Summary
Work History
Education
Skills
Certification
Timeline
Overview
Generic
Lisa Sutphin

Lisa Sutphin

Jacksonville,FL

Summary

Detail oriented professional promoting 10+ years of experience in professional, E/M and hospital outpatient clinical documentation auditing using ICD-10-CM, CPT and HCPCS coding rules and guidelines. Recent ICD-10-PCS class taught by AHIMA. Proficient use of EMRs such as Epic and Cerner. Knowledgeable in CMS Regulations/Guidance and OIG Work Plan. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Work History

Compliance Specialist

UF Health Jacksonville
12.2019 - 10.2023
  • Conduct multi-specialty coding/billing audits of clinical documentation and claims to identify areas of noncompliance and reduce risk utilizing CMS Manuals, NCDs, LCDs, ICD-10, CPT and HCPCS guidelines.
  • Provide written audit findings and any associated corrective action recommendations to clinical leaders, Revenue Integrity and Patient Financial Services.
  • Maintain up-to-date knowledge on current healthcare trends such as Value-Based Care, Hierarchical Condition Category coding, growth of Medicare Advantage Plans and increasing telehealth medicine services.
  • Internal consultant for various clinical departments and specialties consisting of extensive research to include national and state rules/regulations and relaying conclusions

Billing Quality Educator

UVA Physicians Group
06.2010 - 12.2019
  • Conduct internal audits on professional charges to include Evaluation and Management services and prepare and present written reports of results to management, clinical chairs, providers, and department billing staff;
  • Conduct coding/billing training for providers, residents, and billing staff;
  • Adhere to HIPAA regulations when applicable during tasks;
  • Internal consultant for multi-specialty clinical departments consisting of extensive research to include national and state rules/regulations and relaying written conclusions;
  • Keep abreast of ICD-10 and CPT coding changes;
  • Writer and editor of documentation, coding/billing newsletter.

Compliance Auditor

Duke University Health System
11.2009 - 02.2010
  • Conduct internal audits on hospital technical charges and prepared and presented written reports of results to management, clinical chairs, providers, and department billing staff;
  • Conduct coding/billing training for clinicians, residents, and billing staff;
  • Adhere to HIPAA regulations when applicable during tasks.

Manager Coding Advisors

Dartmouth-Hitchcock Medical Center
11.2008 - 11.2009
  • Coordinate efforts of Coding Advisor team for professional charges such as weekly oversight of eleven Coding Advisors, oversight of annual provider education plans, quarterly meetings with clinical sections and Coding Advisors;
  • Oversee the connection between clinical departments and Coding Advisors to ensure outstanding customer service;
  • Align mission of the Coding Advisor program with clinical leadership to ensure a unified approach to coding excellence;
  • Coordinate new provider orientation programs for physicians, midlevels, residents, nurses and technicians;
  • Coordinate appropriate use of coding conventions in each clinical section, maintain understanding of clinical procedures and innovations, identify process deficiencies and improve coding practices;
  • Ensure compliance while optimizing accurate revenue;
  • Develop and maintain coding policies in conjunction with coding management;
  • Coordinate resolution and/or education regarding coding related edits/denials with Coding Managers;
  • Communicate to Coding Director potential risks related to provider coding and/or documentation practices;
  • Oversee Access database for consistency and accuracy of provider audits and education;
  • Oversee all encounter forms for revisions and accuracy;
  • Monitor and maintain appropriate staffing levels;
  • Conduct annual performance reviews adhering to Human Resources policies/procedures;
  • Oversee career growth and professional development for Coding Advisors.

Manager Coding & Compliance

Duke University Affiliated Physicians (DUAP)
05.2001 - 04.2008
  • Conduct internal professional fee audits to include Evaluation and Management services and prepare and present written reports of results to providers and administration;
  • Conduct coding and billing training for providers;
  • Manage and follow-up of Medicode edits rollout to clinics;
  • Provide coding/billing guidance to clinics;
  • Develop and implement policies and procedures to ensure compliance;
  • Establish and oversee compliance program for DUAP and associated clinics;
  • Assist with monitoring risk areas, developing DUHS annual work plan and related audits and reports;
  • Liaison between DUHS Corporate Compliance and the DUAP clinics;
  • Objective reviewer and evaluator of compliance issues/concerns;
  • Develop and implement Exit Interview process;
  • Chair of DUAP Compliance Committee;
  • Special Projects;
  • Member of HIPAA: Evaluation and Monitoring Committee, Strategy Group, Privacy Group, Operations Task Force;
  • Oversee HIPAA implementation;
  • Ongoing monitoring to assure HIPAA compliance;
  • Assist with preparation and implementation of JCAHO requirements;
  • Create billing/coding statistical graphs utilizing IDX data queried from the Faculty Practice Solutions Center website.

Compliance Auditor

UVA Health Services Foundation
03.1998 - 05.2001
  • Conducted internal professional fee audits and prepared and presented written reports of results to management, clinical chairs, providers, and department billing staff;
  • Conducted coding/billing training for clinicians, residents, and billing staff;
  • Assisted in developing and implementing policies and procedures to ensure compliance;
  • Special projects;
  • Trained new Compliance Auditors;
  • Member of Health Information Services Committee;
  • Member of Clinical Pathology Compliance Committee;
  • APC Task Force;

Medical Records Technician

UVA Medical Center
07.1995 - 03.1998
  • Coded inpatient, outpatient, and emergency department records utilizing ICD-9, CPT and HCPCS codes;
  • Trained new coders according to official coding rules and guidelines and UVA policies and procedures.

Education

Master - Business Administration

Meredith College
Raleigh, NC
05.2008

B.S - Health Information Administration

Stephens College
Columbia, MO
05.2003

A.S - Health Information Management

The College of Health Sciences
Roanoke, VA
08.1995

Skills

  • Medical Coding/Billing/Reimbursement
  • Regulatory Compliance and Documentation
  • Auditing Processes
  • Risk Assessments
  • Corrective Action Plans
  • Adult Education
  • HIPAA
  • Academic Medical Centers
  • Level 1 Trauma Centers
  • 3M Health Information Systems
  • Microsoft Office Suite

Certification

  • RHIA (Registered Health Information Administrator)
  • CCS (Certified Coding Specialist)
  • CCS-P (Certified Coding Specialist-Physician Based)
  • CHC (Certified in Healthcare Compliance)

Timeline

Compliance Specialist

UF Health Jacksonville
12.2019 - 10.2023

Billing Quality Educator

UVA Physicians Group
06.2010 - 12.2019

Compliance Auditor

Duke University Health System
11.2009 - 02.2010

Manager Coding Advisors

Dartmouth-Hitchcock Medical Center
11.2008 - 11.2009

Manager Coding & Compliance

Duke University Affiliated Physicians (DUAP)
05.2001 - 04.2008

Compliance Auditor

UVA Health Services Foundation
03.1998 - 05.2001

Medical Records Technician

UVA Medical Center
07.1995 - 03.1998

Master - Business Administration

Meredith College

B.S - Health Information Administration

Stephens College

A.S - Health Information Management

The College of Health Sciences

Overview

28
28
years of professional experience
1
1
Certificate

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Lisa Sutphin