Pam has 40 years in the healthcare industry with more than 20 years of experience managing of risk adjustment, claims, and coding. She has extensive expertise in all aspects of coding in different settings and is well versed in the complexity and processes for conducting CMS national and contract-level RADV audits as well as commercial RADV audits involving training, chart reviews, submissions, and CMS disputes.
Pam’s years of risk adjustment experience while working for a health plan include managing and supervising all risk adjustment activities for retrospective and prospective chart reviews, coding, analytics, and reporting. She also monitored and implemented coding strategies to mitigate risks for MA and commercial RADV audits. In additional to her plan experience, Pam served as the Director of DRGs for a Medicare Peer Review Organization in which she managed state-wide inpatient PPS chart reviews and also developed and conducted coding workshops.
Pam has a BA in Health Information Administration and holds the credentials of RHIA, CCS, CPC, and CRC.