Kimberly Conner
Winthrop,MA
Summary
Passionate, driven and dedicated Clinical Documentation Integrity specialist with strong team building and education skills. Hands on experience in program implementation and development as well as oversight of the health system’s CDI program. Well versed in identifying opportunities for improvement, finding solutions, tracking data, and providing feedback with professionalism and integrity in a variety of settings throughout the health system. Expertise with denial prevention, denial appeals and tracking that include DRG denials, clinical validation denials, level of care and medical necessity denials with a 65-70% overturn rate.
Professional with strong focus on clinical documentation improvement and healthcare compliance. Adept at driving quality and accuracy in medical records through collaboration, analytical skills, and attention to detail. Valued for adaptability, teamwork, and delivering impactful results in dynamic healthcare environments. Skilled in ICD-10 coding, medical terminology, regulatory standards, and data analysis.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Senior CDI Consultant/Denial Management Specialist
Enjoin
09.2023 - Current
- Inpatient and outpatient project management, education, and auditing of adult, pediatric and NICU CDI programs with both MS-DRG and APR DRG focus
- Most recent pediatric audit was January 2024 200 APR DRG cases
- Developed a facility based outpatient program that included ED, observation, and same day surgery
- Negotiated contracts with clients that aligned with the scope of CDI services provided, building trust and long-lasting partnerships.
- Facilitated productive communication between clinical staff members regarding proper documentation techniques, fostering a culture of consistent excellence in record-keeping practices.
- Utilized advanced data analytics tools to monitor the impact of implemented CDI strategies on overall performance metrics, guiding future improvements as needed.
- Developed customized training materials that targeted specific documentation challenges faced by clients, improving their understanding and compliance.
- Delivered dynamic presentations at conferences and workshops on the importance of comprehensive clinical documentation for maximizing financial outcomes for healthcare organizations while maintaining compliance with regulations.
- Improved client satisfaction by providing comprehensive CDI consultation services tailored to individual needs.
- Conducted thorough assessments of client medical records, identifying areas for improvement and making strategic recommendations.
- Coordinated multidisciplinary efforts to enhance the quality of clinical documentation across various departments within client organizations.
- Assisted healthcare organizations in achieving accurate documentation and coding, resulting in increased revenue.
- Managed multiple client accounts simultaneously, ensuring timely completion of projects and strict attention to detail in service delivery.
- Collaborated with interdisciplinary teams to develop effective CDI strategies for optimal results.
- Provided ongoing education and support to clinical staff on proper documentation and coding practices, enhancing overall performance.
- Led successful implementation of CDI programs that improved reimbursement rates for clients while maintaining regulatory compliance.
- Established strong relationships with key stakeholders within client organizations to facilitate communication and collaboration on CDI initiatives.
- Served as a mentor to new team members entering the CDI field, sharing best practices and guiding professional development.
- Formulated techniques for quality data collection to meet expected adequacy, accuracy and legitimacy targets.
- Verified compliance with data retention requirements by managing document catalogues for long-term archival of data associated with contract closeouts.
- Implemented strategic plans to meet company objectives, resulting in increased revenue and market share.
- Collaborated closely with executive leadership to develop long-term strategic plans aligned with company objectives.
