Lori Payne

• Led a team of risk coders focusing on accurate and compliant coding practices to maximize HCC risk adjustment.
• Reviewed medical records for proper risk coding, ensuring alignment with CMS guidelines and compliance regulations.
• Provided training and mentorship to coding staff, enhancing their understanding of HCC guidelines and documentation requirements.
• Collaborated with clinical staff to improve documentation practices, ensuring accurate coding for better patient outcomes and appropriate reimbursements.
• Conducted regular audits and feedback sessions to maintain high standards of coding accuracy and efficiency.
• Worked closely with leadership to identify trends and areas for improvement in coding practices within the organization.
• Developed new workflows to enhance operational efficiency.

Key Responsibilities and Duties:

• Medical Record Review: Conduct thorough concurrent, prospective, and retrospective reviews of medical records to ensure accurate and complete capture of the clinical picture, severity of illness, and complexity of the patient.
• Coding Accuracy and Compliance: Ensure accurate and compliant HCC coding, adhering to industry standards, CMS guidelines, and coding regulations.
• Provider Education: Lead provider education initiatives to improve coding accuracy and adherence to risk adjustment requirements.
• Process Improvement: Identify opportunities for process improvement and implement changes to enhance coding accuracy and efficiency.
• Training and Mentorship: Conduct training related to HCC coding, platform usage, and update training materials.
• Auditing: Conduct prospective and retrospective chart audits to assess risk adjustment coding accuracy.
• Project Management: Manage HCC coding projects, including project status and completing chart reviews as needed.
• Collaboration: Collaborate with healthcare providers, clinical staff, and other departments to obtain necessary documentation and resolve coding issues.
• Staying Current: Stay up-to-date with coding guidelines, regulations, and industry changes.
• Monitoring Performance: Monitor coding productivity and quality, implementing process improvements as necessary.
• Facilitated interdisciplinary collaboration between physicians, nurses, case managers, coders, and other relevant stakeholders regarding the appropriate representation of patient severity levels within EHRs.
• Analyzed data from audits to identify areas for improvement in clinical documentation processes, implementing targeted interventions for positive change.
• Expedited accurate clinical documentation completion by promptly responding to queries from healthcare providers and support staff, offering timely guidance and support.
• Reduced risk exposure by promptly addressing any identified discrepancies or inconsistencies within patient records.
• Assisted in the development of policies and procedures related to clinical documentation processes, promoting consistency across the organization.
• Communicated with physicians, nurses and other caregivers to explain importance of accurate and clear documentation.
• Effectively managed multiple priorities while maintaining strict adherence to established deadlines, ensuring the consistent delivery of exceptional clinical documentation services.
• Maintained strong knowledge of medical terminology, diseases and conditions and procedures.
• Collaborated with multidisciplinary teams to develop best practices in clinical documentation, streamlining processes and reducing errors.
• Carefully reviewed patient files for clarity on diseases, diagnoses and procedures to determine quality of care.
• Ensured compliance with regulatory standards and guidelines through meticulous attention to detail in completing clinical documentation tasks.
• Served as a resource for healthcare professionals seeking guidance on various aspects of clinical documentation, fostering effective communication among team members.
• Participated in continuous education programs, staying up-to-date on industry trends and best practices in clinical documentation management.
• Educated healthcare staff on the importance of proper clinical documentation, fostering a culture of accuracy and accountability.
• Questioned physicians regarding missing or unclear health record documentation and requested further information for clarification purposes.
• Championed ongoing staff development by conducting regular educational sessions on clinical documentation best practices and regulatory requirements.
• Improved clinical documentation quality by conducting thorough reviews and providing feedback to healthcare providers.
• Supported facility-wide efforts towards achieving high-quality performance metrics through comprehensive chart analysis focused on necessary improvements.
• Processed records quickly to avoid delays and keep workflows running smoothly.

• Functioned capably in clinical and administrative support positions within the practices
• Supervised front and back-office staff
• Worked with leadership to identify opportunities and problems and initiate plans for decision-making and problem-solving in the organization, specifically with regard to the practices in a positive manner
• Directly supervised practice staff, including medical assistants and patient specialists, ensuring adequate coverage for all positions and arranging for sick and vacation time coverage
• Worked with the appropriate staff in the office to ensure provider schedules were at a level to achieve identified benchmarks and apprised leadership of any issues with achieving benchmarks
• Made recommendations for staffing levels at the site based on site productivity and patient needs
• Assured adequate provider coverage to meet patients' needs
• Participated in interviewing, hiring, and orienting new staff
• Assured employee evaluations were completed on time and appropriate goals were set for the supervised staff
• Made recommendations for salary adjustments
• Provided oversight of bi-weekly employee timesheets and monitored time clock activities
• Identified areas of concern for providers and brings them forward for resolution and feedback/follow-up
• Assessed improvements made in systems or processes, system efficiency, innovation, and creativity, as well as the commitment to generating new solutions and ideas
• Troubleshooted problems such as non-working equipment, patient complaints, inefficiencies, workplace conflicts, and other items that may disrupt operations
• Interacted with patients and addressed any concerns or complaints
• Utilized specialized medical classification software to assign procedure and diagnosis codes for insurance billing
• Reviewed claims data to ensure that assigned codes met required legal and insurance rules and that required signatures and authorizations were in place prior to submission
• Performed internal retrospective, concurrent, or prospective medical chart audits to ensure that CPT codes billed were appropriate and supported by documentation in the patient record and that all coding/documentation combinations complied with federal and state regulations
• Identified, compiled, and coded patients using ICD-10, CPT and other standard classifications coding systems
• Entered data into a computer database, such as history and extent of disease, diagnostic procedures, and treatment
• Compiled, abstracted, and maintained patient medical records documenting condition and treatment
• Reviewed records for completeness, accuracy, and compliance with regulations
• Initiated processes to follow up on rejected claims
• Phone interactions with insurance agencies
• Verified all data around the patient/claim and found out why it had been denied
• Responsible for timely re-submission and accuracy of billing claims
• Responsible for accurately submitting necessary documentation with claims to insurance companies
• Followed up on all denials within 72 hours of receipt
• Participated in accurate collection activities and accounts receivable management
• This includes mailing second and third notices to past-due accounts and letters of patient responsibility
• Posted payments to accounts and submitted check requests for overpaid accounts
• Managed accounts receivable to reflect collectible dollars
• Responsible for knowing and complying with applicable policies and procedures

