Tracy Gapinski, BSN, RN
Valparaiso,Indiana
Summary
Dynamic and dedicated Registered Nurse with a decade of critical care expertise, specializing in Clinical Documentation Integrity as the Director of Clinical Documentation Specialist and Medical Necessity Denials. Proven track record in conducting second-level concurrent case reviews, fostering physician engagement, and delivering comprehensive staff education and training for new hires. Comprehensive understanding of CMS guidelines for PSI/HAC and FTR measures. Committed to enhancing the culture of Clinical Documentation Integrity through collaborative relationships with clinical medical staff, leveraging a robust clinical background in cardiothoracic and transplant nursing, critical care, cardiac catheterization, electrophysiology, and interventional radiology. Proficient in EPIC patient charting and adept at managing multiple priorities with a solution-oriented approach to ensure optimal patient care and outcomes.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Director Clinical Documentation Integrity/Denials
Powers Health
10.2023 - Current
- Developed strategic initiatives to enhance operational efficiency and drive organizational growth.
- Led cross-functional teams to implement process improvements, resulting in streamlined workflows.
- Mentored staff in best practices, fostering a culture of continuous improvement and collaboration.
- Directed resource allocation and budgeting processes to align with organizational goals and priorities.
- Streamlined Denials Processes into EPIC.
- Established performance metrics and benchmarks to evaluate departmental effectiveness and drive accountability.
- Developed high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
- Managed budgets effectively to ensure optimal use of resources while maintaining financial stability.
- Developed DRG reconciliation process within organization to assist with clean claim.
-
Manager Clinical Documentation Integrity/Denials Coordinator
Community Hospital
04.2022 - 10.2023
- Streamlined operational processes to enhance efficiency and reduce costs.
- Led cross-functional teams in implementing strategic initiatives for market growth.
- Developed training programs to improve staff performance and service delivery standards.
- Analyzed performance metrics to identify areas for process improvement and resource allocation.
- Lead 12 CDI and 5 Denials Management team members.
- Enhanced training processes.
- Facilitated communication between departments to ensure alignment on project goals and timelines.
Lead Clinical Documentation Specialist
Community Hospital
08.2019 - 04.2022
- As Lead Clinical Documentation Specialist, I work with team members providing clinical validation guidance using coding guidelines and coding clinic guidance.
- Second level concurrent case review of highly targeted DRG such as sepsis, congestive heart failure, acute respiratory failure, and acute kidney injury, making recommendations based off of clinical knowledge and coding guidance.
- Developed a training program for new hires.
- Developed a training program within the team to encourage staff to research diagnoses to be presented within the team to better facilitate physician education.
- Direct team members on the importance of physician engagement, encouraging CDI to be a resource to physicians by requiring weekly physicians meetings to foster relationships and growth.
- Working with administration, dietary, and wound care to adequately capture and maintain the integrity of the records.
- Assisting Denials Team with clinical validation of diagnosis.
Clinical Documentation Specialist
Community Hospital
12.2018 - 08.2019
- Managed electronic clinical documentation and uploaded changes or updates using EPIC and Nuance Clintegrity.
- Questioned physicians regarding missing or unclear health record documentation and requested further information for clarification purposes.
- Maintained strong knowledge of medical terminology, diseases and conditions and procedures.
- Communicated with healthcare staff, including physicians, nurses and other caregivers to explain importance of accurate and clear documentation.
- Responsible for accurate case review of average of twenty cases per day.
Registered Nurse-Case Management
Community Hospital
01.2017 - 02.2018
- Partnered with physicians, social workers, activity therapists, nutritionists and case managers to develop and implement individualized care plans and documented all patient interactions and interventions in electronic charting systems.
- Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs.
- Consulted with clinicians to devise and manage effective ongoing care plans for at-risk patients.
- Sent clinical data to insurance companies as needed to ensure proper and timely treatment per individual insurance plans.
