Kimberley Litzsey, MBA, RHIT, CCS-P, CRC
Chatsworth,CA
Summary
Dependable, detail oriented individual with over 15 years of experience with HCC/Risk Adjustment. Seeking a Risk Adjustment position which will provide challenges and opportunities for growth
Overview
16
16
years of professional experience
1
1
Certification
Work History
HCC Coder
CSI Companies
04.2023 - Current
- Assign appropriate ICD–10-CM codes, mapping to risk adjustment models as applicable
- Assign Event codes when documentation in medical record is inadequate, ambiguous, or otherwise unclear for medical coding purposes
- Maintain quality and production standards required by company - all medical coders must maintain minimum QA passing requirements. Quality expectations are 95% accuracy on all projects.
- Remain current on diagnosis coding guidelines and risk adjustment reimbursement reporting .requirements..
Clinical Documentation Improvement Reviewer
Chirok Health
03.2023 - 12.2023
- Perform extensive analysis of patient records to evaluate documentation of HCC diagnoses.
- Reviews medical records to ensure that diagnoses are reported in accordance with CMS and ICD coding documentation guidelines.
- Reviews to ensure capture of all relevant diagnoses is based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.
Risk Adjustment Analyst, Lead
Blue Shield Of CA
01.2022 - 02.2023
- Drive leadership, guidance, and manage all aspects of a given program, including vendor oversight, internal cross-functional partnerships, tracking performance and measuring results.
- Manage data analysis, documenting and verifying the assumptions used in computations such as those used in member risk data and score submissions and establishing revenue accruals.
- Manage the development and implementation of process of company's projects involving departmental or cross-functional teams focused on delivery of new or existing internal/external programs and/or products.
- Implementation of clinical education materials and initiatives related to risk adjustment activities, HEDIS measures, and any appropriate gaps of care.
- Manage provider engagement relationship with measurable, actionable, solutions to Provider Groups that will result in improved documentation accuracy and submission practices.
- Collaborates with providers, coders, facility staff and a variety of internal and external personnel on the education efforts of the IOA Program and facilitate their engagement in the programs.
Lead HCC Coding Specialist
MedPOINT Management
01.2017 - 01.2022
- Train and oversee HCC Coding Specialists
- Maintain departmental communication and processes to increase coding and data validation standards. Assist in developing workflow for coders/auditors.
- Participates in meetings to create, analyze, apply, interpret and/or communicate policies, procedures and regulations effectively.
- Reviews and audits medical records at provider offices/clinics to identify coding risk areas .
- Preformed chart audits medical records at provider offices/clinics to identify risk adjustment coding issues.
- Identified and communicated documentation deficiencies to providers to improve documentation for accurate risk adjustment coding.
- Demonstrated sound knowledge of medical coding guidelines and regulations to assist providers impact of diagnosis coding on risk adjustment payment models.
- Maintain professional and supportive working relationship with providers offices and health plan.
- Demonstrated high level of proficiency with documentation review including review of orders/results for lab, imaging, hospital records, EHR, etc. as possible source for HCC codes..
- Identified training needs prepared training materials and conducted coaching and training as appropriate for clinic staff, physicians.
HCC Coding Specialist
MedPOINT Management
12.2007 - 01.2017
- Preformed chart audits medical records at provider offices/clinics to identify risk adjustment coding issues.
- Identified and communicated documentation deficiencies to providers to improve documentation for accurate risk adjustment coding.
- Demonstrated sound knowledge of medical coding guidelines and regulations to assist providers impact of diagnosis coding on risk adjustment payment models.
- Maintain professional and supportive working relationship with providers offices and health plan.
- Demonstrated high level of proficiency with documentation review including review of orders/results for lab, imaging, hospital records, EHR, etc. as possible source for HCC codes..
- Identified training needs prepared training materials and conducted coaching and training as appropriate for clinic staff, physicians.
Education
MBA - Health Service Management
Golden Gate University
San Francisco, CA05.1990
Bachelor of Science - Health Service Management
Golden Gate University
San Francisco, CA05.1987
Skills
- Extensive knowledge of CMS Risk Adjustment and HCC Coding Process
- Extensive knowledge and adherence to ICD-10-CM/outpatient and CPT coding principles and guidelines
- Working knowledge of CPT/Evaluation and Management guidelines
- Strong computer skills (ie MS Word, Excel, PowerPoint)
- Prior experiences teaching/training others on correct coding guidelines and/or have ability to present to large groups of Physicians/Providers
- EHR Systems- EPIC, NextGen, EClinicalWorks, Practice Fusion
Affiliations
American Health Information Management Association
American Academy of Professional Coders
Certification
Registered Health Information Technician (RHIT)
Certified Coding Specialist – Physician-based (CCS-P)
Certified Risk Adjustment Coder (CRC)
Timeline
HCC Coder
CSI Companies
04.2023 - Current
Clinical Documentation Improvement Reviewer
Chirok Health
03.2023 - 12.2023
Risk Adjustment Analyst, Lead
Blue Shield Of CA
01.2022 - 02.2023
Lead HCC Coding Specialist
MedPOINT Management
01.2017 - 01.2022
HCC Coding Specialist
MedPOINT Management
12.2007 - 01.2017
MBA - Health Service Management
Golden Gate University
Bachelor of Science - Health Service Management
Golden Gate University