Skills
- Office Management
- Records Management
- Database Management
- Spreadsheets/Reports
- Event Management
References
References available upon request.
Timeline
DRG Validator/Auditor
AMN Healthcare
09.2024 - Current
Director of HIM/Privacy-Compliance Officer
Lincoln Prairie Behavioral Health Center
06.2022 - 08.2024
Coding Supervisor
Springfield Clinic
03.2021 - 06.2022
Coding Compliance Specialist
Orthopedic Center of Illinois
10.2019 - 03.2021
Revenue Cycle Analyst
HSHS Medical Group
03.2019 - 10.2019
Outpatient/Inpatient Coder
Passavant Memorial Hospital
11.2015 - 03.2019
Certified Coder
Hannibal Regional Medical Group
01.2015 - 11.2015
Hospital Coder
Hannibal Clinic Operations, L.L.C.
01.2013 - 12.2014
B.S. Health Information Administration -
Stephens College
Medical Coding Certificate -
Spoon River College
Masters of Arts in Legal Studies -
University of Illinois
Master of Science - Healthcare Compliance
National Juris University/Crestpoint University