ACCURATE MEDICAL CODER

Diane Gajda
North Carolina, USA
(908) 912-6337 (908) 91-CODER


About Ahima


View Diane Gajda's profile on LinkedIn


Jump to:
 


 
My Skills and qualifications match the requirements for the job responsibilities of a Remote Manager Internal Coding Advisory Team:

 
 
I am a Certified Coding Specialist (CCS) and ICD10 CM-PCS Trainer with AHIMA and have an Associate of Science degree in Dental Hygiene. I presently work for R1RCM as a Manager of the Internal Coding Advisory Team; also I presently work with Peak Health Solutions Inc. as a Lead Inpatient Auditor.
With R1RCM I manage the internal coding advisory Team Leads and Coding Advisors. I Plan, develop, direct and implement system-wide policies and procedures, track and analyze outcomes, set quality and productivity standards, appropriate staffing, recruiting, hiring, new hire orientation, training, scheduling, payroll processing, and performance monitoring and disciplinary actions.
With Peak Health Inc. My Title is Lead Inpatient Auditor. I provide quality audit reviews on the coders and Auditors on my team in ED/OP/IP/Ancillary and acute coding. I provide guidance and feedback for any inconsistencies and inaccuracies in their daily coding. I assign all client work for my team and handle PTO and time card issues. I maintain a high level of professionalism and work ethics with my team and the clients I handle. My facility demographic includes Acute care Level 1 Trauma with 1,167 beds.

 

 
Highlights:

 
 
  • 2015 AHIMA Approved ICD-10 CM / PCS Trainer
  • 2012 ICD10 Certified
  • Proficient in Microsoft Office, Trucode, Themis, Epic, Star, 3M, 3M360, Smart, Invision and Meditech
  • 2012 Certified Coding Specialist CCS
  • American Health Information Management Association (AHIMA)
  • 2011 Medical Billing & Coding Certificate (GPA 4.0)
  • Westchester Dental Hygienists' Association Inc
  • Dental Hygienist, R.D.H 1989
  • 1989 A.S. - Dental Hygiene, State University of New York - (GPA 4.0)
  • Farmingdale University National Honor Society, President's List, Dean's List
 
   

 
Personality Characteristics:

 
 
  • Strong organizational Skills*
  • Analytical with facts and figures
  • Accurate and detailed
  • Responsible work ethics
 
 
*Assessed by an internationally-recognized instrument for determining personality, character and temperament

 
   

 
Experience:

 
 
(01/2018-Present) R1RCM
 
 
  • Remote Manager Internal Coding Advisory Team
  • Manage the internal coding advisory Team Leads and Coding Advisors who are responsible for resolving all pre-bill inpatient and outpatient coding questions received from the coding Help Line, internal coding team, DNFB-related teams, and/or other coding-related questions.
  • Plan, develop, direct and implement system-wide policies and procedures that will improve and support the overall coding advisory program, ensure timely response to coding questions, and promote accurate coding practices that comply with organizational policies and other applicable regulatory guidelines.
  • Develop and maintain a system to track and analyze outcomes of the coding advisory program
  • Set quality and productivity standards for the team
  • Manage appropriate staffing, recruiting, hiring, new hire orientation, training, scheduling, payroll processing, and performance monitoring and disciplinary actions
  • Develop goals and objectives in accordance with company standards, and develops, oversees and meets the annual department budgetary goals
  • Trends and reports of areas of opportunity for coder education
  • Manage the collection, analysis and presentation of data for the pre-bill internal coding advisory program, and provides reports to Company Compliance, hospital compliance and executive leadership on data trends and the effectiveness of responses.
  • Suggest and coordinate coder education to address specific processes with regard to coding and documentation to prevent recurrence of identified coding issues
  • Work closely with the Site Coding Manager, Education Team, Coding Quality Management Team and/or Inpatient and Outpatient Coding Advisory Leads
  • Manage round-table meetings with the Coding Advisory Team to discuss coding issues and questions; and assist with the planning of the monthly Coding Affinity Group meetings
  • Recommend changes to the workflow to best meet the needs of the organization
  • Proactively identify potential coding compliance and documentation issues
 
(04/2017-Present) Peak Health Solutions, Inc.
 
