CV - Stanley M. Szelazek, BBA, CPC, CPC-H, CCP, CMC, CCAT, ACS-OR,
SENIOR HEALTH INFORMATION MANAGER/CODING AND COMPLIANCE SPECIALIST

Providing cutting edge consultation and leadership for HIM department procedures regarding coding, compliance, and record management for surgeons, physician groups & solo practices, hospitals, and insurance companies. Business process review and improvement accomplished with proven methods for turning around under-performing operations and inspiring performance improvement from employees. Management Strengths include Organizational and Process Improvement: Cost Reduction and Budget Management; JCAHO Standards Compliance; Staff Recruitment Development and Coaching; Quality Assurance and Performance Improvement; and Teambuilding.

HIGHLIGHTS OF QUALIFICATIONS

· Bachelor of Science in Business Administration
· Certified Professional Coder (CPC, Orthopedic Specialist) (AAPC)
· Certified Advanced Coding Specialist – Orthopaedics (ACS-OR) (UCG, Decision Health)
· Certified Compliance Professional (Department of Fraud and Abuse)
· Certified Orthopedic Proficient (AAPC)
· Certified Clinical Account Technician, (AAHAM)
· Certified Medical Coder (PMI)
· National Advisory Board Member for the American Academy of Professional Coders 2003/04.
· National Advisory Board for Decision Health/Orthopaedic Proficiency Board.
· Expert Witness Florida Department of Health Care (Orthopedic coding)
· Gold Facilitator for the Coding and Reimbursement Network. For the Orthopedic and Payer forum. (http://www.codingandreimbursement.net/)
· National Advisory Board Member for the Coding Institute, Medical Billing, Coding Newsletter.
· National Speaker/Educator for the American Academy of Professional Coders.
· Expanding knowledge of medical terminology, medical insurance claims processing, medical insurance coding, ancillary care coding, medical computer applications, medical office procedures and word processing.
· Excellent interpersonal and communication skills with an extensive customer service background.
· Understanding the importance of follow-through and attention to detail.
· Outstanding organizational and time management abilities.
· Computer experience includes: Windowsâ, Word Perfectâ, MS Word 97â, Medical Managerâ, Power Pointâ, Excelâ, Lotusâ and Avatarâ, Ingenix Power Trakâ.

EXPERIENCE

AccountAbility Physician practice billing Services 2/04 to present
Principal

President and founder of AccountAbility Physician practice billing Services. Services include, Practice Assessment of patient access operations, patient flow, paper flow, medical record flow, telephone flow, Business Operations Flow, coding, billing procedures, account receivable analysis, payer mix, management reports, Managed Care Services, contract review and negotiations, fee schedule matrix, managed care strategy, Marketing Strategies, demographic studies, referral sources, satisfaction survey, Practice Benchmarking, practice billing Consulting, Practice Compliance Strategies, and practice billing.
www.myaccountability.org

PALM BEACH COMMUNITY COLLEGE 9/03 to Current
Adjunct Professor

Medical Coder Specialist (ATD B526.) This program is designed to prepare the student for employment as a medical coder. Medical coders assign codes to each diagnosis and procedure documented in a patient's medical record. The program content includes medical terminology, medical office technology, health care delivery systems, health information services, coding skills, employability issues, medical terminology, Insurance and Billing, Health Care Concepts, Body Structure and Function, Fundamentals of Medical Coding, Health Information Management and Medical Coding I and II.

LIGHTHOUSE ORTHOPAEDIC ASSOCIATES 1/02 to 2/04.
Compliance Officer /Director

Perform auditing of physician evaluation and management service codes on a quarterly basis; Physician education; 100% surgical review; certified letters of medical necessity; re-negotiation of contracts’ PIP suits; workers compensation grievances with the state of Florida and/or attorney, complaints and resolutions to the Florida Department of Insurance for PPO’s; Auto’s; File legal suits against HMO’s through the State Wide Providers Health Organization in the state of Florida; Non-Par surgery pre-negotiations; W/C surgery pre-negotiations, post audits on billing/reimbursement; 100% of Medicare/Medicaid remittance reviews/auditing; Medicare Hearings; Creation and implementation of HIPPA Privacy and Security Compliance Plan, Creation and implementation of the Group Practice Compliance plan as recommended by the OIG (see compliance manual at www.lighthouseortho.com ) Trend/Tracking reports of errors. Enforce all compliance rules and regulations adopted by the practice, Creation of forms specific to the practice, (i.e. ABN, BNI, Assignment of benefits, Pre-negotiation contracts.)

