High- Performance Health Care Professional
with a Master's in Health Administration will
have a Master's of Legal Studies Health
Care Law, and A Certified Professional
Coder CPC , Certified Professional
Compliance Officer CPCO , Certified Risk
Adjustment Coder CRC , and a Risk
Adjustment Practitioner RAP ,
comprehensive experience in Commercial
Medicare and Medicaid reimbursement,
rules and regulations, ICD 10 coding,
conventions, and guidelines. Strengths
include attention to detail, strong problem
resolution skills, ability to work
independently as well as an effective team
player.
Overview
16
16
years of professional experience
Work History
State and Federal Regulatory Oversight
MVP Health Care
Rochester, NY
12.2021 - Current
State and Federal Regulatory Oversight
Coordination of all State and Regulatory audits and requests within the
Operations department
Engage with corporate compliance to ensure that all regulatory requirements impacting operations are communicated, implemented, and monitored to ensure compliance, working with both internal and external functional areas.
Ensure that vendors are meeting all compliance regulations and service level agreements for the operations department.
Create, carry out, and deliver audit reports to the oversight committee and executive leadership.
Plan, lead and coordinate for Federal and State audits for Department of
Financial Services, Health Effectiveness Data and Information Set
Risk Mitigation Coordinator
MVP Health Care
Rochester
05.2012 - 12.2021
Enterprise-wide responsibility for physician education of ICD-10-CM Diagnostic Coding
Lead the development and implementation of risk adjustment tools for provider network.
Collaborates directly with providers and office staff to audit and provide feedback in ICD-10 coding.
Project Lead with vendors to develop and implement projects for MVP’s Risk Adjustment programs across all Lines of Business
Perform team audits of ICD-10 coding to ensure diagnostic coding accuracy.
Track trends to determine training needs.
Consult with the Director, Risk Adjustment, and Coding Team to ensure success in the Medicare Advantage HCC Risk Adjustment and Commercial Exchange payment models.
Coder
MVP Health Care
Rochester
12.2007 - 05.2012
Responsible for applying coding rules consistent with CMS rules and regulations.
Verify and ensure the accuracy, specificity and appropriateness of diagnosis codes based on services rendered.
Maintain up-to-date knowledge of CPT, HCPCS, ICD 9CM codes and revisions.
Review medical record documentation to accurately code primary/secondary diagnosis and procedure codes using the ICD 9CM and CPT F coding conventions.
Consult with and educate physicians on coding compliance and conventions to ensure billing compliance and appropriate reimbursement.
Act as a point of contact for providers through chart review initiatives.
Education
Master of Science - Health Care Law
University of Oklahoma College of Law
Oklahoma City, OK
05.2024
Master of Science - Health Administration
Roberts Wesleyan College
Rochester, NY
12.2012
Bachelor of Science - Health Administration
Roberts Wesleyan College
Rochester, NY
05.2011
Skills
Verbal Communication
Decision-Making
Team Management
Relationship Building
Problem Resolution
MS Office
Research
Remote Office Availability
Dependable and Responsible
Attention to Detail
Cultural Awareness
Affiliations
American Academy of Professional Coders
Certified Professional Compliance
Officer CPCO
American Academy of Professional Coders
Certified Risk Adjustment Coder CRC
American Academy of Professional Coders
<ul>
<li>Spearhead the management and oversight of the National Bio and Agro-Defense Facility (NBAF) project, a pivotal national asset developed in partnership with the U.S</li>
<li>Department of Agriculture (USDA) and the U.S</li>
<li>Department of Homeland Security (DHS)</li>
<li>Collaborate with USDA and DHS stakeholders to ensure a seamless transition of operations and mission capabilities from the aging Plum Island Animal Disease Center (PIADC) to NBAF, ensuring uninterrupted research, diagnostics, and training essential to national security</li>
<li>Lead the operational endurance phase, validating work processes and laboratory setups to guarantee compliance with the highest safety and biocontainment standards, particularly in biosafety level-4 (BSL-4) environments</li>
<li>Act as the hiring manager, conducting interviews and selecting high-quality employees to ensure the success of both DCA and NBAF</li>
