What You Need to Know About Claim Denials
Let’s Get in Touch
We’re here to help. With people, process, and technology to support your business.
Tune in to our podcast, 'What You Need to Know About Claim Denials,' with guest speakers Kelly Walton, Executive Directors of HealthCare Operations, and Josh Holland, Vice President, - from ComforceHealth, an Innova Solutions company. Get expert tips and tricks to help you get the coverage you deserve. Join our community of listeners taking charge of their insurance claims.
Quality Assurance Team Lead
As a DRG validator, Torey provided coder education, and interacted with physicians for clinical reviews. Torey’s experience writing appeals and working clinical & coding denials is one of her professional highlights. Torey is also a specialist in web-based appeal technology for forensic coding review and appeal response management for a myriad of health care entities.
Torey proudly holds an MBA from Webster University. She also proudly holds the AHIMA CCS and the AAPC CPC credentials. Torey is an AAPC Approved Coding Instructor and considers coder education a professional passion.
Senior Quality Assurance Auditor
Amber Chaploney, ABA, COC, CHONC, CPMA, CRC, is a Senior Quality Assurance Auditor, working in HIM for 13 years. She is proficient at Professional Fee, Surgery and Facility charge capture. Amber has worked directly with outpatient clinics, facilities, physicians, and surgeons educating on best practices, for auditing, coding, and billing compliance.
Amber has worked in various outpatient settings, coding and auditing for Emergency Department, Recurring Account services, Same Day Surgery, Observation and Professional Fee Services. She has extensive experience in coding and auditing for Hematology/Oncology and Radiation Oncology services working with large Cancer Treatment Facilities across the US, capturing data for research in cancer treatment and documentation compliance. As part of client services for a large Cancer Hospital, Amber trains new coders for Outpatient Facility services in Hematology and Oncology with specific coding Guidelines working with them until they code at a 95% or greater quality and productivity level.
Amber has recently received her CRC for Risk Adjustment Coding utilizing this in special projects for quality audits and Outpatient CDI. She has utilized this knowledge to assist Primary Care offices to properly document for capturing all HCC’s ensuring appropriate payments to facilities and providers.
Amber is passionate about HIM and educating and training other coders and is a member of the American Academy of Professional Coders (AAPC). She became interested in coding and billing after beginning her career as a Veterinary Technician working with large and small animals. She has owned and trained her own horses and loves her two Dachshunds. In her spare time, she loves to read, continues to make various needlepoint and crochet craft projects, and spends time every summer on her pontoon at the lake with her family.
Quality Assurance Team Lead
Cheryl has 12 years of HIM experience in the Professional Fee, Surgery, Facility and Revenue Cycle charge capture and reimbursement arenas. She is an expert in coding, auditing, education, including Outpatient CDI and risk adjustment coding. Cheryl worked directly with outpatient clinics for day-to-day operations with physicians and surgeons, revenue cycle process and implementation of suggestions for revenue enhancement. Prior to joining the ComforceHealth team, Cheryl worked with both onshore and offshore coding and auditing teams to ensure performance quality as a subject matter expertise. She developed professional fee denials management and appeal letters for new surgical interventions with a 96% reimbursement rate from third-party payors. She also created a series of webinar learning courses in evaluation and management, various HIM and surgical topics for internal and global clients. She has been involved directly with one-on-one coding and documentation education with physicians and other health care professionals.
Cheryl has been involved in the implementation of EPIC software and multiple-module(s) installation for specialty charge capture and revenue optimization. She is well versed in triage and problem solving for revenue cycle issues occurring with physicians and outpatient facilities in multiple States. She was been involved in training of physicians and other health care staff in the use of EPIC for documentation and charge capture functionality, adhering to interoperability and compliance guidelines.
Cheryl has a multi-faceted education, beginning by graduating from Henry Ford College in Paralegal Studies, working in medical malpractice and toxic tort litigation. She obtained her Bachelors’ Degree from the University of Michigan, graduating Cum Laude in Behavioral Science. She went on to return to school at Schoolcraft College, becoming President of the student HIT Club, winning multiple scholarships along with the Yvonne Harbert Achievement Award for student excellence. She obtained her Associate of Science Degree, gaining her certifications as a Registered Health Information Technician. Cheryl believes that continued education and knowledge are the keys to success. Therefore, Cheryl went on to obtain additional training and certifications as a Certified Professional Medical Auditor, Certified Documentation Expert for Outpatient Services and a Certified Risk Adjustment Coder. She is member of the American Health Information Management Association (AHIMA), the Michigan Health Information Association (MHIMA), Southeastern Michigan Health Information Management Association (SEMHIMA), the American Academy of Professional Coders (AAPC) and the National Association of Medical Auditing Specialists (NAMAS).
Quality Assurance Team Lead
Erin Cassady, RHIT, CCS is the Quality Assurance Team Lead at Comforcehealth. In this role, she is responsible for daily QA, education and training of new coding staff in addition to external audit and educational services
Erin has over 10 years of experience in the HIM profession with senior consulting and Inpatient subject matter expertise along with clinical documentation improvement, education, auditing, compliance and coding mentorship.