Created new Medical History and Physical Exam form specific to Orthopedics, partnering with Freechart.com. Initiate all secondary appeals, implementing front-office processes to ensure the collection of self-pay balances/responsibilities. Provide physician letters to medical directors for grievances and negotiations. Staff Education on coding and compliance. Conduct all new hire orientations and write policy and procedure manuals. Creation and implementation of the practice compliance programs for both HIPAA and Federal standards.

Accomplishments:

Creation and implementation of HIPAA Privacy & Security compliance plans. www.lighthouseortho.com
Creation and implementation of the OIG recommended group practice compliance plan. www.lighthouseortho.com
Achieved an overall physician documentation standard of 85% through audits and education.
Creation of Practice Web site. www.lighthouseortho.com
Conducted coding and reimbursement classes for all staff.
Produced over $500K in collected revenue via post surgical review audits and submission of corrected claims for medically necessary and appropriately billed services, State law suits utilizing the Statewide Provider and Subscriber Assistance Program, foundation contract audit, Department of Insurance grievances, Medicare hearings, letters of appeal and PIP demand letters. This recovery was collected in an 18- month time frame

American Academy of Professional Coders, Salt Lake City, Utah
National Independent Physician/Facility Educator 12/03 to Present

Prepare state specific presentations regarding physician and facility reimbursement. Lectures to include state laws regarding CMS (Medicare and Medicaid State specific reimbursement information), LMRP/LCD information and resources, Specialty Societies, Workers Compensation Programs, CHIP, ERISA, HMO, PPO prompt payment statutes, PIP/No Fault and State Specific Statutes regarding Agency for Healthcare Administration and assistance. These lectures also include Physician practice billing and training for patient access, check in and out, coding and reimbursement, understanding RBRVS and RUC, Federal Register and comment periods for effecting change, Malpractice insurance, contract negotiations and compliance strategies that are reasonable and adaptable. Travel and lecture to AAPC local chapters at a rate of two states per month. These educational workshops are provided for physicians, facilities and their staff. This forum provides AAPC credential attendees with 8 continuing education units per lecture. www.aapc.com

KEMPER NATIONAL SERVICES, PLANTATION, FL 6/99 – 1/02
Quality Assurance Team manager for MBRO 6/01 to 1/02.

Managed the Quality Assurance Department for Medical Bill Review Operations. Provided oversight 20-employee staff. The Quality Insurance Staff was responsible for the performance of monthly audits of the internal staff of Medical Bill Review. Supervised Operations. Both 100% audits for new staff in MBRO, and Random Reviews (performed monthly) for seasoned staff. Counseled and trained the Medical Bill Review Operations Staff. Coordinated branch claims office communications on a quarterly basis as well as communications to resolve issues as needed. Ensured that all State Fee Schedules are maintained and updated on a quarterly basis. Completed Surgical Provider audits and assisted Medical Director and Surgical Staff with research for coding Appropriateness. Assisted with the research for an ambulatory Surgical Center Payment Schedule and in the creation and implementation of the company created reimbursement methodology. Managed and groomed employees for successful development of careers within the Quality Assurance Dept. as well as Medical Bill Review Operations. Provided a quality report on the Medical Bill Review Operations Dept. on a monthly basis. Supervised the quality processing for all medical, hospital and no fault claims.

Surgical Auditor, 6/99 to 6/01.

Reviewed all surgery claims for 48 states over $250K for coding appropriateness and approval of payment. Instrumental in devising new strategies, which enhanced our revenue with the implementation of current coding/reimbursement guidelines. Assisted in the creation of the Kemper ASC (ambulatory surgical center) fee schedule for usual and customary states, which offered no statutes or guidelines for reimbursement for medically necessary services. Worked directly with top Orthopaedic and Spine/Neurosurgeons on coding/reimbursement issues as well as scrubbing op notes.

