Priyanka Rajesh Agrawal

Project: CDI-IP (American Advanced Management)

https://americanam.org/

Client: Colusa, Coalinga

Tools: CPSI ClientWare, 3M

Role & responsibilities:

-Worked on review process: Concurrent Review for real-time accuracy, Retrospective Review for missed documentation post-discharge, and Post-Discharge Review before final coding for completeness.

-Regularly audited clinical documentation for accuracy, completeness, and compliance.

-Trained clinical staff on documentation best practices and new coding scenarios.

-Addressed documentation issues with CDI teams.

-Developed processes to enhance documentation accuracy and efficiency.

-Ensured documentation met regulatory standards.

-Provided one-on-one support and mentoring for continuous improvement.

-Presented CDI topics and provided project updates.

-Evaluated patient records for accuracy and identified improvement areas.

-Analyzed documentation data to identify trends and areas for improvement.

Project: CDI-IP

Client: MetroHealth

Tools: 3M, Citrix, Excel

Role & responsibilities:

-Audited CDI-IP clinical documentation.

-Led regular coder and CDI-IP meetings.

-Presented on CDI-IP topics in client meetings.

-Organized client project update meetings.

-Provided one-on-one support for continuous improvement.

-Ensured accuracy and completeness of patient records.

-Evaluated documentation for accuracy and compliance.

-Educated CDI coders on new scenarios and guidelines.

-Developed processes for documentation accuracy.

-Trained and mentored new CDI coders.

Project: DRG Validation

Clients: MNR, Intermountain, City, Purit, Humana, 1199P, EP, PruittCS, LONNJ, LONNC, Atrio, ASCMI, LONFL, LONNY, LONMI, LONCO, HOMEP, P3, PartnersHealth, LONIL, L144P

Tools: CAVO, Core, 3M

Role & responsibilities:

-Identify and correct inconsistencies and deficiencies in medical documentation.

-Audit and code complex inpatient records (e.g., transplants, cardiac, cancer)

-Code and bill medical claims accurately for hospital and physician facilities.

-Stay updated on coding requirements through ongoing education and certification.

-Review and process Medicare, Medicaid, and commercial insurance claims; appeal denials as needed.

-Conduct monthly compliance reviews and provide coder education.

-Communicate directly with physicians regarding documentation and queries

-DRG Validation (MS-DRG, ARP-DRG)

Project: HCC

Client: Optum Care (CA, WA, FL)

Tools: Citrix, Optum ICD data

Role & responsibilities:

-Reviewed medical records and assigned Medicare HCC Risk Adjustment diagnosis codes.

-Abstracted data and accessed EMR systems remotely.