MARYBETH RILEY
South Portland,ME
Summary
Experienced Clinical Documentation Improvement Specialist with a proven track record in enhancing coding, documentation, and improving quality. Skilled in refining processes to align with industry standards and enhance accuracy in capturing the patient's current clinical picture. Recognized as a valuable team player, known for adaptability and commitment to achieving results through collaborative efforts and strong organizational skills.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Clinical Documentation Improvement Specialist, RN, BSN, CRC, CPC-A
InterMed, PA
05.2017 - Current
- Conducted prospective medical record review to identify co-morbidities and complications, ensuring complete documentation and proper diagnoses coding per ICD-10 guidelines.
- Participated in the development and implementation of new workflows and protocols to improve coding and documentation processes. Maintained adherence to AHIMA and ACDIS guidelines regarding compliant query language.
- Created customized education materials for internal CDIS use as well as provider education, promoting consistency with messaging across the team. Provided one-on-one provider education at routine intervals.
- Assisted with internal CDIS audits to ensure consistency in query practices and provide ongoing education and training opportunities within the team.
- Collaborated on Lean 6 Sigma Projects while participating in the Lean 6 Sigma Greenbelt Certificate Program.
- Utilized multiple external payer reports to review for gaps in patient care and quality improvement opportunities such as HEDIS measures. Collaborated with internal Business Intelligence team to develop comprehensive reports capturing all pertinent data for chronic condition recapture, streamlining workflows, and team efficiency.
- Completed external payer projects as requested, including Patient Assessment Forms (PAF) and Health Business Intelligence (Health BI).
- Monitored changes in laws, regulations, rules, and code assignments from governing agencies such as CMS and AAPC that impacted documentation and reimbursement. Identified issues and trends in coding and documentation that affect patient risk scores.
Clinical Documentation Specialist, RN, BSN, CRC, CPC-A, CCDS
Maine Medical Center
07.2020 - 02.2022
- Facilitated appropriate documentation to ensure that level of services and acuity of care are accurately reflected in the medical record. Conducted follow-up review of clinical documentation to ensure points of clarification with the physician have been recorded in the chart.
- Improved overall quality and completeness of clinical documentation by performing thorough record review.
- Reviewed Medicare charts in assigned areas with a goal of both capturing MCC, CC and optimizing DRG when medically indicated.
- Tracked responses to CDMP and trends in compliance.
- Demonstrated clinical knowledge, skills and abilities for patient population served.
- Participated in data collection, evaluation and recommendations for process improvement.
- Maintained open positive communication with physicians, interdisciplinary care team members and department director. Developed and delivered education to physicians, staff and others to clarify and promote coding guidelines.
Clinical Assistant, RN
InterMed, PA
12.2014 - 05.2017
- Responsible for assessment of provider schedules to maintain workflow. Preloaded records prior to routine visit per protocol and oversight, and managed telephone encounters utilizing triage and telehealth principles.
- Roomed complex and acutely ill patients, obtain vital signs, perform medication reconciliation, communication patient information to provider, input orders, and document all clinical data correctly and appropriately in the patient’s EHR.
- Assisted providers with procedures and administer injections and immunizations as ordered.
- Demonstrated initiative, responsibility, flexibility and decision-making. Demonstrated critical and reflective thinking as well as the ability to prioritize and handle multiple tasks.
- Maintained confidentiality and compliance in all patient care activities.
Registered Nurse II
Milestone Foundation
05.2013 - 02.2015
- Assessed client’s withdrawal acuity, medical conditions, and current psychiatric state both by phone and walk-in basis for admission to the 16-bed detoxification program.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
- Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.
- Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
- Skillfully managed challenging patient situations using de-escalation techniques, crisis intervention strategies, and therapeutic communication skills.
Registered Nurse II
Maine Medical Center
08.2014 - 12.2014
- Responsible for assessment, diagnoses, outcome identification, planning, implementation, documentation and evaluation of the effects of nursing care.
- Administered medications and treatments as ordered for five to seven patients on a medical-surgical floor.
- Provided patient education regarding diagnoses, medications, discharge instructions, and pertinent lifestyle modifications.
- Acted as a patient advocate and aid in facilitating communication between the patient and provider.
- Provided emotional support for both the patient and family as appropriate.
Education
Bachelor of Science - Nursing, Magna Cum Laude
University of Maine
Fort Kent, ME05.2017
Associate of Applied Science - Nursing
Central Maine Medical Center College of Nursing And Health Professions
Lewiston, ME05.2013
Skills
- EHR software proficiency
- Experience with Microsoft applications
- In-progress Lean Six Sigma Green Belt certification
- Risk adjustment coding expertise
- Strong interpersonal collaboration
- Analytical problem-solving
- Detail-oriented mindset
- Skilled in prioritizing tasks simultaneously
- Adaptability and flexibility
- Relationship building
- Strong personal drive
Certification
Certified Risk Adjustment Coder - CRC
Certified Professional Coder - CPC -A
Bachelor of Nursing, BSN
Timeline
Clinical Documentation Specialist, RN, BSN, CRC, CPC-A, CCDS
Maine Medical Center
07.2020 - 02.2022
Clinical Documentation Improvement Specialist, RN, BSN, CRC, CPC-A
InterMed, PA
05.2017 - Current
Clinical Assistant, RN
InterMed, PA
12.2014 - 05.2017
Registered Nurse II
Maine Medical Center
08.2014 - 12.2014
Registered Nurse II
Milestone Foundation
05.2013 - 02.2015
Bachelor of Science - Nursing, Magna Cum Laude
University of Maine
Associate of Applied Science - Nursing
Central Maine Medical Center College of Nursing And Health Professions
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