Verna L. Summerer CPC
Cross Plains,TN
Summary
Highly skilled, knowledgeable and proficient manager bringing extensive, specialized experience in management, HHS RADV Audits, HCC/Risk Adjustment, ICD10 coding and training, provider education and clinical documentation improvement. Possesses 15+ years proved ability to assess technical capabilities, chart auditing for Risk Adjustment and implementing process improvements and streamlining operations for business efficiency.
Overview
15
15
years of professional experience
Work History
Manager, Medicare Risk Adjustment
On Belay Health Solutions
06.2021 - Current
- 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.
Coding Operations Manager
Change Healthcare
02.2016 - 06.2019
- 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
Senior Coding Trainer
Optum
06.2015 - 01.2016
- New hire orientation and training CMS-HCC
- Ongoing coding education CMS-HCC
- Chart audits
Risk Adjustment Consultant
Blue Cross Blue Shield of TN
11.2014 - 05.2015
- Clinical chart review for documentation and coding accuracy for HCC/Stars/HEDIS.
- On-site provider training and education.
Senior Clinical Program Manager
UnitedHealth Care
09.2013 - 11.2014
- ICD-9-CM to ICD-10-CM code set mapping
- Fasciltated team ICD-10-CM training
- ICD-10-CM code map audits
Coding & Operations Manager
Optum
01.2011 - 09.2013
- 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
Coding Team Lead
Inspiris, Inc
03.2009 - 01.2011
- EMR system training for new staff
- Maintained work flow process
- Assisted in implementation of new client policy requirements
- Performed internal coding quality audits
Education
Technical/Professional - Medical Coding
Allied Schools
Laguna Hills, CA2009
Associate of Science - Computer Studies
Portadown College of Further Education
Portadown, Craigavon1990
High School Diploma -
Banbridge High School - Banbridge, Co. Down, Northern Ireland
1988
Skills
- Operations Management
- HHS RADV Audits
- Provider education
- HEDIS & STARS
- ICD-10 training & education
- Medical chart audits
- HCC/Risk Adjustment
- Clinical Documentation Improvement
- Compliant provider queries
Timeline
Manager, Medicare Risk Adjustment
On Belay Health Solutions
06.2021 - Current
Coding Operations Manager
Change Healthcare
02.2016 - 06.2019
Senior Coding Trainer
Optum
06.2015 - 01.2016
Risk Adjustment Consultant
Blue Cross Blue Shield of TN
11.2014 - 05.2015
Senior Clinical Program Manager
UnitedHealth Care
09.2013 - 11.2014
Coding & Operations Manager
Optum
01.2011 - 09.2013
Coding Team Lead
Inspiris, Inc
03.2009 - 01.2011
Technical/Professional - Medical Coding
Allied Schools
Associate of Science - Computer Studies
Portadown College of Further Education
High School Diploma -
Banbridge High School - Banbridge, Co. Down, Northern Ireland
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