• Performed pre-live, go-live, and follow-up training for new EHR implementations
• Developed customized, solution-oriented training and adoption plans specific to individual practices and coordinated the optimization through full adoption
• Captured best practices and advised on suggested workflow modifications
• Optimized workflow and documentation by performing virtual training with existing practices to improve the EHR satisfaction rating
• Completed needs assessment and end-user proficiency assessment for the affiliate and staff
• Completed customizations to enhance workflow productivity
• Performed new hire training for the practice
• Participated in ongoing training to maintain subject matter expertise by attending new release training while staying current on MIPS guidelines and other self-study pieces of training
• Assisted in developing teaching outlines and other associated training, including MIPS and CCM
• Provided Athena customer support and webinars for affiliates and staff
• Captured and shared critical information with the internal management team and developed approved communications to share with network physicians
• Administrative responsibilities included but were not limited to reviewing assignment calendar, making travel arrangements, and completing expense and trip visit reports timely to reflect the office's training competency
• Updated Salesforce (CRM) to document completed case assignments

• Trained providers and staff on the use of the features and functions of the service
• Established rapport; gain and maintain credibility with diverse audiences
• Performed pre-live, go-live, and follow-up training for transition to the new EMR system (AthenaHealth)
• Used best practices to manage practices
• Developed training plans specific to the practice or Provider and coordinated optimization through the transitions
• Managed time effectively with minimal supervision to accurately scope projects and ensured that practices were trained on time
• Optimized workflows and documentation
• Ensured that all practices, including those existing, were used to accelerate clinic processes
• Responsible for training clients on medical software using classroom, remote, on-the-job, and blended training techniques
• Managed the client training schedules and workflow of the practice and coordinated with project managers and administrators to properly execute the training for all staff
• Participated in ongoing training to maintain expertise by attending new release pieces of training, self-study, MIPS guidelines, and documentation guidelines
• Recorded details of client feedback through the training process
• Responsible for contributing to the creation of training resource material
• Collaboratively planned and executed client training programs using existing tools and training processes
• Project managed several simultaneous client engagements, ensuring expectations and deliverables were documented and met, key stakeholders were informed, and client satisfaction was achieved
• Coordinated Go-Live events, staff, travel, and communications
• Provided Athena support for staff
• Escalated cases and troubleshooted issues
• Ability to prioritize and multi-task in a fast-paced environment, manage several projects simultaneously, meeting all deadlines, and communicate potential conflicts to the manager
• Created videos and programs for instruction

• Assisted DPM in the clinic and during procedures
• Supervised back-office staff
• Maintained and oversaw daily clinic schedules of multiple providers
• Trained providers and staff on EPIC and EMR systems
• Met established productivity, schedule adherence, and quality standards
• Guided, oversaw, and trained new clinic staff; oversaw orientation
• Maintained and updated training materials as needed to aid in educational processes
• Educated clinical staff on hardware, software, systems, and processes
• Inventoried and maintained clinic supplies
• Utilized support desk ticket systems to track, prioritize, document, and resolve EMR issues
• Educated at-risk patients on foot care
• Answered and responded on time to patient emails and phone calls
• Coordinated patient care within the department and with other specialties
• Oversaw multiple provider teams/act as a liaison between specialties
• Set up and cleaned exam rooms
• Cleaned and maintained surgical instruments as well as clinical instruments
• Prepared in-room surgical procedure trays
• Performed at-risk foot care per provider orders
• Entered and maintained patient privacy concerning patient records
• Documented wounds using accurate wound assessment protocol
• Maintained paperwork for insurance purposes, including proper coding
• Ensured letter documentation meets client, regulatory, and accreditation requirements
• Scheduled patient appointments for clinic, surgery, and referral
• Called or electronically submitted prescriptions for the provider's signature
• Carried out and received orders from providers for patient needs
• Gathered and submitted paperwork for diabetic shoe submission/DME
• Performed and recorded vital signs and ensured medical histories were updated in the patient's medical records
• Prepared specimens for transport to provide stability to the laboratory
• Prepared and drew medications per provider's order for in-office use
• Performed laser treatment of fungal nails
• Prepared and completed FMLA paperwork
• Wound care certification
• Oncology foot care certification
• Diabetic foot care specialist certification

• Continuing education in [Subject]