Stacy Frisina
Tucson,AZ
Summary
Business manager with proven leadership and organizational skills seeking a challenging position that will take full advantage of my background as well as offer the opportunity for increasing levels of responsibility and professional growth.
Overview
32
32
years of professional experience
1
1
Certification
Work History
Clinical Performance Manager
Optum
07.2019 - Current
- Worked with technical resources to conduct root cause analysis and prevent future issues.
- Maintained open lines of communication between managers and employees for a transparent organizational culture that valued feedback.
- Tracked, analyzed and executed quality and continuous improvement initiatives to hold departments accountable for performance.
- Cultivated strong relationships with key stakeholders, ensuring effective communication across all levels of the organization.
- Produced detailed and relevant reports for use in making business decisions.
Senior Coding Manager, Physician Practice Coding Compliance and Education
Banner University Medical Group (formerly University of Arizona Health Network - UAHN)
01.2015 - 07.2019
- Monitored and communicated regulatory changes influencing professional documentation, coding, CPT, ICD-9-CM, ICD-10-CM and modifier assignment.
- Tracked and trended coding quality audit results to identify additional educational opportunities and patterns over time.
- Developed and presented physician and coder educational plans and create in-service materials to address identified coding trends/deficiencies and facilitate charge corrections.
- Worked closely with physicians and department administrators to provide scheduled as well as ad hoc education to physicians.
- Selected, trained, coached, motivated and directed workflow for staff assigned to Educator and Auditor positions.
- Worked collaboratively with other leaders to establish coding quality, productivity and best practices.
Physician Plan Coding Quality and Education Coordinator
University of Arizona Health Network
01.2014 - 01.2015
- Performed data quality audits on professional coders to validate ICD-9/ICD-10 diagnosis codes, CPT-4 codes, and missed secondary diagnoses and procedures.
- Developed tracking procedure for incoming coder/physician inquiries.
- Reported development, tracking and trending audits and errors.
- Responsible for setting up a designated email address for the Coding Quality and Education department.
- Also monitored and addressed coder inquiries sent to designated email address.
- Researched, interpreted and communicated federal and state payer regulations related to professional medical documentation, coding and billing.
- Facilitated post-quality review education and feedback to physicians and coders, providing excellent customer service.
Fraud, Waste and Abuse Prevention Analyst
University of Arizona Health Plans
01.2009 - 01.2014
- Developed processes and procedures for this new position.
- Performed data analysis of physician claims history to substantiate fraud and abuse allegations.
- Compiled audit results and provided feedback and education to physicians.
- Traveled with Network Development Provider Representatives on physician visits and provided physicians with educational material regarding Fraud, Waste, and Abuse.
- Chaired a Fraud, Waste, and Abuse Committee consisting of Medical Directors, Department Managers, and Compliance Officer.
- Maintained a working knowledge of AHCCCS and Medicare rules and regulations.
- Monitored physician claims for potential billing errors
- Reviewed medical records to substantiate medical necessity for codes submitted
- Maintained an excellent working relationship with leaders in all departments, providing superior customer service
- Extensive knowledge regarding CPT, HCPCS, and ICD-9 codes
- Passed AAPC ICD-10 Proficiency Exam.
Claims Supervisor
University of Arizona Health Plans
01.2006 - 01.2009
- Supervised the claims processing and clerical staff up to 15 people, including hiring, development, appraisals and disciplinary action when necessary.
- Responsible for maintaining the daily workflow of the claims staff to include pend management, work distribution, and assuring that the processing of claims meets departmental quality and quantity standards are met.
- Developed numerous processes and workflows for processors and Claims Department to ensure AHCCCS Compliance.
- Responsible for troubleshooting, identifying, and resolving any claims issues that may arise.
- Developed and maintained good working relationships with physicians, to ensure customer satisfaction through scheduled or impromptu meetings.
- Worked closely with other departments to ensure accurate, timely payment of claims.
- Assisted with the implementation of the Claims Customer Service Call Center.
Account Associate
Lovitt & Touché
01.2002 - 01.2005
- Managed vendor accounts for over 300 McDonald's Owners and Operators.
- Audited all applications and policies for new and renewal clients.
- Assisted Claims Manager and Clients on claims issues.
- Maintained daily continual client contact to assure highest level of customer service.
Claims Supervisor
Mountain States Administrative Services (A Division of Lovitt & Touché)
01.1999 - 01.2002
- Provided supervision and training to claims examiners and support staff.
- Developed initiatives and assigned projects related to coverage verification, payment approval, etc.
- Lead all administrative responsibilities related to claim functions.
- Developed policies and procedures related to the claims business.
- Managed claims and pending inventory.
- Experienced with subrogation, anti-fraud and vendor management issues.
- Trained staff on Medicare/Medicaid's ICD-9, CPT, HCPCS and revenue code billing guidelines.
- Provided training to claims department regarding the importance of HIPAA Compliance.
Senior Claims Examiner
Coresource
01.1992 - 01.1999
- Provided training and guidance to new claims processors.
- Assisted Customer Service Department when phone queue was busy, answering questions from members and physicians regarding eligibility and claims status.
- Processed medical, dental, vision, and facility claims timely and accurately.
Education
CRC Risk Adjustment Coding -
AAPC
National08.2021
Certified Professional Coder -
LS Coding And Education
Tucson, AZ01.2008
Certified Professional Outpatient Coder -
LS Coding And Education
Tucson, AZ01.2008
Medical Terminology -
Pima Community College
Tucson, AZ01.2007
Fraud, Waste and Abuse Prevention Education -
Novia School of Self-Funding
Tucson01.2001
Medical Terminology 350 -
DCM Instructional Systems
Tucson01.1994
Reengineering Training Program -
Intergroup Healthcare Corporation
Tucson, AZ01.1994
Skills
- Coaching and Mentoring
- Customer Focus
- Performance Analysis
- Data Interpretation
- Friendly, Positive Attitude
- Teamwork and Collaboration
- Dependable and Responsible
- Flexible and Adaptable
- Problem-Solving
Certification
Certified Professional Coder (CPC)
Certified Outpatient Coder (COC)
Certified Risk Coder (CRC)
Timeline
Clinical Performance Manager
Optum
07.2019 - Current
Senior Coding Manager, Physician Practice Coding Compliance and Education
Banner University Medical Group (formerly University of Arizona Health Network - UAHN)
01.2015 - 07.2019
Physician Plan Coding Quality and Education Coordinator
University of Arizona Health Network
01.2014 - 01.2015
Fraud, Waste and Abuse Prevention Analyst
University of Arizona Health Plans
01.2009 - 01.2014
Claims Supervisor
University of Arizona Health Plans
01.2006 - 01.2009
Account Associate
Lovitt & Touché
01.2002 - 01.2005
Claims Supervisor
Mountain States Administrative Services (A Division of Lovitt & Touché)
01.1999 - 01.2002
Senior Claims Examiner
Coresource
01.1992 - 01.1999
CRC Risk Adjustment Coding -
AAPC
Certified Professional Coder -
LS Coding And Education
Certified Professional Outpatient Coder -
LS Coding And Education
Medical Terminology -
Pima Community College
Fraud, Waste and Abuse Prevention Education -
Novia School of Self-Funding
Medical Terminology 350 -
DCM Instructional Systems
Reengineering Training Program -
Intergroup Healthcare Corporation