Kristin Mizelle, RHIA, CPCO, CPC
Windsor,NC
Summary
Highly motivated health information management professional offering 14-year background in coding, compliance, auditing, provider education, CDI, revenue cycle management, leadership, team building
Overview
11
11
years of professional experience
1
1
Certification
Work History
Senior Regulatory Compliance Analyst
ECU HEALTH-OFFICE OF AUDIT AND COMPLIANCE (OAC)
07.2021 - 04.2023
- Perform compliance audits and monitoring activities across ECU Health to ensure data integrity, and compliance with federal state regulations pertaining to, but not limited to: Complete revenue cycle, Medical record documentation, Coding and billing, Conflict of interest, and Clinical trials billing
- Coordinates external governmental record agency medical or financial record requests
- Responds to and investigates allegations of non-compliance and ensures allegations, concerns or questions relating to other ECU Health departments are routed appropriately
- Provides guidance, conducts research and acts as a subject matter expertise regarding compliance matters
- Serves as a resource for general healthcare compliance practices.
Compliance Auditor
ECU HEALTH MEDICAL GROUP HIMS CODING
08.2017 - 07.2021
- Conducts internal auditing and monitoring of coding accuracy and documents the findings with support tied to regulatory guidance
- Develops and coordinates education that will ensure success based on the individuals specific needs
- Maintains documentation of all audit activity and communicates findings with leadership as appropriate
- Builds collaborative relationships with providers and practices providing education to ensure documentation adheres to coding and regulatory guidelines.
Coding Specialist II
ECU HEALTH CORPORATE HIMS CODING
12.2016 - 08.2017
- Provide code assignment for all levels of Outpatient Coding
- Assign diagnostic and procedural codes using ICD-10 CM and CPT and any other designated coding classification system in accordance with the UHDDS coding guidelines
- Assign diagnosis/procedure codes utilizing the 3M Encoder and CAC to arrive at the most accurate code with 5 days of date of service
- Incorporate current regulatory coding requirements and guidelines appropriately
- Maintain weekly coding productivity log and provide feedback to the Manager of HIMS regarding any coding issues/problems
- Maintain coding accuracy of 95% or better
- Responsible for reviewing claims and correcting edits through CAC/ARMS
- Participate in In-Service education, updates and conferences to remain current with coding requirements and guidelines.
Coding Specialist II
ECU HEALTH MEDICAL GROUP - Ahoskie, NC
03.2013 - 12.2016
- Responsible for all coding and compliance functions of a multi-specialty physician group of ECU Health Medical Group General Surgery, Neurology, & Women’s Care with 2 general surgeons, 1 neurologist, 2 gynecologists, and 1 midlevel serving at 2 hospitals in Eastern North Carolina
- Ensure 3-day turn-around time of coding and revenue capture of all service lines
- Perform quarterly internal coding audits with providers to ensure compliance and provide education
- Strong working relationship with the physicians and staff
- Increased overall provider compliance rate from 70% to 100%
- Review work queues on a daily basis to ensure timely billing and prevention of errors.
Coding Specialist I
ECU HEALTH MEDICAL GROUP- Greenville, NC
06.2012 - 03.2013
- Responsible for coding and auditing functions of a multi-specialty physician group with over 300 providers serving at 10 hospitals and 29 counties in Eastern North Carolina
- Audited providers of various specialties and provided education to ensure overall compliance accuracy rate of 90%
- Assisted manager with the delegation and supervision of coding audits to ensure code assignment within 2-days and communication of any audit discrepancies to the coders
- Oversight of MICU service line and maintained 72-hour turn-around
- Maintained benchmark of 4 provider audits per day and kept within 48hour turn-around time.