LIGHTHOUSE ORTHOPAEDICS PRACTICE, Lighthouse Point, FL 1/00
Compliance Officer Consultant

Developed a compliance program for the practice of six orthopaedic physicians. Re-evaluated and provided troubleshooting for all insurance denials, appealed all denied claims that are justified, provide practice managers with weekly error trend reports, provide educational clinics to all staff relating to coding and billing issues. Provided all physicians with up-dates and coding information as appropriate, updated the system (medical manager) for fee schedule changes, provided customer service support and troubleshooting assistance to collection and billing staff as needed. Created and edited a monthly newsletter that provides the staff with educational information based on trend errors. Created and supplied physicians with creative “quick reference” tools for ease in code selection, chaired weekly meetings with practice managers providing staff with billing errors and methods of correction.

FLORIDA MEDICAL CENTER, Fort Lauderdale, FL 6/97 to 5/99
Nursing Administration Office Manager

Provided administrative support to Chief Nursing Officer and to the Director of Nursing Operations. Coordinated schedules and meetings, prepared and handled budget for all nursing managers and directors (27), ordered supplies, scheduled trips and all accommodations, kept track of and sent e-mails. Collected all budget data for all nursing departments. Maintained high-level of customer service. Managed all aspects of the administrative nursing department

CRAWFORD CENTER, Wilton Manors, FL 10/96 to 10/98
Child Welfare Counselor (Part-time)

Provided one-on-one and group counseling as well as therapy for young abused children under the age of twelve. Also facilitated behavior modification and group therapy sessions, and assisted in activities of daily living, Kept meticulous therapy notes and charted patient progress.

COUNTOUR NAILS, Plantation, FL 1/93 to 12/96
Operations Manager

Reported directly to the President/Owner of the spa. Supervised 85 employees in the daily operations of the spa. Responsible for staff recruitment, interviewing, hiring, contract negotiations, performance reviews. Facilitated goal setting and monitored performance improvement. Scheduled educational update seminars for staff. Opened and closed spa daily. Provided customer assistance. Maintained vendor relations.

EDUCATION/CERTIFICATION

Bachelor of Science in Business Administration 6/95

Courses included: Business Process Management, Operations Research, Project Management, Planning and Control Systems, Business Forecasting and Economics, Statistics for Management Decision Making,
Logistics Management, Managerial Effectiveness, Employee Relations in Business, Motivation and Leadership, Negotiations, Business Accounting, and others.

Insurance Coding Specialist Program Completed 12/98

Medical insurance claims processing, medical insurance coding, ancillary care coding, medical computer applications, medical terminology, medical office procedures, and word-processing.

American Academy of Professional Coders Certification Program 9/99 to 11/99

Extensive Review of CPT, ICD-9 and HCPC

CV - Margie Scalley Vaught, CPC, CPC-H PCE, CCS-P, MCS-P, ACS-OR

With over 21 years experience in the Healthcare arena, in positions from nurse’s aide to ward clerk and medical transcriptionist to office manager, Margie understands how offices are structured. Fourteen of those years were spent in the field of Orthopedics. She obtained Certified Professional Coder (CPC) designation in 1995 from the American Academy of Professional Coders (AAPC), where she served as a National Board Member for over 3 years. Currently she is performing work for the AAPC as a technical support person, in the Education Department. Also in 1996 she obtained the status of Professional Credit Executive (PCE), which deals with extending credit issues, bankruptcy and collection efforts under the current legal system. She further obtained the designation of CCS-P (Certified Coding Specialist – Physician) in September 2000 from American Health Information Management Association (AHIMA). Having also obtained the credential of Medical Compliance Specialist-Physician (MCS-P) in Jan. 2001, thus giving a more detailed background of compliance issues as outlined by the OIG. In 2003 obtained the credential of ACS-OR Advanced Coding Specialist – Orthopedic. She is a recognized AAPC Approved PMCC Instructor. She has served as the technical advisor for the Orthopedic Practice Coder, for Decision Health since 2000. Since 1998 she has been providing consulting services to CodeCorrect.com, in regards to their question and answer sections. This section allows their clients to post coding questions relating to all aspects of the medical field and then she will research and come back with supporting information in answer form. In addition she contributes and writes articles for the AAOS Bulletin on an ongoing basis as well as other publications such as AAPC Coding Edge, Orthopedic Technology Review and CodeCorrect Website. Adding to this she also performs internal audits, education and training of physicians and office staff, and helps clinics establish billing and coding compliance manuals, as an Independent Consultant. She has also provided work for GoreTex, LTD in regards to billing, coding and reimbursement issues related to their casting products. She provided to Gore a ‘Billing Manual for Physicians’ Offices’ to help them understand the Federal Rules and regulations related to billing and coding for supplies to obtain reimbursement. She also presents to physician offices/groups regarding documentation and coding requirements. Current member of MGMA/ACMPE, BONES, AAPC, Society for Clinical Coding (SCC), PACHOM and AHIMA. Margie stays current by attending the annual conventions for BONES, AAPC, MGMA and also the AMAs CPT symposium. She has also provided testimony regarding correct coding issues and compliance in Fraud and Abuse cases.