 
  • Remote Lead Inpatient Auditor/ AHIMA ICD10 CM-PCS Trainer
  • Improve the accuracy of coding compliance and clinical documentation
  • Coordinate the efforts of the coding compliance and audit team by providing support and education
  • Direct the coding compliance and audit team on time management; and delegation of performance improvement projects and responsibilities
  • I Work independently in a leadership role and seeks guidance from the Director of Coding, Quality & Clinical Services for planning, implementing, administering, and evaluating ongoing activities related to physician documentation and coding compliance.
  • I Develop and ensure alignment with yearly strategic work plan for process audits, processes governmental audits, performs appeals, and monitors trends and outcomes to ensure compliance with government regulations.
  • I coordinate and oversight of processes conducted by colleagues in Compliance, including reporting and documentation of action plans and education plans to meet established accuracy rates. Effects organizational change to maintain/attain goals from a managerial and professional developmental perspective in the areas of clinical documentation and coding accuracy.
  • I oversee the communication of related policy and procedure manuals and informational memorandums and newsletters, and provides education to physicians, clinicians, and coding staff when necessary.
  • Communicate with clients to keep up to date with their standard operating procedures
  • Perform external and internal audits
  • Perform weekly meetings with auditors for trends on errors as well as updates on coding clinics and guidelines
  • Create and illustrate Power Point presentations to educate auditors, coders and facilities
  • Prepare spreadsheets for productivity and accuracy
  • Approve and monitor PTO requests
  • Escalate IT and access issues
  • Perform Interviews as well as PIP (Performance Improvement Plan)
 
(07/2015-04/2017) Himagine Solutions Inc.
 
 
  • Remote Project Lead / ICD10 Lead Auditor / AHIMA ICD10 CM-PCS Trainer
  • Improve the accuracy of coding compliance and clinical documentation by coordinating the efforts of the coding compliance and audit team by providing support and education; directing the coding compliance and audit team on time management; and delegation of performance improvement projects and responsibilities.
  • I Work independently in a leadership role and seek guidance from the Director of Coding; Quality & Clinical Services for planning, implementing, administering, and evaluating ongoing activities related to physician documentation and coding compliance. I Develop and ensure alignment with yearly strategic work plan for process audits, process governmental audits, performs appeals, and monitor trends and outcomes to ensure compliance with government regulations.
  • I coordinate and oversee processes conducted by colleagues in Compliance, including reporting and documentation of action plans and education plans to meet established accuracy rates, effects of organizational change to maintain/attain goals from a managerial and professional developmental perspective in the areas of clinical documentation and coding accuracy. I oversee the communication of related policy and procedure manuals and informational memorandums and newsletters, and provide education to physicians, clinicians, and coding staff when necessary.
  • Communicate with clients to keep up to date with their standard operating procedures
  • Perform external and internal audits
  • Perform weekly meetings with auditors for trends on errors as well as updates on coding clinics and guidelines
  • Create and Illustrate Power Point Presentations to educate Auditors, Coders and Facilities
  • Prepare spreadsheets for productivity and accuracy
  • Approve and monitor PTO requests
  • Escalate IT and access issues
  • Perform Interviews as well as PIP (Performance Improvement Plan)
 
 
(07/2013-Present) Accretive Health (Renamed R1RCM)
 
 
  • Assistant Team Lead
  • Conduct audit reviews in ED/OP/IP/Ancillary and Acute coding/assign all client work/responsible for PTO and time card issues
  • QA Specialist ED/OP/IP/Ancillary and Acute Coding
 
 
(04/2012-Present) Amphion Solutions
 
 
  • Assistant Team Lead
  • Conduct audit reviews in ED/OP/IP/Ancillary and Acute coding/assign all client work/responsible for PTO and time card issues
  • QA Specialist ED/OP/IP/Ancillary and Acute Coding
  • Proficient in Trucode and Themis software, Epic, Star, 3M, 3M 360, Invision and Meditech
 