<li>Serve as a subject matter expert pert for the payroll system Paychex, overseeing and approving payroll for 63 officers biweekly while managing paid time off and leave requests to maintain the security posture for the facility</li>
<li>Monitor project milestones, providing critical updates to senior management and stakeholders while ensuring alignment with USDA's mission objectives and federal guidelines</li>
<li>Direct the development and execution of strategic initiatives to facilitate efficient collaboration with federal partners, ensuring all laboratory operations adhere to regulatory requirements set forth by the Federal Select Agent Program (FSAP)</li>
<li>Foster a culture of excellence and professionalism within the team, emphasizing rigorous training, safety compliance, and operational integrity as key components of NBAF's mission to safeguard public health and the nation's food supply</li>
<li>Monitored budgeting activities by tracking expenditures and providing regular updates to management.</li>
<li>Analyzed existing processes within a department or organization in order to identify areas for improvement or increased efficiency.</li>
<li>Implemented quality control measures throughout each stage of a project's lifecycle.</li>
<li>Worked closely with senior managers to ensure that all projects were completed according to schedule.</li>
<li>Conducted research on potential vendors, suppliers, contractors and subcontractors for projects.</li>
<li>Provided administrative support to the Project Manager in order to facilitate successful project outcomes.</li>
<li>Prepared monthly progress reports summarizing key accomplishments achieved since the last report.</li>
<li>Trained junior staff on best practices for managing multiple projects simultaneously.</li>
</ul> at Defense Contracting Activity, LLC<ul>
<li>Spearhead the management and oversight of the National Bio and Agro-Defense Facility (NBAF) project, a pivotal national asset developed in partnership with the U.S</li>
<li>Department of Agriculture (USDA) and the U.S</li>
<li>Department of Homeland Security (DHS)</li>
<li>Collaborate with USDA and DHS stakeholders to ensure a seamless transition of operations and mission capabilities from the aging Plum Island Animal Disease Center (PIADC) to NBAF, ensuring uninterrupted research, diagnostics, and training essential to national security</li>
<li>Lead the operational endurance phase, validating work processes and laboratory setups to guarantee compliance with the highest safety and biocontainment standards, particularly in biosafety level-4 (BSL-4) environments</li>
<li>Act as the hiring manager, conducting interviews and selecting high-quality employees to ensure the success of both DCA and NBAF</li>
<li>Serve as a subject matter expert pert for the payroll system Paychex, overseeing and approving payroll for 63 officers biweekly while managing paid time off and leave requests to maintain the security posture for the facility</li>
<li>Monitor project milestones, providing critical updates to senior management and stakeholders while ensuring alignment with USDA's mission objectives and federal guidelines</li>
<li>Direct the development and execution of strategic initiatives to facilitate efficient collaboration with federal partners, ensuring all laboratory operations adhere to regulatory requirements set forth by the Federal Select Agent Program (FSAP)</li>
<li>Foster a culture of excellence and professionalism within the team, emphasizing rigorous training, safety compliance, and operational integrity as key components of NBAF's mission to safeguard public health and the nation's food supply</li>
<li>Monitored budgeting activities by tracking expenditures and providing regular updates to management.</li>
<li>Analyzed existing processes within a department or organization in order to identify areas for improvement or increased efficiency.</li>
<li>Implemented quality control measures throughout each stage of a project's lifecycle.</li>
<li>Worked closely with senior managers to ensure that all projects were completed according to schedule.</li>
<li>Conducted research on potential vendors, suppliers, contractors and subcontractors for projects.</li>
<li>Provided administrative support to the Project Manager in order to facilitate successful project outcomes.</li>
<li>Prepared monthly progress reports summarizing key accomplishments achieved since the last report.</li>
<li>Trained junior staff on best practices for managing multiple projects simultaneously.</li>
</ul> at Defense Contracting Activity, LLC