REINE-ELODIE YAO
Conroe,TX
Summary
Dynamic Risk Adjustment Consultant at Stanford Health Care, adept at strategic growth management and data analysis. Achieved a significant reduction in DNB from $22 million to $9.5 million through effective team leadership and collaboration. Proficient in ICD-10 coding, with a strong focus on compliance and performance improvement initiatives.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Risk Adjustment Consultant
STANFORD HEALTH CARE
Palo Alto, CA
03.2023 - Current
- Company Overview: Academic Medical Center - Level 1 Adult and Level 1 Pediatric Trauma Center – 4,100 physicians and residents, 14,000+ employees, $13.9 billion operating revenue.
- Collaborate with risk adjustment contractors, primary care departments, and population health leaders to assess the current state of the Risk Adjustment program, and develop strategies for growth and optimization.
- Oversee the onboarding and management of the Clinical Documentation Specialists contractor, ensuring effective execution of the pre-visit chart review project.
- Define Risk Adjustment Factor (RAF) KPIs, and identify data sources for monitoring and reporting, including generating RAF-related queries for data extraction.
- Prepare presentations and reports for Joint Operating Committee (JOC) meetings, including updates on RAF statistics and insights for both the PCF and MSSP populations.
- Conduct internal audits, and perform targeted HCC documentation and coding reviews to ensure compliance and accuracy in risk adjustment practices.
- Serve as a subject matter expert on risk adjustment coding, providing oversight for external vendors, and assisting in the development of Risk Adjustment Standard Operating Procedures (SOPs).
Outpatient Facility & Professional Fee Coding Quality Specialist
STANFORD HEALTH CARE
Palo Alto, CA
07.2018 - 02.2023
- Company Overview: Academic Medical Center - Level 1 Adult and Level 1 Pediatric Trauma Center – 4,100 physicians and residents, 14,000+ employees, $13.9 billion operating revenue.
- Collaborated with Patient Financial Services (PFS) coders to address pertinent cases to attain the DNB goal.
- Performed coding quality reviews for both physician and facility coding cases (surgical, emergency, and ancillary).
- Explained provider charge variations via analytical summaries provided to Revenue Integrity Program Managers.
- Partnered with the Charge Capture Team, Revenue Integrity Department, Patient Financial Services, and Health Information Management departments to resolve issues.
- Reviewed denied/rejected cases for coding accuracy and appeal opportunities with PFS coders.
- Created educational coding topics for the outpatient coding team, and administered Performance Improvement Plans.
- Instrumental in implementing Single Path Coding (SPC), collaborating with Facility and Profee departments for planning, implementation, training, and quality control.
- Responded to patient inquiries, disputes, and provided appropriate coding rationale for the resolution.
- Provided education for documentation and coding issues.
- Coached, educated, and supported coders
- Assisted with writing new policies, procedures, and training materials, and reviewed current policies.
Single Path Coding Interim Manager /DNB Project Manager
STANFORD HEALTH CARE
Palo Alto, CA
01.2021 - 01.2022
- Company Overview: Academic Medical Center - Level 1 Adult and Level 1 Pediatric Trauma Center – 4100 physicians & residents- 14,000+ employees - $13.9 Billion Operating Revenue
- Provided oversight to a team of nineteen coders (surgical & non-surgical)
- Reduced the DNB for Outpatient services from $22 Million to $9.5 Million (Weekly goal is $10 Million)
- Monitored the DNB daily for progress toward the established goal and the charge lag in the professional fees Workqueue
- Analyzed trends (WQs, productivity, DNB goal, charge lag, volume per SPC specialties)
- Managed the daily operations by strategizing on the resource allocation per service line and determined the need for contract coders to reach the charge lag and DNB goals
- Provided leadership and expertise in ICD-10-CM, HCPCS, CPT-4 coding systems, and APC payment systems.
- Collaborated with the providers to improve clinical documentation to facilitate accurate coding
Outpatient Coding Quality Specialist
COOPER UNIVERSITY HOSPITAL
Camden, NJ
10.2016 - 06.2018
- Customized claim edit rules with Epic analysts, aligning with Medicare reimbursement methodology.
- Conducted quality audits monthly, boosting coding accuracy for team of sixteen coders.