 
(07/2012-07/2013) Altegra Health
 
 
  • HCC Coding
 
 
(08/1993-04/2002) Dr. Saul
 
 
  • Dental Hygienist / Coder and Biller
  • Proficient at using DentalWriter software for ADA CDT Codes
  • Performed infection control procedures resulting in 100% compliance with OSHA regulations
 
   

 
Education:

 
 
2012 Advanced Hospital Coding & CCS Prep Bronx Community College (GPA 4.0)
 
 
2011 Medical Billing & Coding Certificate Allen School Jamaica New York (GPA 4.0)
 
 
  • Knowledge of medical business office procedures and billing/collection practices
  • Utilization of Medisoft, CPT, and ICD-9-CM coding books to code medical services utilizing ICD9-CM, HCPCS and CPT coding system
  • AudiUresearch coding discrepancies for compliance, reimbursement and accuracy
  • Insurance Pre-authorization/Pre-certification; Knowledge of third party operating procedures and practices
  • Prepare information for collection agency
  • Process outbound 837 electronic bill submissions
  • Knowledge of AHIMA Code of Ethics and/or AHIMA's Code of Ethical Coding
 
 
1989 A.S . - Dental Hygiene State University of New York (GPA 4.0)
 
 
  • Knowledge of dental clinical procedures and classifications of oral disease
  • Utilization of dental instruments as pertains to dentistry
  • Infection control practices and compliance
 
   

 
Seminars and Workshops:

 
 
  • 2017 Injuries, Poisoning, Adverse Effect Coding ICD-10 Presentation
  • 2017 Matters of the Heart: ICD-10- CM/PCS Coding Hypertension and Circulatory Procedures
  • 2016 General Surgery Coding ICD-10 CM and PCS
  • 2016 Diabetic Complications Itís Not Complicated ICD-10 Presentation
  • 2016 Skin & Subcutaneous Presentation
  • 2015 ICD-10- CM / PCS Trainer
  • 2015 Anatomy and Diseases of the Heart Advanced ICD-10-PCS Training
  • 2015 ICD-10-CM Inpatient with External Cause Competency Exam
  • 2015 ICD-10-PCS Inpatient Competency Exam
  • 2014 TruCode Refresher
  • 2014 ICD-9 for Sepsis
  • 2014 3M 360 Computer Assisted Training Class
  • 2013 ICD-10-CM vs ICDĖ9-CM
  • 2012 Diagnostic Coding for Hospital Outpatient Ancillary Services
  • 2012 ICD-10-PCS Body System or Body Part webinar
  • 2012 ICD-10 Training Session
  • 2012 HIPPA Security & HITECH
  • 2012 Injections and Infusions, AHIMA Distance Education Course
  • 2012 Injections and Infusions webinar given at Amphion
  • 2012 Diabetes Mellitus and Its Many Manifestations from a Clinician's Perspective webinar given at Amphion
  • 2012 Wound Therapy webinar given at Amphion
  • 2012 Evaluation and Management webinar given at Amphion
  • 2012 Trucode May Refresher Course
  • 2011 Cardiology Procedure Coding, AHIMA Distance Education Course
  • 1995 Orofacial Cancer, University of Detroit Mercy School of Dentistry, Cold Spring , New York
  • 1994 Infection Control, Dental Society of the State of New York, New York, New York
  • 1994 Local Anesthetics, University of Detroit Mercy School of Dentistry, Cold Spring , New York
  • 1994 Nutrition Education, University of Detroit Mercy School of Dentistry, Cold Spring , New York
  • 1990 Periodontal Instrumentation, College of Technology at Farmingdale, Farmingdale, New York
  • 1990 Pharmacology Update, College of Technology at Farmingdale, Farmingdale, New York
 
     
   

Diane Gajda
North Carolina, USA
(908) 912-6337 (908) 91-CODER


 
I am confident that it would be time well spent for you to permit me the consideration of an in-person meeting or preferable phone conference in order for me to demonstrate my potential value to your organization. I can be reached at (908) 91-CODER or by email at diane@accuratemedicalcoder.com
 

 

Page designed and managed by Liontec Systems, a computer support and management company providing web development, network and system support, digital media production and social media development