CDI Education Specialist
ACDIS
04.2022 - 11.2023
- ACDIS full-time instructor for ACDIS CDI Boot Camps and content creator for PROPELCDI advisory services as a subject matter expert for ACDIS and frequently writes for ACDIS publications and speaks at ACDIS events including adult, pediatric, and NICU
Independent Contractor denials specialist
Enjoin
10.2022 - 04.2023
- Evaluation of clinical validity, DGR and Medical necessity denial letter’
- Write effective appeals for denials with a 65-70% overturn rate
CDI Program evaluator/advisor
10.2022 - 10.2022
- Assessed and reported gaps in CDI practice including:
- Number of record reviews per day
- Missed opportunities for capture of specified diagnoses that would impact CC/MCC capture, increase severity of illness and risk of mortality, and PSI/HAC reduction
- Education and communication with all medical surgical service lines as well as case management and quality departments
- Compliant query practices both written and verbal
- Tracking outlined CDI metrics/CDI impact
- Developed and implemented strategies to optimize CDI performance
- Redesigned CDI/coding policies to support improved query process and accurate final coding
- Refined job descriptions and roles for CDI staff, physician advisor and denials management team
CDI Director
South Shore Health
03.2019 - 03.2022
- Redefined CDI practice for the inpatient program by identifying areas of opportunity, training CDI staff, coding, and providers as well as improving communication throughout the organization
- Leveraged technology to improve production and accuracy to achieve appropriate reimbursement, capture of acuity, and increase case mix index
- Initiated outpatient CDI projects in collaboration with population health and outpatient providers
- Initiated new programs for denial prevention through a pre-bill clinical validation process as well as denial appeals process including DRG, clinical validity, level of care, and medical necessity denials
- Established HAC/PSI reduction program in partnership with the Quality and Safety department
- Established training and education for providers in all areas of specified documentation including E/M, Hospital billing and professional billing
- Worked with the IDN, ACO, BACO to support initiatives and goals
CDI Specialist • CDI manager • Clinical Financial Resource
01.2013 - 01.2019
- Initiated CDI program as a new CDI to obtain appropriate clinical documentation through extensive interaction with physicians, nursing staff, other patient care givers, and in collaboration with Health Information Management coding staff to ensure that appropriate reimbursement is received for the level of services rendered to patients and the clinical information utilized in profiling and reporting outcomes is complete and accurate
- Use of extensive knowledge of documentation requirements and guidelines in accordance with CMS, AHA, AHIMA and NCHS to improve the overall quality and completeness of clinical documentation by performing admission/continued stay reviews using clinical documentation guidelines
- Educate internal staff on clinical documentation needs, changes to clinical documentation guidelines, coding and reimbursement issues and conduct follow up reviews of clinical documentation to ensure points clarified with the physician have been recorded in the patient’s record
- Participated in utilization review meetings to identify areas of opportunity
- Lead initiative projects across multiple hospitals including sepsis core measure, malnutrition and obesity identification, capture and treatment, and STS data abstraction and reporting for Thoracic Surgery
- Provide input for reporting of metrics and measures of CDI, CM, and/or UR program activity to hospital executive and medical leadership
SICU/Burn Trauma Charge Nurse
Portsmouth Regional Hospital
01.2012 - 01.2013
SICU/Burn Trauma Charge Nurse
Brigham and Women’s Hospital
01.1998 - 01.2011
SICU/Burn Trauma Charge Nurse
Johns Hopkins
01.1997 - 01.1998
Education
BSN -
University of Phoenix
Associate Degree - Nursing
North Shore Community College
School of Nursing -
Boston College
Skills
- Innovative problem-solving
- Excellent analytical and critical thinking skills
- Effective communication and collaboration
- Tailored and effective education
- Project management
- Team building
- Data analysis
- Trending
- Reporting
- Solution oriented
- Registry data abstraction
- Epic
- 3M 360
- Cobious
- Xoslis
- InterQual
- Word
- Excel
- PowerPoint
- Teamwork and cooperation
- Critical thinking
- Professionalism and ethics
- Continuous learning commitment
- Conflict resolution
- Healthcare compliance
- Revenue cycle management
- Interdisciplinary collaboration
- Clinical documentation expertise
- CDI program development
- Data abstraction
- Physician education and training
- Clinical validation techniques
- Regulatory guidelines awareness
- Auditing and monitoring
- Quality improvement strategies
- Multitasking
- Problem-solving
- Excellent communication
- Organizational skills
- Team collaboration
- Active listening
- Effective communication
Certification
- CCDS
- CCDS-O
Awards
Healthcare Financial Management Association MAP award, 2021, Individual Hospital outstanding achievements in pursuit of revenue cycle excellence.
Credentials
- BSN
- CCDS
- CCDS-O
Timeline
Senior CDI Consultant/Denial Management Specialist
Enjoin
09.2023 - Current
Independent Contractor denials specialist
Enjoin
10.2022 - 04.2023
CDI Program evaluator/advisor
10.2022 - 10.2022
CDI Education Specialist
ACDIS
04.2022 - 11.2023
CDI Director
South Shore Health
03.2019 - 03.2022
CDI Specialist • CDI manager • Clinical Financial Resource
01.2013 - 01.2019
SICU/Burn Trauma Charge Nurse
Portsmouth Regional Hospital
01.2012 - 01.2013
SICU/Burn Trauma Charge Nurse
Brigham and Women’s Hospital
01.1998 - 01.2011
SICU/Burn Trauma Charge Nurse
Johns Hopkins
01.1997 - 01.1998
Associate Degree - Nursing
North Shore Community College
School of Nursing -
Boston College
BSN -
University of Phoenix
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