Erins professional highlights include having been instrumental in the training of newly graduated HIM professionals in a large hospital system. This included development of a tailored training program that allowed new professionals entering the field to quickly adapt and learn in their new roles. Erin also provided educational services to both CDI and coding staff in specialized areas including Mortality reviews, PSI/HAC reviews along with query validation. Erin was a Medical Coding and Billing Instructor at Lincoln College of Technology. Erin quickly discovered through her role as an instructor her love of education! While teaching, Erin received multiple recognitions from both teaching staff and students, being recognized by many students as being influential in starting their career paths whether it be in coding, medical assisting or nursing. Erin’s subject matter expertise spans both Inpatient and Outpatient facility coding having began as Observation Facility Coder.
Erin has an Associate degree in Health Information Management from Owens Community College along with her Registered Health Information Technician and Certified Coding Specialist certification. She is a member of AHIMA and Ohio Health Information Association (OHIMA). Erin believes in a strong educational foundation in coding and truly believes that anyone can become a successful coder with the right resources.
Inpatient Quality Assurance Auditor
Christina Jacobson, CCS is an IP QA Auditor with almost 10 years of coding and training experience. She has served on an ICD 10 implementation team which assisted facilities across the country in readying themselves for the ICD 10 transition. This included physician training and education. She has also served as an ICD 10 training manager. In this role, she was responsible for education and compliance training for 60+ beginner coders in anticipation for ICD 10. She, along with the education manager, created education power points, training modules and testing material to ensure a thorough understanding of the requirements needed to transition to coding in ICD 10. Her pass/success rate was 96%.
Christina has also worked with Medicare Audits, outpatient coding and auditing, medical records, insurance verification and hospital collections. She is well-rounded in all aspects of the HIM field.
As a coder, auditor, educator, and manager, her professional goal is making sure that coders have a firm understanding of coding principals and the resources needed to keep learning.
A passionate HIM professional, Christina is proud of her professional and academic accomplishments. She holds a Certificate of Completion in Medical Coding from an AHIMA-approved university and completed the AHIMA Train the Trainer program including attaining ICD 10 Trainer designation.
Outpatient/ONC Quality Assurance Auditor
Tina R. Smith, COC, CPC, CHONC-OP is an Oncology QA Auditor with over 12 years of outpatient coding & revenue cycle experience. Tina’s career in revenue cycle began as a Revenue Cycle Manager for a neurology practice and has since transitioned into coding quality assurance and revenue integrity. Tina’s concentration is oncology coding and education.
Tina is passionate about her role as a designated specialized ONC auditor at ComforceHealth. Her focused oncology expertise began while working 7 years on site at a large cancer center in Florida Having earned the specialty credential of Certified Hematology /Oncology Coder to supplement her CPC and COC core credentials is a professional highlight. Tina enjoys the oncology coding complexity because it gives her the opportunity to learn hands-on and extensively about Pathology & Laboratory, Radiology & Hematology in addition to Oncology alone. Tina’s professional expertise also includes Emergency Department, physician pro-fee and facility outpatient coding.
Tina holds the COC, CPC and CHONC from the AAPC and is currently enrolled in the certified medical auditor training course through AAPC and will sit for the CPMA exam in the summer of 2020.
Outpatient Quality Assurance Auditor
She has an extensive background in coding and auditing, as well as all phases of the reimbursement cycle. Additionally, she has worked with predictive analytics technology to perform pre and post bill auditing for several large hospital systems nationwide. She also has experience in commercial insurance, conducting DRG audits for payment recovery opportunities.
Her previous position was Outpatient Coding Manager for the University of Louisville Hospital; a teaching level 1 trauma facility. Other notable experience includes Corporate Compliance Coordinator for Baptist Health Kentucky and Surgical Coding Auditor for the Cleveland Clinic.
She has been a featured speaker at the Kentuckiana Chapter of the Association of Clinical Documentation Improvement Specialists (ACDIS) conference, educating nurses and other clinical professionals on coding changes and challenges.
Amy holds both an Associate and Baccalaureate degree from Bowling Green State University, located in her native state of Ohio. She is credentialed by both the AHIMA and HFMA; with an RHIT and CRCR, respectively.
Director of Healthcare Services
Kelly’s notable experience includes developing customized coding and physician education for healthcare systems nationwide and being a 3M 360 implementation subject matter expert. Kelly is also a seasoned speaker at local and state conferences, such as MEHIMA and AAPC Bangor, ME Chapter. For several terms, Kelly taught the coding curriculum as Adjunct Faculty Member at Beal College in Bangor, ME; her alma mater. Her passion for mentoring and educating the HIM community continues in her role at ComforceHealth. Kelly’s operating motto is “steel sharpens steel and we all stand to learn from each other.”