- Identified errors in coding denials through data analysis, collaborating with Revenue Integrity and Billing teams.
- Engaged in weekly stakeholder meetings to analyze claims and improve clean claim rates.
- Tailored written coding workflows within Epic for each outpatient service line.
- Established coding policies and procedures governing all hospital outpatient services.
- Facilitated monthly education sessions, enhancing expertise of outpatient coding team.
Interim Practice Manager - Contractor
e4 SERVICES
Glen Burnie, MD
03.2016 - 10.2016
- Managed a team of five clinic staff, including medical assistants, unit secretaries, and a biller/coder.
- Completed Epic Cadence (scheduling application) and Prelude (registration application) training.
- Managed operations of the practice, including registration, scheduling, billing, and coding functions
- Assessed the current workflows to identify gaps and opportunities for enhancement
- Implemented improvements and optimization plans based on the workflow analysis results
HIM Manager/Privacy Officer
VASCULAR ACCESS CENTERS
Philadelphia, PA
03.2014 - 02.2016
- Managed a team of two interventional radiology coders, enhancing departmental efficiency.
- Collaborated with Billing, Credentialing, Contracting, and Compliance Departments to analyze denied claims.
- Educated physicians and clinical staff to improve clinical documentation accuracy and patient safety indicators.
- Partnered with Director of Clinical Compliance to develop clinical documentation education programs.
- Successfully implemented ICD-10-CM across twenty practices, ensuring compliance.
- Created standardized revenue cycle education training plan with supporting materials for clinical staff.
- Conducted workflow analyses for underperforming centers, implementing targeted improvements.
- Generated daily Business Object reports, providing actionable revenue data analyses.
- Conducted performance evaluations, providing feedback and coaching for team development.
HIM Manager/Privacy Officer
LIFECARE HOSPITALS OF CHESTER COUNTY
West Chester, PA
04.2013 - 03.2014
- Managed a team of two coders.
- Developed the first physical security access tracking system for the organization.
- Monitored facility compliance with the HIPAA Omnibus Rule.
- Monitored coding functions with the clinical review nurse for clinical documentation improvement.
- Performed medical record release of information per policies and procedures, and HIPAA guidelines.
- Analyzed all medical records for completeness, accuracy, and timeliness.
- Ensured compliance with all applicable laws, regulations, and industry standards.
- Conducted regular meetings with staff to discuss progress and identify areas of improvement.
- Conducted performance reviews for team members.
Coder II
CHRISTIANA HOSPITAL
Newark, DE
07.2012 - 03.2013
- Assigned ICD-9-CM and CPT codes for all diagnoses and procedures with accuracy.
- Abstracted relevant data and entered it into Quantum abstracting system.
- Applied UHDDS definitions, CMS regulations, and guidelines to ensure coding compliance.
- Utilized Microsoft Office suite and electronic medical record effectively for documentation.
Education
Master of Science - Health Informatics
Temple University, College of Health Professions and Social Work
Philadelphia, PA05.2015
Bachelor of Science - Health Information Management
Temple University, College of Health Professions and Social Work
Philadelphia, PA05.2012
Associate of Science - Biology
Camden County College
Blackwood, NJ05.2008
Skills
- Epic enterprise
- 3M 360 encoder
- Encoder pro
- Tableau
- Edge reporting
- Milliman MedInsight
- Vital Ware
- Business objects
- Microsoft Office Suite
- Risk adjustment
- Clinical documentation
- ICD-10 coding
- Data analysis
- Performance improvement
- Stakeholder engagement
- Team leadership
- Presentation skills
- Collaboration skills
- Strategic planning
- Communication skills
- Regulatory compliance
- Executive support
- Budget management
