Rileigh Koch
Wasilla
Summary
Versatile and experienced healthcare administrator with a strong background in physician documentation, medical coding, billing, and CMS compliance. Skilled in leadership development and fostering a solution-oriented mindset. Known for proficient and effective written and oral communication skills, and meticulous attention to detail. Proven self-starter with a drive to excel in any given task. Committed to continuous learning and growth in healthcare administration.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Quality Assurance Director
Aegis Healthcare
07.2023 - Current
- Improved the precision of medical billing through meticulous audits of physician documentation and codes, pinpointing areas for enhancement and bolstering billing compliance.
- Increased company revenue by identifying areas of loss and implementing cost-saving measures.
- Elevated the precision of medical billing by conducting comprehensive audits of physician documentation and codes, effectively identifying opportunities for enhancement and ensuring heightened billing compliance.
- Consistently developed physician and coder education for a dual-focused approach to quality documentation and coding.
- Fostered collaborative interpersonal relationships with physicians, department leads and staff, maximizing effectiveness and company-wide impact.
- Ongoing education for physician and oversight of Clinical Quality Measures.
- Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
- Oversight, consultation, and education for mobile physicians, coders and billers across three states.
- Covered areas including quality provider documentation, coding, billing, insurance denials, OKR development and tracking, and CMS compliance.
- Conducted ongoing and quarterly physician audits and developed reports for managing partners and department leads.
- Annual CMS MIPS reporting for the company.
- Developed and implemented new forms, policies and procedures, to include Physicians Standards of Care Handbook, physician educational handouts and references, revised patient intake paperwork and various other forms.
- Educated by CFO and independently sought out educational opportunities on auditing, reporting, CMS compliance, coding, and billing.
- Demonstrated exceptionally effective, diplomatic, oral and written communication with physicians and staff.
- Delivered presentations on leadership tools, communication, departmental processes, benchmarks, CMS compliance, etc.
- Emphasized a solution-focused approach in QA, addressing systemic deficits rather than problem-focused mindset.
Quality Assurance Consultant
Aegis Healthcare
10.2022 - 07.2023
- Enhanced the accuracy of medical billing by thoroughly auditing physician documentation and codes, identifying opportunities for improvement and increased billing compliance.
- Conducted comprehensive chart reviews to validate coding accuracy, ensuring proper reimbursement for services rendered.
- Contributed to cost savings by identifying areas of potential overbilling or underbilling in medical claims processing.
- Established strong working relationships with physicians and other healthcare professionals to facilitate open communication channels regarding best documentation practices.
- Assessed risks associated with billing practices based on the analysis of historical trends in claim denials.
- Maintained an up-to-date understanding of evolving healthcare regulations by engaging in continuous professional development opportunities.
ER Admitting
Williamson Medical Center
06.2014 - 11.2014
- Obtain patient information, including but not limited to collecting and verifying insurance information
- Register Emergency Room patients in accordance with HIPPA standards utilizing efficiency and a personable nature
- Operate a busy switch board, transferring calls, as well as managing and broadcasting codes hospital-wide as needed.
- Work in high stress situations utilizing organization skills and maintaining composure to ensure best possible results.
- Exercise stability and professionalism while interacting with patients or families under emotional duress.
- Know and execute safety procedures as necessary.
- Register and verify patient records before triage with most up-to-date information.
Patient Access Representative
South Peninsula Hospital
12.2013 - 05.2014
- Accept Emergency Room patients in timely and organized fashion, while utilizing personable nature
- Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
- Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
- Frequently answer phones and transfer calls.
- Input and organize data onto spreadsheets relating to patient records and security.
- Contributed to reduction of accounts receivables by adhering to predetermined policies and procedures to recover amounts due from patients.
- Facilitated communication between patients and various departments and staff.
Pharmacy Technician
Walgreens
02.2013 - 08.2013
- Receive and process payments on a point-of-sale computer system.
- Maintain a clean and safe environment to maximize efficiency.
- Communicated with physicians and insurance providers when necessary to verify prescription information as well as coverage.
- Calculated dosage, filled prescriptions and prepared prescription labels with absolute accuracy.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Stocked, labeled and inventoried medication to keep accurate records.
- Input prescription information into computer system to accurately fulfill prescription orders.
Education
High School Diploma -
Independence High School
Thompson's Station, TNNo Degree - Nursing
Trevecca Nazarene University
Nashville, TNCPC
American Academy of Professional Coders
2022
Skills
- Experience with most Microsoft products to include word, excel, powerpoint
- Professional written and oral communication skills
- Strong Interpersonal Skills
- CPT, HCPCS, and ICD-10-CM codes and guidelines
- CMS Compliance
- HIPAA Compliance
- Insurance Verification
- Clinical Documentation
Certification
- CPC - Certified Professional Coder
Timeline
Quality Assurance Director
Aegis Healthcare
07.2023 - Current
Quality Assurance Consultant
Aegis Healthcare
10.2022 - 07.2023
ER Admitting
Williamson Medical Center
06.2014 - 11.2014
Patient Access Representative
South Peninsula Hospital
12.2013 - 05.2014
Pharmacy Technician
Walgreens
02.2013 - 08.2013
High School Diploma -
Independence High School
No Degree - Nursing
Trevecca Nazarene University
CPC
American Academy of Professional Coders
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