Mary Ellen Reardon
Health Care Compliance
Rochester,NY
Summary
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
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
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
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, OK05.2024
Master of Science - Health Administration
Roberts Wesleyan College
Rochester, NY12.2012
Bachelor of Science - Health Administration
Roberts Wesleyan College
Rochester, NY05.2011
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
Timeline
State and Federal Regulatory Oversight
MVP Health Care
12.2021 - Current
Risk Mitigation Coordinator
MVP Health Care
05.2012 - 12.2021
Coder
MVP Health Care
12.2007 - 05.2012
Master of Science - Health Care Law
University of Oklahoma College of Law
Master of Science - Health Administration
Roberts Wesleyan College
Bachelor of Science - Health Administration
Roberts Wesleyan College
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