Presentations (not all inclusive)

· Decision Health Audio presentation 2004 Changes for Orthopedic Coding, December 9th, 2003
· MGMA OPA Pre-Conference Orthopedic Coding, Oct 12, 2003
· Decision Health (UCG) Coding Extravaganza Full Day Orthopedic Coding May 5th, 2003; Orlando Florida
· New England Medical Societies – In-Office procedures (June 2003)
· AAPC Workshop Department 2003 – HIPAA and OIG Compliance; Chart Auditing; Surgical Chart Auditing and Guidelines; CPT and E/M Coding Guidelines and Documentation Issues; Orthopedic Coding; 2003 CPT/HCPCS and ICD-9 coding changes; NPP coding; ICD-9-CM Coding;
· BONES Annual Convention – DME and NPP coding (April 2003)
· AAPC National Convention – Feet procedures (April 2003)
· Ohio State Medical Association – Orthopedic Coding (March 2003) and NPP Coding (March 2003)
· Coding Summit – Fracture Care and Injection, UCG, October 2002, Las Vegas
· Orthopedic Coding, MGMA Orthopedic Practice Assembly, Preconference workshop October 2002
· Conquering Orthopedic Coding; UCG July 2002 and Sept 2002
· Washington State Orthopedic Society – June 2002 General Orthopedic Coding
· BONES Annual convention June 2002, Wisconsin, 3 Sessions, General Orthopedic Coding; Spine Coding; Extremity Coding
· Coding Gaunlet – Vermont, New Hampsire and Maine Medical Societies, May 2002 – 2 Sessions Advanced ICD-9 Coding and NPP documentation
· AAPC National Convention 2002, Washington DC
· 2 Breakout session taught – Tracking Supplies and Unlisted Procedure Coding
· 2002 CPT New Codes for Orthopedic Coding, Part B News, UCG, OPC, Audioconference Jan 2002
· AAPC Workshop Department 2002, presenting the following: “Surgical Coding Guidelines and Auditing – 5 locations” “Advanced CPT Documentation and Guidelines – 5 locations” “Advanced CPT Chart Auditing and Compliance – 3 location”, “Auditing, Documentation and Privacy – What does the AMA, OIG and HIPAA have to say – 4 locations” “Complance Information” 1 location
· AAPC Workshop Department 2001, “Chart Auditing and Compliance Issues,” Simi Valley CA Oct 2001
· “Breaking Through the Confusion of New Casting Codes,” Part B News/OPC, Audioconference Oct 2001
· “Conquering Orthopedic Coding”, Part B News, Washington DC Nov 2001
· “Conquering Orthopedic Coding”, Part B News, New Orleans, LA Sept 2001
· “Coding Strategies for Shoulder Surgery” Coding Institute, Audioconferece June 2001
· “Conquering Orthopedic Coding”, Part B News, Orlando, FL, Mar 2001
· E/M Coding and Chart Auditing
· AAPC Annual Conventions 1999-1997,
· Co-presenter on Orthopedic Coding
· Co-presenter on Review course for Certification
· Knowing your Insurance 1995, Yakima, WA
· Explaining what to look for, what to ask for in selecting insurance coverage