Olaide Raji
Santa Clarita,USA
Summary
8+ years of Inpatient/CDI experience and multi-inpatient coding experience Medical Graduate with several years of experience. CCS certification through AHIMA Experience in Chart Review, Clinical Documentation Improvement Programs, ICD-10 coding review, HCPCS, DRG Validation, Claim denial appeals, CPT Classification, and grouping. Review of Claim Denial letters and respond promptly with clinical justifications. Demonstrated leadership roles in Physicians and Care Management team education to improve accuracy and timely completion of documentation. Regular seminars and presentations are held for unit attendance, house staff, and other care team members. Versatile, articulate, and result-oriented individual with written and verbal skills necessary to achieve desired goals. A highly motivated individual with excellent problem-solving, communication, and interpersonal skills. Utilized 3M Encoder, Meditech, Epic, Cerner, Optum eCAC, and NexGen
Overview
17
17
years of professional experience
1
1
Certification
Work History
CDI Specialist
UnitedHealth Group/Optum services
10.2021 - Current
- Concurrent and retrospective review of inpatient medical records to evaluate the acuity of patients’ illness and to support the acute care services rendered using Cerner and Optum computer-assisted coding (CAC)
- Clarifications with physicians regarding missing, unclear, unsupported or conflicting clinical documentation
- Assigns Principal diagnosis, CC/MCC, evaluates for the severity of illness (SOI) and risk of mortality (ROM) on all patients while in hospital
- Partners with coding professionals to ensure the accuracy of diagnostic and procedural data and completeness of supporting documentation to determine the working and final DRG assignments- DRG reconciliation.
- Sepsis observation and evaluation, Mortality review.
- Participate in case management meetings, CDI huddles, and quality committees.
- Educate physicians through the query process and presentations at clinical meetings.
- Audit accurate and complete assignment of ICD-10-CM and ICD-10-PCS codes, MS-DRG, POA status, and discharge disposition.
CDI Specialist
Conifer Health Solutions
03.2021 - 09.2021
- Concurrent and retrospective review of medical records
- Ensure Complete and compliant documentation accurately reflecting the patient's illness severity and mortality risk.
- Queries physicians regarding missing, unclear, or conflicting health record documentation when necessary.
- Conducts follow-up reviews of clinical documentation to ensure points of clarification have been recorded within the patient’s medical record.
- Keep daily production logs containing several cases reviewed and queries sent/responded to for weekly output evaluation.
- Interact with the coding team to resolve documentation and coding issues and ensure proper DRG assignment.
- Code conditions and procedures using ICD-10-CM and PCS
- Second level review for conditions that can affect SOI and ROM
CDI Specialist
Community Memorial Hospital
12.2018 - 10.2020
- Concurrent review of inpatient medical records. 20+ charts per day for metrics
- Ensure Complete and compliant documentation accurately reflecting the patient's illness severity and mortality risk.
- Capture medical conditions that impact the DRG, especially CC and MCC.
- Utilized the query process to get the documentation perfect.
- Educate physicians through query processes or when they call over the phone, and ensure that queries are responded to promptly.
- DRG reconciliation and validation, data quality assurance.
- Impact review monthly for all cases with queries during the month.
- Code conditions and procedures using ICD-10-CM and PCS.
CODER AUDITOR
Prime Healthcare Services
10.2018 - 12.2018
- Retrospective medical record review for appropriateness and accurate coding assignment
- Check for opportunities for queries that may have been missed and advise CDI professionals to send the query to the Provider.
- Assign appropriate ICD-10 codes using the coding guidelines for various specialties.
Clinical Documentation Specialist
Prime Healthcare Services
05.2016 - 10.2018
- Concurrent chart review and coding
- Facilitate complete, compliant documentation that accurately reflects the patient's illness severity and mortality risk.
- DRG reconciliation and validation, data quality assurance.
- Generate queries when necessary.
- Concurrent review of inpatient medical records for the identified payer population
- Analysis of the clinical status of the patient, current treatment plan, and past medical history and identify a potential gap in physician documentation.
- Presentation of topics related to new updates in coding guidelines.
- Discuss with physicians to make sure queries are responded to on time.
- Audit and educate physicians on meaningful use targets in the Hierarchical Condition Category (HCC) and risk adjustment to reflect quality outcomes and specialty clinics.
- Retrospective chart review for HCC
- Chart review for medical necessity for some laboratory investigations to satisfy insurance requirements.
Substitute Teacher
Los Angeles County Office of Education
08.2008 - 04.2016
- Provided individual assistance to students using direct instruction.
- Managed classrooms of behaviorally challenged kids in juvenile halls.
- Assessed students’ learning abilities and progress.
Education
M.D. - Medicine and Surgery
OAU University
Ile-Ife, Nigeria04.1996
MBA - Healthcare Management
Western Governors University
Salt Lake City, Utah07.2024
Skills
- Basic computer knowledge, including Microsoft Office programs, including Word, Excel, and PowerPoint
- EHR: Epic, Meditech, NexGen, 3M encoder, Optum CAC, Cerner, Optum360
- Expert problem solving
- Analytical thinking
- Management collaboration
Certification
- Lean Six Sigma Black Belt Certification July 2013
- Lean Six Sigma Master Black Belt Certification August 2015
Affiliations
- California Health Information Association (CHIA)
- America Health Information Association (AHIMA)
Timeline
CDI Specialist
UnitedHealth Group/Optum services
10.2021 - Current
CDI Specialist
Conifer Health Solutions
03.2021 - 09.2021
CDI Specialist
Community Memorial Hospital
12.2018 - 10.2020
CODER AUDITOR
Prime Healthcare Services
10.2018 - 12.2018
Clinical Documentation Specialist
Prime Healthcare Services
05.2016 - 10.2018
Substitute Teacher
Los Angeles County Office of Education
08.2008 - 04.2016
M.D. - Medicine and Surgery
OAU University
MBA - Healthcare Management
Western Governors University
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