Jacqueline Anderson is a Senior Director at Ankura based in Washington, DC. She has more than 20 years of experience providing coding, compliance, operational, investigative, and industry expertise and assistance to payers and providers including large healthcare systems, academic medical centers, physician practices, dialysis clinics, and durable medical equipment companies. Jacqueline’s key areas of expertise include coding data quality and compliance, clinical documentation improvement (CDI), medical staff documentation education, prospective payment systems, revenue capture, risk adjustment payment methodologies, and operations. Extensive experience in the qualitative and quantitative analysis of medical record clinical data, ICD-10-CM and CPT/HCPCS coding guidelines, DRG reimbursement, Medicare policies and regulations, and data collection.
Jacqueline’s professional experience includes:
- Due diligence for billing and coding compliance evaluation of claims for dermatology, OB-GYN, radiology, emergency medicine, and addiction medicine services. The results of our work are used to inform the investor’s analysis of risk and revenue generation.
- Compliance reviews focused on coding and billing with applicable regulatory guidance including Medicare, state Medicaid, and commercial payers. Evaluation of documentation and claims for critical care, emergency medicine, addiction medicine, orthopedics, ophthalmology, podiatry, and acute care inpatient services.
- Served as project management officer and led the design, build, planning, and implementation steps for a comprehensive state-of-the-art clinical documentation and coding excellence program for health information management department at an academic medical center located in southern United States. Project scope included assessment of existing processes and workflows, evaluation of organizational structure and staffing model, metrics reporting, and technology. Additionally, project included the conduct of a medical record coding and documentation audit, provision of coder and clinical documentation excellence (CDE) staff education, development of physician engagement, and accountability strategies and customized CDE education for medical staff.
- Served as interim CDI director and ICD-10 physician readiness workstream lead for a 475 bed AMC. Responsible for CDI program development and all management and daily operational activities for department. Oversight of ICD-10 clinical documentation and physician readiness workstream activities. Developed and maintained ICD-10 physician readiness workplan and risk assessment tool; developed overall ICD-10 physician education strategy and plan; coordinated execution of ICD-10 medical staff education; developed specialty-specific medical staff CDI education curricula; developed ICD-10 documentation clarification templates; and performed remediation and re-design of Epic documentation tools and templates for ICD-10.
- Served as interim coding manager for multiple large teaching hospitals and supervised the coding, abstracting, and reporting of clinical information for inpatient, outpatient, ambulatory surgery, and emergency services.
- Managed CDI Program re-invigoration, design, and re-structure for seven region healthcare system (18 hospitals). Responsibilities included development/revision of CDI mission statement, policies, processes, tools, metric reports, training, and job descriptions. Managed the development and conduct of CDI education for CDS staff for all hospitals.
- Performed medical necessity and clinical documentation reviews utilizing criteria established by CMS and outlined in CMS National Coverage Determinations (NCD) and Fiscal Intermediary Local Coverage Determinations (LCD).
- Conducted numerous inpatient, outpatient, emergency, psychiatric, and DRG audits evaluating the accuracy and quality of coded medical record data for hospitals nationwide.
- Managed multiple Centers for Medicare & Medicaid Services (CMS) task orders evaluating the accuracy and completeness of inpatient encounter data submitted by Medicare+Choice organizations using analysis techniques and medical records reviews. Scope of work included evaluation of the capture of coded data utilizing the proposed CMS-HCC risk adjustment payment methodology.
- Performed various aspects of coding reviews on several hundred professional claims including inter-rater reliability tasks to support multiple insurance companies in national class action litigation. Professional claim reviews included assessment of proper CPT coding, use of modifiers, unbundling rules, and payer adjudication process.
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