Kelley J. Lawson
     RHIT, CCS, CPC-H

Manager - HIM/UR

lawsonk@nextwave.info

Ms. Lawson is responsible for medical record auditing, training hospital and medical office staff on documentation and ICD-9 and CPT-4 Coding, and evaluations of Compliance with federal, state, and, payor rules and regulations. Ms. Lawson’s experience in these areas include:

• Periodic focused and/or random chart audits to assure proper payment and compliance with all applicable regulations and payor guidelines.
• Review of payor denials of provider claims to focus appeal efforts and identify system and/or documentation refinements to prevent reoccurrence.
• Evaluation and/or development of specific Compliance plans for the Health Information (HIM) department to operationalize Corporate Compliance Plans.
• Audits of matched physician and hospital charts and bills to assure consistency and proper payment.
• Focused chart audits to support Diagnosis Related Group (DRG) refinement efforts.
• Research and clarification of client problematic coding issues with physicians and appropriate national coding resources, and development or review of client specific coding guidelines.
• Development or review of client specific documentation guidelines for the medical staff.
• Evaluation and implementation of medical claims and analysis computer software, including conversion from previous systems, and setup and testing of multiple reimbursement formulae.
• Review of claims from a payor perspective to assure proper payment.
• Workflow analysis, policy, and procedure development for Medical Records Department.
• Workflow analysis, policy, and procedure development for claims payment.
• Pioneered the use of new V codes to be utilized for new technology. Her work is documented in the Federal Register.
• Instrumental in developing recommendations published by HCFA regarding the Physician Query Process.
• Is published regularly in the AdHIMA newsletter, with her own "Kelley’s Korner".

Prior to joining NWI, Ms. Lawson worked for Blue Shield of Northeastern New York for six years. While at Blue Shield, she held positions including DRG Analyst, DRG Coordinator, and Technical Analyst for Claims Operations and Member Services. Previously, she held positions as Data Quality Technician at the Hospital Association of New York State (HANYS) and as Medical Record Director with the Slocum Dickson Medical Group. Her coding certifications include RHIT (Registered Health Information Technician); Certified Coding Specialist (CCS), and Certified Professional Coder Hospital (CPC-H). She founded and was the first President of the Procedural Coders of Albany, New York (affiliated with the American Academy of Professional Coders-AAPC). She received her education at Mohawk Valley Community College and the State University of New York at Cortland.