Years of Healthcare Experience
MICHALIN D. ROBERTS, LPN,CRC
Certified Risk Adjustment Coder And Licensed Nurse
Raleigh,NC
Summary
Experienced Risk Adjustment Coder and Licensed Practical Nurse offering over 15 years of healthcare experience. Background includes 9+ years of Medicare Risk Adjustment Coding and Auditing experience. Valuable Auditor offering strong research and problem-solving skills, backed by both clinical education and AAPC training. Seasoned Nurse with expertise in Care Management, Chronic illness and Long-term care needs. Effective engagement within interdisciplinary teams to develop, implement and adjust interventions. Supports the needs of diverse patient populations with clinical knowledge and interpersonal communication skills. Passionate about providing culturally-competent assistance to every patient. Excellent problem-solving, charting and quality assurance management skills.
Overview
16
16
8
8
years of post-secondary education
3
3
Certifications
Work History
Licensed Practical Nurse
Springmoor Retirment Community
Raleigh, NC
05.2019 - 07.2020
- Night Shift Team Lead
- Monitored, tracked and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
- Managed patient care through closely monitoring respiration, blood pressure and blood glucose levels.
- Cared for wounds, provided treatments and assisted with procedures.
- Assisted with admissions, appointments, transfers and discharges.
- Obtained biological specimens for ordered tests and prepared for laboratory transport.
- Comforted and counseled patients and families throughout care process.
- Delivered updates in patient status to charge nurse, recording all changes in medical records.
- Documented accurate and complete patient information to address patient problems and expected outcomes.
Remote Risk Adjustment Coder- Project Contractor
Gebbs
Marina Del Rey, CA
09.2018 - 11.2020
- Contract employee
- Audited Medical records and interpreted documentation to identify all diagnoses and procedures.
- Guarded against fraud and abuse by verifying all coded data accurately reflected services provided.
- Coded Outpatient and Inpatient Professional Services at average rate of 4+ per hour (Project determined).
- Utilized active listening, interpersonal and telephone etiquette skills when communicating with others.
- Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
Remote Risk Adjustment Coder- Project Contractor
Indogene
Kennesaw, GA
09.2018 - 12.2018
- Short-Term Contract Coder
- Reviewed outpatient records and interpreted documentation to identify all diagnoses and procedures.
- Reviewed patient charts to better understand health histories, diagnoses and treatments.
- Maintained high accuracy and proficiency standards
- Resourcefully used various coding books, procedure manuals and on-line encoders.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
High risk Care Coordinator
UNC Physicians Network
Morrisville, NC
08.2017 - 09.2018
- Perform Medical Chart Audits for RADV-RAF compliance/HCC validation and MCAIP suspected condition verification.
- Identify documentation inconsistencies and provide clinical documentation improvement education to Physicians to promote best practice measures for accurate risk adjustment coding.
- ICD-9/ICD-10 out-patient/in-patient coding for risk adjustment purposes.
- Cancer Staging Coder for UNC Hospital Oncologists/Surgeons.
- Employee Engagement Coordinator- Coordinate Workforce Engagement Survey, Provide suggestions to Network leadership for improved workplace engagement.
- Create and provide Physician and staff education/coaching.
- Develop productivity standards and workflows for various Medicare Advantage Value Based Care projects.
- Develop process improvement for chart audit process.
- Perform on-site and off-site chart audits for Physician Network and Independent ACO practices for annual MIPs measures, Stars and other Physician Practice quality care and improvement projects.
- Perform “Go-Live” chart abstractions for Practices on-boarding into Epic EMR System.
- Supported patient care excellence via planning and interpretation of programs.
- Maintained accuracy, completeness and security for medical records and health information.
- Reviewed charts and flagged incomplete or inaccurate information.
- Used classification manuals to gain additional knowledge of disease and diagnoses processes.
- Kept accurate log of all requests for medical information and records.
- Identified new methods to optimize medical records management.
- Created plans and communicated deadlines to ensure projects were completed on time.
Care Manager Raleigh District
CoCare Management
Hollywood, FL
07.2014 - 06.2018
- Provide care management services to Members of a private health insurance company who have chronic/severe health conditions.
- Visit members in home, hospital stays, PCP/Specialist visits.
- Develop, implement and evaluate individualized patient- centered care plans based on intensive Member assessments.
- Serve as an advocate for Member’s welfare and as a liaison between Members and their families, community partners, PCP and other health care providers.
- Support Members in achieving health goals and reducing instances of exacerbation through coaching and education of self-management of symptoms.
- Maintain accurate, timely records via electronic documentation system.
