Gail Gordon Resume 2015

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  1. 1. GAIL GORDON, MSHA/EDUCATION, CPC, SSGB 145 Fiesta Circle St. Louis, MO 63146 314-680-3143 gailgordon314@gmail.com SUMMARY HCC Coding Manager with 10+ years of Revenue Cycle Management. - PARTICULAR STRENGTHS - ICD-9/CPT-4 Coding Change Management Training & Staff Development Government &TPA Compliance Quality Control - 6 Sigma EHR Implementation/Migration Physician Credentialing Conflict Resolution Financial Counseling HCC Coding, CDPS Chart Auditing ICD-10 Proficient EXPERIENCE Innovare Health Advocates St. Louis, MO 2013-Present Population 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 IHAs HCC Coding Initiatives. Precision Practice Management St. Louis, MO 2012-2013 ACCOUNT 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 - 2012 ACCOUNTS 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.
  2. 2. 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 - 2009 SENIOR 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 Administrators 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 - 2007 HOSPITAL 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 gailgordon314@gmail.com EDUCATION/TRAINING University of Phoenix Creve Coeur, MO M.S. Healthcare Administration, Minor Education University of Phoenix Creve Coeur, MO B.S. Healthcare Administration St. Louis University St. Louis, MO Total Quality Management Six Sigma-Green Belt American Academy of Professional Coders Certified Professional Coder Professional Organizations
  3. 3. American Academy of Professional Coders