Akram A.

Clinical Documentation Integrity Specialist @ SOUTHERN CALIFORNIA HOSPITAL AT CULVER CITY

About

I am an internal medicine physician that practiced medicine for 5 years and a certified clinical documentation specialist with 4 years experience in clinical documentation improvement, including but not limited to concurrent medical records review to ensure meeting guidelines for IP admissions and assigning the highest possible and most appropriate DRG, querying physicians when needed, physician education, retrospective medical records review for ensuring documentation integrity, submitting retrospective appeals for IP admission/DRG downgrade denials, physicians education, legal screening, peer to peer discussion, case management, and training new hires.I have a proven record of generating significant merit increases through both concurrent and retrospective review.I am CCDS certified.

Country

United States

City

Los Angeles Metropolitan Area

Industry

Hospital & Health Care

Skill

Medicare, Health Insurance, Managed Care, Provider Relations, Healthcare, Workers Compensation, Medicaid, Utilization Management, Claim, Insurance, Healthcare Management, Hospitals, HIPAA, Credentialing, Healthcare Industry, Claims Management, Healthcare Information Technology, PPO, Medical Billing, Network Development

Experience

Clinical Documentation Integrity Specialist

SOUTHERN CALIFORNIA HOSPITAL AT CULVER CITY

2017-6 - Present · 9 yrs 4 mos

Los Angeles Metropolitan Area

• Reviewed concurrent admissions daily to ensure accuracy of physicians' documentation as compared to the Medicare approved verbiage with querying physicians when needed • Ensured IP admissions meet MCG/IQ guidelines for concurrent admissions and appealed denied accounts for IP admission with an overturn rate around 75% • Appealed DRG downgrade denials with high overturn rate up to 70% for denied diagnoses and procedures, including coding and clinical validation • Assisted CM to decrease denial rate for IP admissions by 50% by reviewing new admissions in a timely manner followed by communicating findings with physicians to ensure choosing proper level of care .• Worked closely with management on providing physician education to improve diagnoses capture,enhance evidence based clinical documentation, improve clinical documentation to comply with universally recognized diagnoses criteria, and decrease denial rate

Primary Physician

Community and Private Hospitals

2011-5 - 2016-1 · 4 yrs 9 mos

Cairo, Egypt

- Worked as a primary care provider in governmental and commercial facilities - Provided medical services, including but not limited to emergency care, minor surgical procedures, primary medical care, and general practice

Education

Ain Shams University

Medicine

2002 - 2009 · 7 yrs

I was a student in the medical school of Ain shams university where I went through clinical and basic sciences course to get the Bachelor Degree in Medicine and Surgery