- Medication reconciliation and verification of Member compliance with medications and knowledge of prescribed use.
Remote Data Review Coding Consultant
Inovalon
Bowie, MD
09.2010 - 07.2017
- Complete remote medical chart audits for risk adjustment purposes for Medicare, Medicaid, and Commercial Health Insurance.
- Performed quality over-reads of previously completed record reviews to ensure accuracy, completeness and overall high quality of record review process.
- Utilize ICD9/ICD10 inpatient/outpatient coding to accurately map appropriate diagnosis to the correct HCC’s.
- Review diverse medical records- electronic and traditional paper records from Physician Office, Hospital and Specialty Practices.
- Maintain high accuracy and productivity ratings Projects worked include HCC’s, CRG’s, CDPS, HHS-HIX.
- Guarded against fraud and abuse by verifying all coded data accurately reflected services provided.
- Reviewed outpatient records and interpreted documentation to identify all diagnoses and procedures.
- Electronically download medical records via internet, intranet, and associated web portal.
- Utilized active listening, interpersonal and telephone etiquette skills when communicating with others.
LPN Health Care Coordinator/Supervisor
Aversboro Assisted Living of Garner
Garner, NC
05.2010 - 10.2010
- 119 Bed Facility.
- Management of Staff on all shifts.
- Health Record Maintenance.
- Daily Assessments of Residents.
- Maintain Knowledge of Budget and Census.
- Coordinated with other healthcare providers concerning treatment plans for patients.
- Communicated with doctors, nurses, patients and other employees to identify and resolve healthcare needs.
- Responded to inquiries from doctors, nurses and patients with accurate information.
Admissions and Marketing Professional Training
Capital Nursing And Rehab
Raleigh, NC
03.2010 - 05.2010
- Admissions and Marketing Professional Training.
- Detailed instruction on Medicare Medicaid and Private insurance.
- Developed Skills on marketing services to community and importance of Census generating and patient volume for business success.
LPN Care Coordinator/Supervisor
Carolina Meadows
Chapel Hill, NC
06.2008 - 03.2010
- Alzheimer’s/Dementia Unit.
- Supervision, Teaching, and Coaching of multiple staff on all shifts.
- Participate in interviewing, hiring, and termination process.
- Implementation and staff training of new EMR system
- Monthly and quarterly quality assurance reporting.
- Assess and monitor on-going status of each resident and report to interdisciplinary team.
- Responsible for appropriate communication of resident status to Resident family, Physicians, and other members of the health care team.
- Comply with State and County Adult Care Home and Health Department Sanitation regulations.
- Market Dementia program in the community.
- Helped to develop, improve and implement nursing policies and procedures.
- Maintained medication room in full compliance with government and facility requirements.
- Oversaw medication passes and all direct patient care.
- Evaluated and improved team member performance through coaching and training.
- Took samples such as blood and urine to complete diagnostic and routine assessment tests.
- Updated policies and procedures, leading continuous improvement of resident assessments and care.
- Completed resident assessments in accordance with current regulations and guidelines.
- Conferred with Physicians to discuss patient condition and medical care, helping to optimize treatments and enhance outcomes.
- Established nutritious meal plans and prepared daily offerings to meet patient dietary needs.
- Attended training courses and seminars to remain up-to-date on emerging medical technology and techniques.
LPN Staff Nurse
UNC Hospitals Endoscopy Center
Chapel Hill, NC
08.2006 - 06.2008
- Assist Physicians during Endoscopic procedures.
- Provide Admissions Assessment and Teaching to patients and families.
- Monitor vital signs, ensure proper hydration, in recovery room following endoscopic procedures.
- Provide post procedure instruction per MD orders.
- IV insertion and maintenance.
- Obtain blood samples through venipuncture and store appropriately for lab testing.
- Assist Physicians with Office Visits.
- Managed patient care through closely monitoring respiration, blood pressure and blood glucose levels.
- Assisted with admissions, appointments, transfers and discharges.
- Answered incoming phone calls from patients to provide basic assistance and triage medical concerns.
LPN Office Nurse/Cardiac Phone Triage
North Ohio Heart Center
Elyria, OH
03.2005 - 08.2006
- Assess incoming patient calls, report symptoms and concerns to Cardiologist, provide guidance per MD recommendation.
- Determine possible emergency and need for immediate medical attention and contact EMS and notify MD.
- Manage and update Physician orders.
- Provide patient education pre-and post-Cardiology procedures.
- Communicate Physician orders between local and national physician office.
- Assist Physicians with Office Calls and patient follow-up.
LPN Charge Nurse
The Bridge at Abbewood
Elyria, OH
11.2004 - 05.2005
- Supervision of Staff.