- Training and development
- Strategic growth management
- Resource allocation
- Project implementation
- Trend analysis
- Team leadership & development
- Analytical thinking
- Outcome accountability
- Problem-solving
Affiliations
- AHIMA (American Health Information Management Association), Active member since 2010
- TxHIMA (Texas Health Information Management Association), Active member since 2018
- PHIMA (Pennsylvania Health Information Management Association), Active member 2010 – 2018
- SePHIMA (Southeastern Pennsylvania HIMA), Active member 2010 - 2018
Certification
- Registered Health Information Administrator (RHIA), 05/2012
- Certified Coding Specialist (CCS), 12/2013
- Certified Risk Adjustment Coder (CRC), 04/2025
Awards
- Mentor of the Year – Stanford Health Care, 10/2020
- Employee of the quarter – Cooper University Health Care, 01/2017
- Student Triumph Award – American Health Information Management Association (AHIMA), 2012
- Professional Excellence – Temple University College of Health Professions & Social Work, Spring 2012
- Academic Achievement Scholarship Award – Pennsylvania HIM Association, Spring 2012
Locations
- Palo Alto, Palo Alto, CA
- Camden, Camden, NJ
- Glen Burnie, Glen Burnie, MD
- Philadelphia, Philadelphia, PA
- West Chester, West Chester, PA
- Newark, Newark, DE
- Standish, Standish, ME
- Blackwood, Blackwood, NJ
Professional Highlights
- STANFORD HEALTH CARE, Palo Alto, Palo Alto, CA, Risk Adjustment Consultant, 01/2023, Present
- STANFORD HEALTH CARE, Palo Alto, Palo Alto, CA, Single Path Coding Interim Manager /DNB Project Manager, 01/2021, 12/2022
- STANFORD HEALTH CARE, Palo Alto, Palo Alto, CA, Outpatient Facility & Professional Fee Coding Quality Specialist, 01/2018, 12/2023
- COOPER UNIVERSITY HOSPITAL, Camden, Camden, NJ, Outpatient Coding Quality Specialist, 01/2016, 12/2018
- E4 SERVICES, Glen Burnie, Glen Burnie, MD, Contract Consultant, 01/2016, 12/2016
- VASCULAR ACCESS CENTERS, Philadelphia, Philadelphia, PA, HIM Manager/Privacy Officer, 01/2014, 12/2016
- LIFECARE HOSPITALS OF CHESTER COUNTY, West Chester, West Chester, PA, HIM Manager/Privacy Officer, 01/2013, 12/2014
- CHRISTIANA HOSPITAL, Newark, Newark, DE, Coder II, 01/2012, 12/2013
References
References available upon request.
Timeline
Risk Adjustment Consultant
STANFORD HEALTH CARE
03.2023 - Current
Single Path Coding Interim Manager /DNB Project Manager
STANFORD HEALTH CARE
01.2021 - 01.2022
Outpatient Facility & Professional Fee Coding Quality Specialist
STANFORD HEALTH CARE
07.2018 - 02.2023
Outpatient Coding Quality Specialist
COOPER UNIVERSITY HOSPITAL
10.2016 - 06.2018
Interim Practice Manager - Contractor
e4 SERVICES
03.2016 - 10.2016
HIM Manager/Privacy Officer
VASCULAR ACCESS CENTERS
03.2014 - 02.2016
HIM Manager/Privacy Officer
LIFECARE HOSPITALS OF CHESTER COUNTY
04.2013 - 03.2014
Coder II
CHRISTIANA HOSPITAL
07.2012 - 03.2013
Master of Science - Health Informatics
Temple University, College of Health Professions and Social Work
Bachelor of Science - Health Information Management
Temple University, College of Health Professions and Social Work
Associate of Science - Biology
Camden County College
Similar Profiles
Alexander King Schaap VAlexander King Schaap V
Senior Service Desk Agent at Stanford Health Care & Stanford School Of MedicineSenior Service Desk Agent at Stanford Health Care & Stanford School Of Medicine
Arlene LegaspiArlene Legaspi
Food Service Worker at Stanford Health Care, 300 Pasteur Dr, StanfordFood Service Worker at Stanford Health Care, 300 Pasteur Dr, Stanford
MAILAH F. RAPADA, PT, DPTMAILAH F. RAPADA, PT, DPT
Senior Physical Therapist at Stanford Health Care/Cisco Life Connections Health CenterSenior Physical Therapist at Stanford Health Care/Cisco Life Connections Health Center
Rebecca ValentineRebecca Valentine
Clinical Laboratory Technician at Stanford Health CareClinical Laboratory Technician at Stanford Health Care
Jaclyn BoyceJaclyn Boyce
TurboTax Expert at IntuitTurboTax Expert at Intuit