Verna Summerer, CPC, CRC

Provides investigation and analysis to a variety of clients. Contributes to forensic engagements related to medical coding and billing, revenue cycle and payment integrity. Analyzes healthcare claims data to identify improper payments, billing and coding errors.

• Clinical documentation integrity
• Prospective and concurrent chart reviews
• Claims audits across numerous EMR systems
• Provider education
• Streamlined workflows by identifying bottlenecks in existing systems and implementing appropriate solutions.
• Cross-trained existing employees to maximize team agility and performance.
• Defined clear targets and objectives and communicated to other team members.
• Developed and maintained relationships with customers and suppliers through account development.

• Claims data verification/reconcilliation for enrollment and ICD-10-CM, CPT and clinical documentation
• Reporting and data analysis
• QA audit reviews for CMS submission
• Weekly client calls
• Staff training

• New hire orientation and training CMS-HCC
• Ongoing coding education CMS-HCC
• Chart audits

• Clinical chart review for documentation and coding accuracy for HCC/Stars/HEDIS.
• On-site provider training and education.

• ICD-9-CM to ICD-10-CM code set mapping
• Fasciltated team ICD-10-CM training
• ICD-10-CM code map audits

• EMR system training for new staff
• Maintained work flow process
• Assisted in implementation of new client policy requirements
• Performed internal coding quality audits

• Oversaw hiring and training of new staff in current EMR systems
• Collaborated with Medical Director to ensure clinical documentation requirements were met
• Implemented quality/performance metrics
• Created department forecasts, future planning and development
• Evaluated quality improvement activities to maintain 98% dept accuracy
• Contributed to the growth of the prospective in-home assessment program; 8,000 completed in 2009, 125,000 projected for 2013
• Managed approximately 57 employees
• Offshore onsite HCC training - 20+ employees