gail gordon resume 2015
TRANSCRIPT
GAIL GORDON, MSHA/EDUCATION, CPC, SSGB
145 Fiesta Circle St. Louis, MO 63146 314-680-3143 [email protected]
SUMMARY
HCC Coding Manager with 10+ years of Revenue Cycle Management.
- PARTICULAR STRENGTHS -
ICD-9/CPT-4 Coding Change Management Training & Staff DevelopmentGovernment &TPA Compliance Quality Control - 6 Sigma EHR Implementation/MigrationPhysician Credentialing Conflict Resolution Financial CounselingHCC Coding, CDPS Chart Auditing ICD-10 Proficient
EXPERIENCEInnovare Health Advocates St. Louis, MO 2013-PresentPopulation Health Data Services Manager
Train, consult, audit, develop strategic relationships, and detailed analysis and reporting,
Develop and ensure continued achievement of quality measures and incentives, HCC coding compliance, and medical office revenue optimization for both primary as well as contracted service medical offices.
Support clinicians as they apply population health management and value based payment methodologies to their practices to improve patient experience and clinical quality and positively impact resource utilization.
HCC Coding and Education Services, Account Manager Quality Measure Reporting for 3 IPAs; 32+ clinicians. Develop and implement the HCC Medicare Advantage & Education
Services program for clinicians and office staff/coders. Perform assessment of current state of clinician coding patterns. Research & audit medical charts to ensure appropriate submission of
HCC diagnosis codes according to CMS regulatory guidelines. Develop guidelines to ensure Clinical Documentation Best Practices. Develop & implement educational program to prepare for ICD-10
transition. Adhere to all official coding rules & CMS guidelines for both FFS and
MA coding and billing practices. Coordinate external audits performed by MA Health Plans.
Communicate audit findings along with recommendations for improvement to clinicians.
Assist in the development and support of IHA’s HCC Coding Initiatives.
Precision Practice Management St. Louis, MO 2012-2013ACCOUNT MANAGER, CPC
Lead CPC for large local hospital ED.
Lead CPC for local hospital Bone Marrow Transplant Clinic CPC for orthopedic and podiatry accounts. Assist management in preparing for ICD10 implementation. Be a resource for Client Representatives answering any Billing/Coding questions
that may arise.
Feet for Life Podiatry Centers St. Louis, MO 2009 - 2012ACCOUNTS RECEIVABLE SUPERVISOR
Provide comprehensive, day-to-day implementation of accounts receivable, collection and customer service activities of multi-physician practice, significantly increasing previous market-share.
Established cost estimation and co-payment practices at patient intake, generating improved collection processes and reducing outstanding receivables. Initiate phone and written communication with past due accounts to ensure compliance.
Resolved timeliness and complete payment issues with government billing, reducing the number of appeals and resubmissions by 80%.
Assisted with migration from third-party billing agency to in-house accounts receivable management.
Credentialed physicians in government and third-party payer programs. Coded physician encounter notes to ensure accurate billing and compliance with
payers.
Hanger Prosthetics and Orthotics Olivette, MO 2007 - 2009SENIOR OFFICE ADMINISTRATOR
Managed A/R for multiple offices in Missouri and Illinois to ensure accurate billing, reimbursements and collections practices. Reduced AR from 57% down to 0-3% for those 120 days and over.
Supervised 12 Office Administrators to maintain A/R within target goal of 5% and under for 120 days. Traveled to struggling offices to mentor, directly supervise and assist in resolving problem claims.
Developed a training protocol for Office Administrator’s annual educational needs. Delivered orientation to new Administrators and trained on best practices. Maintained Medicare/Medicaid compliance.
Provided on-site direction of daily operations and scheduling of staff during absences of Administrators at various area offices.
Implemented a patient evaluation clinic that generated $96K in revenue. Coordinated and hosted education clinics for patients and families, providing
current information on available care protocols and resources.
SSM St. Joseph Hospital of Kirkwood Kirkwood, MO 2004 - 2007HOSPITAL REGISTRAR
Pre-registered patients via phone and written orders. Greeted patients to the Emergency Room.
Entered patient data into the hospital data entry system (McKesson Star) including demographic and insurance information.
Collected insurance copayments as required by insurance companies and contractual agreements.
Provided customer service assistance and support to staff and patients.
GAIL GORDON Page 2
314-680-3143 [email protected]
EDUCATION/TRAINING
University of Phoenix Creve Coeur, MOM.S. Healthcare Administration, Minor – Education
University of Phoenix Creve Coeur, MOB.S. Healthcare Administration
St. Louis University St. Louis, MOTotal Quality Management
Six Sigma-Green Belt
American Academy of Professional CodersCertified Professional Coder
Professional OrganizationsAmerican Academy of Professional Coders