Hi, I’m
Theresa E. Nyberg
Registered Nurse
Summary
Analytical, supportive leader with 25+ years of success in healthcare administration and health information management (HIM) while honing MS-DRG methodologies and coding procedures to effectively audit medical charts/records. Recognized for my ability to meet deadlines, identify inefficiencies, and implement process improvements that will enhance customer experience/satisfaction. Effective communicator capable of consulting with healthcare professionals, patients, and physicians to analyze medical documentation; committed to patient confidentiality and HIPAA regulations. I am an RN with 30 plus years of experience.
Overview
35
years of professional experience
1
Certification
Work History
Momentum Resources Solutions
08.2021 - Current
Job overview
- Customer/client focused individual who enjoys leading team projects and participating in process implementation
- I strive to be approachable, amicable, flexible, and innovative in all my internal and external client interactions
- Experienced business traveler capable of building rapid rapport with physicians, mid-level providers, C-suites, and support teams for in-person intensive education sessions.
HMS Holding Corp
Coding Auditor
04.2018 - 02.2021
Job overview
- Effectively utilize audit software to assess medical charts/invoices, perform ICD-10/ICD-9 coding and transcribe denial letters while reforming billing to reflect documentation per physician within compliance to boost clients’ savings
- Integrate medical chart coding principles to surpass daily performance and achieved daily objectives in accordance with standard procedures to meet client’s deadline/expectations
- Independently resolve computer issues, perform DRG/coding validation analysis to prevent coding issues and implement practical solutions; enforce strict confidentiality and professionalism while encouraging myself to hone my capabilities by attending professional educational classes/seminars
- Proficient with 3M 360 and Webstrat for coding and CDI
- Expert DRG auditing and clinical validation
- Risk adjustment coding and auditing
- PACE and managed care experience
- Inpatient and outpatient coding and CDI
- Proficient at Cerner, Meditech, Cognify, Epic, TruChart, and HPF EHR systems
LEXICODE INC
REMOTE DRG AUDITOR
08.2015 - 03.2018
Job overview
- Effectively utilize audit software to assess medical charts/invoices, perform ICD-10/ICD-9 coding and transcribe denial letters while reforming billing to reflect documentation per physician within compliance to boost clients’ savings
- Integrate medical chart coding principles to surpass daily performance and achieved daily objectives in accordance with standard procedures to meet client’s deadline/expectations
- Independently resolve computer issues, perform DRG/coding validation analysis to prevent coding issues and implement practical solutions; enforce strict confidentiality and professionalism while encouraging myself to hone my capabilities by attending professional educational classes/seminars
- Key Achievements
- Acquired 100% QA accuracy that aided my ability to exceed productivity standards.
INOVALON, INC
REMOTE REVIEWER CONSULTANT
08.2013 - 08.2015
Job overview
- Accurately interpreted medical terminology to efficiently process ICD-9 coding for inpatient/outpatient charts while interacting with staff and healthcare providers to validate medical documents/invoices
- Gained comprehensive education on medical coding and reviewing to improve my role and deliver exceptional service
- Key Achievements
- Commended for maintaining over 95% accuracy on QA assessments while exceeding productivity standards
- Received Superior rating on yearly evaluations.
GRAND RAPIDS HOME HEALTH CARE
DIRECTOR OF NURSING
01.2012 - 09.2013
Job overview
- Instilled drive to accomplish organizational goals and apply quality improvements; successfully achieved agency certification by appraising/passing CAHPS surveys, implementing quality assurance (QA) program to improve healthcare services and productively resolving patient/family issues
- Formulated/analyzed financial budgets to determine cost-effective solutions, oversaw healthcare professionals to ensure excellent patient care, generated action plans to implement positive change, frequently audited medical records to assure systematic procedures and conducted risk assessments
- Led the recruitment process by reviewing credentials and conducting interviews and to select qualified candidates while enforcing regular training sessions
- Held daily meetings to inform staff of objectives and updated procedures to improve workflow and reinforce outstanding performance while conducting performance evaluations to provide training based on individual need and admitting/visiting patients to rectify situations and confirm quality care
- Key Achievements
- Established department policies/procedures and Oasis-C education to improve staff retention and initiate structure throughout the organization
- Modernized facility by leading the transition from manual to electronic processes that helped streamline procedures and reduce human error.
CORAM INFUSION, INC
DIRECTOR OF NURSING
01.1988 - 09.2006
Job overview
- Direct oversight of nursing department consisting of 60 registered nurses to ensure successful infusion services; delegated objectives to administer medication/fluids via IV, record vitals, and research patient medical records to avoid potential drug complications
- Encouraged staff to frequently attend seminars to aid their development and proficiency while conducting research studies for major educational institutions throughout Chicago and nationwide
- Teamed up with physicians/pharmacists and sales force to improve patient satisfaction, maximize efficiency and ensure smooth operations.
Education
Kellogg Community College
Associate Degree from Nursing
Western Michigan University
Aurora University
Baker College
from Design
Skills
- ICD-9/ICD-10 Coding
- Continuous Process Improvement
- Records Management
- Patient/Customer Relations
- Excellent Physical Assessments
- Wound Vacs
- PICC Lines
- Risk Mitigation/Management
- Wound Care
- Superior Interpersonal Communications
- Research & Analysis
- Technical Proficiencies:
- Microsoft Word, Excel, Outlook; DRG/Grouper auditing software and Health Information Management Systems
- Government Standards
- Document Recordkeeping
- Non-Compliance Assessment
- Microsoft Office
- Auditor Assistance
- Results Orientation
- Issue Resolution
- Extravagance and Fraud Detection
- Collect Data
- Quality Assessments
- Reliability and Integrity Improvement
- Report Creation
- Typing and 10-Key Entry
- Correspondence Writing
- Critical Thinking and Analysis
- Goal Development
- Regulatory Compliance
- Continuing Education
- Reports and Documentation
- Cost Savings Options
Certification
Michigan Professional Registered Nurse since 1981
Timeline
Momentum Resources Solutions
08.2021 - Current
Coding Auditor
HMS Holding Corp
04.2018 - 02.2021
REMOTE DRG AUDITOR
LEXICODE INC
08.2015 - 03.2018
REMOTE REVIEWER CONSULTANT
INOVALON, INC
08.2013 - 08.2015
DIRECTOR OF NURSING
GRAND RAPIDS HOME HEALTH CARE
01.2012 - 09.2013
DIRECTOR OF NURSING
CORAM INFUSION, INC
01.1988 - 09.2006
Kellogg Community College
Associate Degree from Nursing
Western Michigan University Aurora University Baker College
from Design
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