Kelly’s strong subject matter background began as an inpatient coder and since then has expanded to include professional billing, charge reconciliation, physician education and outpatient workflows. In addition, she has served as a valued member of ICD 10 implementation and revenue cycle committees.
A passionate HIM professional, Kelly is proud of her professional and academic accomplishments. Kelly holds an Associates of Applied Science degree in Health Information Management and holds the AHIMA RHIT and CCS credentials.
Vice President
Josh and his family live in Tampa, FL. During his free time, he can usually be found exploring the outdoors enjoying boating, fishing and camping.
Senior Clinical Documentation Improvement Services Consultant
Christina Perkins is a Senior Clinical Documentation Improvement Services Consultant at ComforceHealth. She is a dedicated revenue cycle professional with over 11 years of experience. During her career, Christina has had the unique opportunity to travel across the country as a senior consultant, curating her skills to include analyzing, implementing, and improving CDI departments at various healthcare facilities. Christina has experience across a wide range of facility types, from large teaching hospitals and university health systems to a multi-hospital heath system with critical access and community net facilities. She has significant experience in developing CDI departments from the ground up and re-vamping previously established departments to assess opportunities for clinical and financial improvements in DRG, SOI, and ROM.
Christina is also an expert in denials management, recovery audit review and appeals. She has successfully implemented and managed denials management teams and processes with exceptional results.
Prior to joining ComforceHealth, Christina flourished as a revenue cycle and coding leader by significantly improving DNFB totals and denial overturn rates. Christina has successfully engaged and earned the trust of healthcare professionals across the revenue cycle spectrum, including clinicians.
Christina’s experience allows her to offer wholistic, expert guidance with respect to the revenue cycle while understanding the unique challenges down to the facility level. Christina is passionate about continuing education and is a proud CDI professional.
Coding Operations Manager
As a Coding Operations Manager for ComforceHealth, Jeanette is responsible for the management and delivery of coding services for an assigned group of coding consultants and clients. Jeanette monitors coder productivity, quality , and all areas of consultant accountability to ensure the success of the business.
She interacts directly with the client, ensuring the success and growth of the project and collaborates with all areas of ComforceHealth to ensure successful and profitable client engagement.
Jeanette Thomas is an accomplished healthcare industry leader with 20 years of experience. Her background in Health Information Management includes clinical, facility, auditing, DRG Validation, educational services and management. She has also worked several years with the Revenue Cycle as a Manager of Patient Financial Services and Managing Quality and Training for the Revenue Cycle.
She has been an educator for 15 years, teaching in HIM programs as an Adjunct instructor for the RHIT Associate Degree program for CAHIM approved education institutes and the CCS certificate program.
Jeanette earned her Associates of Applied Science in HIM and her Bachelor of Science in Technical Management /Healthcare Administration from DeVry University.
She has served on committees with AAPC as Education Chair, GAHIMA as Membership Chair and Healthcare Financial Management Association on the Certified Patient Account Rep (CPAR) committee.
Director of Coding Operations
Donna Sherburne is the Director of Coding Operations here at ComforceHealth. In this role, she leads the Coding Department for the organization’s domestic and global workforce. Collaborating with our Global and Domestic leaders, she oversees the execution of meeting our clients coding needs by managing best practices while maintaining compliance, integrity, quality, and providing proven results.
Donna is a known industry leader and has over 17 years of Health Information Management (HIM) experience in facility and profee coding, including both inpatient and outpatient services. She focuses on providing our clients with solution-driven results by Managing Coding Volumes revenue cycle initiatives/issues including DNFB/DNFC, Coding Denials provides the coding team with her subject matter extensive experience in MS-DRGs, APR-DRGs, DRG Validation, ICD 10 CM/PCS and CPT code assignment, auditing, education and clinical documentation improvement (CDI). She has proven abilities to manage complex workloads and project management skill set.
Donna earned her Associates of Applied Science in HIM from Joliet Junior College, IL, where she graduated Magna Cum Laude. Prior to joining ComforceHealth, her continued passion for coding afforded her the opportunity to serve in various Managing roles leveraging her expertise to mentor new coders while identifying process improvement opportunities and partnering with executive teams to optimize operations and overall service delivery.
Group Vice President of ComforceHealth
As the Group Vice President for ComforceHealth, Melissa has ultimate responsibility for all operations for the organization. She also sets the strategic vision and direction for ComforceHealth, working towards achieving financial goals and objectives, and increasing operating performance.
Melissa has 12 years of dedicated experience serving middle revenue cycle. She is a results driven leader with a proven track record of exceeding revenue and bottom-line goals.
Prior to joining the ComforceHealth team, Melissa was the Vice President of Strategic Business Development at himagine solutions where her responsibilities included securing major new business and developing large, high-profile strategic accounts. Before himagine solutions, Melissa was a Regional Sales Vice President, Southeast, at Precyse.
Melissa holds a BA in Psychology from the University of South Florida and is a member of FHIMA, AHIMA, and HFMA.
( O ): 813.349.1771
( C ): 813.464.5710