Victoria Fountain

Codes data from patient records utilizing computerized coding systems to ensure optimal reimbursement of the hospital. Translates diagnostic and procedural information and sequences these codes through the use of a computerized encoding and DRG grouper application.

Abstracts data from patients’ medical records using the computerized abstracting system in order to compile accurate and timely statistical data. The Coder reviews and analyzes all patient types to determine the principal diagnosis and procedure and other significant diagnoses and procedures.

Identifies and verifies medical and surgical complications and comorbidities as well as medical necessity. Works independently reviewing medical record documentation, laboratory reports, radiology reports, and consultation reports to identify medical conditions evaluated and treated during the visit.

Corrects abstracts with incorrect codes to ensure compliance with required regulations and accreditation standards.

As needed, responds to physician inquiries that concern the proper documentation of diagnostic procedural information and questions regarding coding assignments.

• Providing case management to individuals utilizing the DSAAPD Community Services Program (CSP) which provides assistance to elderly and disabled individuals in the community to avoid institutionalization. Receiving referrals for services, performing home visits every six months to complete initial assessments for needs and services, creating care plans and service orders, maintaining cases over time, completing interim and redetermination assessments in the home at regular intervals, and connecting individuals to a variety of community resources as needed (e.g. Meals on Wheels, Adult Protective Services).

• Providing targeted case management to individuals with developmental and intellectual disabilities living in Neighborhood Group Homes. Coordinating all supports and services for individuals on the Medicaid Home and Community Based Waiver program, including residential, nursing, behavioral, day program, and supported employment. Providing in-person home visits every 3 months, and reviewing each individual’s Person Centered Plan with their support team on an annual basis. Developing plan outcomes and ensuring completeness of all information regarding the individual. Coordinating with various State and outside agencies as needed (e.g., Fiscal office, Social Security Administration).

• Providing support for CVS Caremark clients (insurance companies) and account management as part of the Health Plan Client Support Team. Researching requests, executing approved overrides for pharmacy plan benefits, carrying out pharmacy restrictions/locks, managing claims and prior authorizations, contacting clients, pharmacies, and other entities for information or approval as needed.

• Providing administrative support to the Neurobehavioral Health team, assisting residents in scheduling virtual (Zoom) calls, scheduling resident outings by coordinating with multiple staff and departments, updating the staffing calendar for the NBH and Activities departments, managing work orders for maintenance requests, creating requisitions for needed supplies, maintaining resident case files, assisting the staff psychologist with her calendar, working closely with the Activities Therapy department, and other administrative duties.

• Receiving and processing client applications for Diamond State Health Plan Plus and Home and Community Based Waiver Medicaid services, preparing case files for social workers, answering phones, and functioning as the point of contact for clients as well as the public, assisting clients and family members with questions about services, maintaining and archiving records, handling incoming/outgoing mail, taking minutes during staff meetings, and providing administrative support to the Senior Social Worker Case Managers.