- 45 bed assisted living facility.
- High volume Medication Administration.
- Provide Resident Assessment and Health maintenance.
- Communicate with Resident’s families And Physicians.
- Assist Physicians with patient office visits.
Medical Assisting Instructor
Lorain County JVS
Oberlin, OH
01.2004 - 01.2005
- Provide basic medical office instruction.
- Instruction of medical office skills and technique.
- Provide ICD-9 coding instruction.
- Instruct students on professionalism, patient etiquette, and Medical office accurate documentation.
- Implemented new educational techniques to boost student comprehension
- Provided immediate and constructive feedback to students individually and as group.
- Evaluated students' competencies through written assignments and examinations.
- Used Microsoft Word and other software tools to create documents and other communications.
Medical Assistant
Tri-City Family Medicine
Elyria, OH
05.2001 - 01.2003
- High Volume 5 Physician office.
- Basic nursing care and patient education.
- Assisted in out-patient surgery and local anesthesia.
- Maintain patient medical history.
- Basic Drug Administration.
- Responsible for medication assistance program.
Pharmacy Technician
Giant Eagle Pharmacy
Sheffield, OH
10.2000 - 01.2001
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Ordered medicines daily to replenish stock and increase inventory in anticipation of need.
- Communicated with prescribers to verify medication dosages, refill authorizations and patient information.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems and locating items.
- Counted and labeled prescriptions with correct item and quantity.
Family Health Specialist
Lorain County Community Action Agency
Lorain, OH
03.1999 - 05.1999
- Hearing and vision screenings.
- Maintain current immunization records.
- Provided links to community support for parents.
- Assure entire health record of the Head Start Child Participant is accurate and up to date.
Education
Registered Nursing
Wake Technical Community College
Raleigh, NC 08.2019 - Current
Associate of Arts -
Lorain County Community College
OH 08.2019 - 05.2021
Associate of Science -
Lorain County Community College
OH 08.2019 - 05.2021
Licensed Practical Nurse - Nursing
Lorain County Community College
Elyria, OH 08.2002 - 08.2004
Certified Medical Assisting - Medical Assisting
Lorain County Community College
Elyria, OH 05.2000 - 06.2002
General Studies
University of Akron
Akron, OH 08.1996 - 12.1998
Skills
Medicare Risk Adjustment Coding and Auditing Experience
Certification
Certified Risk Adjustment Coder
Affiliations
National Society of Leadership and Success
AAPC
Timeline
Registered Nursing
Wake Technical Community College
08.2019 - Current
Associate of Arts -
Lorain County Community College
08.2019 - 05.2021
Associate of Science -
Lorain County Community College
08.2019 - 05.2021
Licensed Practical Nurse
Springmoor Retirment Community
05.2019 - 07.2020
Remote Risk Adjustment Coder- Project Contractor
Gebbs
09.2018 - 11.2020
Remote Risk Adjustment Coder- Project Contractor
Indogene
09.2018 - 12.2018
AAPC MACRA Proficient
08-2018
Six Sigma Yellow Belt
03-2018
Certified Risk Adjustment Coder
02-2018
High risk Care Coordinator
UNC Physicians Network
08.2017 - 09.2018
Care Manager Raleigh District
CoCare Management
07.2014 - 06.2018
Remote Data Review Coding Consultant
Inovalon
09.2010 - 07.2017
LPN Health Care Coordinator/Supervisor
Aversboro Assisted Living of Garner
05.2010 - 10.2010
Admissions and Marketing Professional Training
Capital Nursing And Rehab
03.2010 - 05.2010
LPN Care Coordinator/Supervisor
Carolina Meadows
06.2008 - 03.2010
LPN Staff Nurse
UNC Hospitals Endoscopy Center
08.2006 - 06.2008
LPN Office Nurse/Cardiac Phone Triage
North Ohio Heart Center
03.2005 - 08.2006
LPN Charge Nurse
The Bridge at Abbewood
11.2004 - 05.2005
Medical Assisting Instructor
Lorain County JVS
01.2004 - 01.2005
Licensed Practical Nurse - Nursing
Lorain County Community College
08.2002 - 08.2004
Medical Assistant
Tri-City Family Medicine
05.2001 - 01.2003
Pharmacy Technician
Giant Eagle Pharmacy
10.2000 - 01.2001
Certified Medical Assisting - Medical Assisting
Lorain County Community College
05.2000 - 06.2002
Family Health Specialist
Lorain County Community Action Agency
03.1999 - 05.1999
General Studies
University of Akron
08.1996 - 12.1998
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