Education
Bachelor of Science - Health Information Management
East Carolina University
Greenville05.2023
Associate of Science - Health Information Technology
Edgecombe Community College
Tarboro, NC05.2016
Associate of Applied Science - Medical Office Administration
Martin Community College
Williamston, NC05.2009
Skills
- Leading Providers & Operations
- Implementing & improving workflows
- Ensuring Compliance
- Adhering to regulatory guidelines
- Team Collaboration
- Special Projects & Education
- Audit Management
- Regulatory Knowledge
- Teamwork Abilities
- Process Improvement
- Policy Development
- Decision Making
- Auditing Experience
- Process Implementation
- Compliance Reporting
- Leadership Techniques
Certification
- Registered Health Information Administrator, American Health Information Management Associate (AHIMA), 2023
- Registered Health Information Technician, American Health Information Management Association (AHIMA), 2017 - 2023
- Certified Professional Compliance Officer, American Academy of Professional Coders, 2022
- Certified Professional Coder, American Academy of Professional Coders (AAPC), 2011
Accomplishments
- Worked intensively with the ECU Health Medical Group HIMS auditing & coding team to perform ‘mini’ audit reviews as a courtesy to all providers across VMG, to ensure they received appropriate training and feedback regarding the 2021 ambulatory E/M guideline changes.
- Participated in the research, education and/or tip sheet development for several topics and specialties, including Behavioral Health, Outer Banks Urgent Care (PPD SOP) AWV with Prolonged Preventive Care, and SBAR for 2019 Medicare Rule.
- Worked collaboratively with Provider, Informatics, and Operations to improve providers EMR template to ensure compliant coding. Gained providers & operations respect and provided credibility.
- Worked actively with a physician advisor in the Outer Banks region on creating an E/M educational coding series called ‘Cracking the Code’, and then teamed up with the physician to deliver the educational series to providers across multiple ECU Health Medical Group regions.
Affiliations
- 2023 AAPC President for Greenville’s Local North Carolina Chapter, 2023
- Current AHIMA Member
- Current AAPC Member
Leadership Experience
- Provided education and direction to Providers and Leadership based on coding, auditing, and documentation trends.
- Clinical Rotation at ECU Neurology, 2 months, 2016, Reviewed/audited provider E&M coding and neurology procedure coding. Assisted two other students and trained them on how to score E&M levels and how to assign codes.
- Clinical Rotation with Vidant Health Hospital in HIMS Management, 3 months, 2015, Assisted the HIMS operational manager with various projects at different hospitals. Shadowed the supervisory duties, and gained knowledge in HIMS, Quality Management, Utilization Review, and Compliance.
- Assisted Coding Manager at Vidant Medical Group’s Central Business Office, 2012, Assisted with the delegation and supervision of coding audits to ensure code assignment within 2 days and communication of any audit discrepancies to the coders.
Personal Information
Title: RHIA, CPCO, CPC
Awards
- NCHIMA’s 2020 Scholarship Award, 2020
- North Carolina’s 2009 Academic Excellence Award at Martin Community College, 2009
Timeline
Senior Regulatory Compliance Analyst
ECU HEALTH-OFFICE OF AUDIT AND COMPLIANCE (OAC)
07.2021 - 04.2023
Compliance Auditor
ECU HEALTH MEDICAL GROUP HIMS CODING
08.2017 - 07.2021
Coding Specialist II
ECU HEALTH CORPORATE HIMS CODING
12.2016 - 08.2017
Coding Specialist II
ECU HEALTH MEDICAL GROUP - Ahoskie, NC
03.2013 - 12.2016
Coding Specialist I
ECU HEALTH MEDICAL GROUP- Greenville, NC
06.2012 - 03.2013
Bachelor of Science - Health Information Management
East Carolina University
Associate of Science - Health Information Technology
Edgecombe Community College
Associate of Applied Science - Medical Office Administration
Martin Community College
- Registered Health Information Administrator, American Health Information Management Associate (AHIMA), 2023
- Registered Health Information Technician, American Health Information Management Association (AHIMA), 2017 - 2023
- Certified Professional Compliance Officer, American Academy of Professional Coders, 2022
- Certified Professional Coder, American Academy of Professional Coders (AAPC), 2011
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