- Assisted with discharge planning.
Registered Nurse
St. Anthony Hospital
08.2012 - 12.2016
- Registered Nurse in the Cardiac Catheterization Lab.
- Assist physicians performing left and right heart catheterization, various cardiac and interventional radiology procedures, Intra-aortic balloon pump, vertebroplasty, line and drain placement, EKOS procedures, angiography, and electrophysiology.
- Administer medications and sedation.
- BLS certified, IAPB, EKOS, Electrophysiology
- EPIC trained.
- Taught patients how to improve lifestyle choices, dramatically reducing chance of symptom reoccurrence.
- Informed patients and families of effective treatment options and at-home care strategies, enhancing long-term outcomes.
Registered Nurse
Loyola University Medical Center
09.2008 - 09.2012
- Registered Nurse- Cardiothoracic Intensive Care Unit
- Direct care of cardiothoracic patients from operating room for immediate recovery and management of care of coronary bypass surgery, valve replacement, thoracotomy, and heart and lung transplantation in Intensive Care setting.
- Monitoring of multiple vasoactive medications, and ventilator support.
- Developed strong clinical skills, critical thinking and further enhanced patient advocacy skills.
- Communicated and worked directly along side physicians and residents.
- Education of patients on disease and recover process, lifestyle choice with relation to disease process after transplantation.
- Nursing preceptor for nursing students educating on prioritization, patient care, documentation, and medication administration.
- Charge Nurse
- Preceptor to new staff nurses.
Registered Nurse
Methodist Hospitals CV/CCU ICU
06.2006 - 08.2008
- Registered Nurse in Intensive Care Unit as new graduate nurse,
- Developed critical thinking skills and became proficient in management of patients requiring medication administration, titration of vasoactive medications, Prisma dialysis, and ventilator support.
- Code Blue team.
- Developed skills in wound care.
- Assisting sterile technique and central line placement.
- Developed patient advocate skills.
- Proficient in laboratory value interpretation.
- Monitored patient condition, including interpreting and tracking EKG readings, identifying irregular telemetry readings and updating team members on changes in stability or acuity.
Education
Bachelor of Science - Nursing
Purdue University Calumet
Hammond, IN4 2011
Associate of Science - Nursing
Purdue University Calumet
Hammond, IN4 2006
Skills
- Clinical Experience
- Critical Thinker
- Registered Nurse
- ICD-10
- Decision-making
- People management
- Verbal and written communication
- Strategic planning
- Acute Care
- Clinical leadership
- Clinical Documentation
- Educator
- Professional Communication Skills
- EPIC
- Nuance Clintegrity
- Optum
- Concurrent Inpatient review
- Team leader
Accomplishments
- Supervised team of 20 staff members.
- Developed training process for new Denials and CDI.
- Ehanced work-life balance for team with fully remote positions.
- Improved CMI across the system with workflow processes.
Additional Information
- Licensure , Indiana Nursing License 2006
- Plan to take the CCDS exam in near future.
Certification
- Certified Clinical Documentation Specialist, CCDS
Languages
English
Timeline
Director Clinical Documentation Integrity/Denials
Powers Health
10.2023 - Current
Manager Clinical Documentation Integrity/Denials Coordinator
Community Hospital
04.2022 - 10.2023
Lead Clinical Documentation Specialist
Community Hospital
08.2019 - 04.2022
Clinical Documentation Specialist
Community Hospital
12.2018 - 08.2019
Registered Nurse-Case Management
Community Hospital
01.2017 - 02.2018
Registered Nurse
St. Anthony Hospital
08.2012 - 12.2016
Registered Nurse
Loyola University Medical Center
09.2008 - 09.2012
Registered Nurse
Methodist Hospitals CV/CCU ICU
06.2006 - 08.2008
Associate of Science - Nursing
Purdue University Calumet
Bachelor of Science - Nursing
Purdue University Calumet