Mollie A. Day-Hughes
Springfield
Summary
Experienced in charge master management, claim edit resolution, and cross-functional collaboration, with expertise in healthcare systems and data analytics tools. Skilled in developing compliant policies and procedures for revenue integrity, and proficient in ICD-10 coding and EHR systems. Seeking to leverage extensive analytical skills as a Sr. Charge Accuracy Analyst.
Experienced analyst prepared for this role with strong focus on data interpretation, financial modeling, and strategic planning. Known for collaboration and delivering results, adaptable to changing needs, and reliable. Skilled in data visualization, problem-solving, and stakeholder communication. Employers value analytical mindset, teamwork, and consistent performance.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Sr. Charge Accuracy Analyst
Vanderbilt
Nashville, TN
02.2021 - Current
- Charge Master Management: Updating, maintaining, and auditing the Charge Description Master (CDM) for accurate codes, descriptions, and pricing.
- Edit Resolution: Analyzing and resolving complex claim edits (NCCI, MUE) using coding rules, billing guidelines, and patient documentation.
- Auditing & Reconciliation: Conducting internal audits of charges against clinical records to ensure accuracy and compliance.
- Process Improvement: Identifying trends, proposing solutions, creating training materials, and educating departments on charge capture and coding.
- Cross-functional Collaboration: Working with coding, compliance, IT, revenue cycle, and clinical staff to resolve discrepancies and improve workflows.
- Data Analysis: Using SQL, Power BI, or Tableau to create dashboards, monitor payment accuracy, and provide insights.
- System Expertise: Serving as a subject matter expert for EHR systems (like Epic) and billing software.
Revenue Integrity Specialist/ED Educator
Trinity Medical Center
Iowa, WA
04.2023 - 02.2026
- Reviewed patient accounts for accurate charge capture, timely filing of claims, and appropriate reimbursement.
- Monitored trends in denials management activities through the development of reports utilizing data analytics software tools.
- Created policies and procedures related to revenue integrity that are compliant with applicable laws and regulations.
- Collaborated with clinical staff to streamline coding processes, enhancing workflow efficiency.
- Developed and maintained coding standards ensuring compliance with healthcare regulations.
- Mentored junior coders on best practices and updates in coding guidelines.
- Facilitated knowledge sharing within the team by conducting regular code reviews, training sessions, and workshops on relevant topics.
Claims Auditor Appeals- Compliance Auditor/ED
Well-path
US
08.2018 - 04.2023
- Performs audit of claims received because of out of facility services with the highest degree of accuracy and timeliness.
- Confirms correctness of claim amounts, eligibility, and events resulting in the claims.
- Understands and references CCS provider contracts, leased network contracts, and other relevant artifacts as they relate to claims audit and appeals.
- Claims Appeals functions including claims audits, high dollar review, contract compliance, and response narratives.
- Obtains samples and audits the use of the most up to date provider contracts, fee tables, and other reference data used in the claims processing functions.
- Reports and tracks audit findings, summarizes problem areas, and identifies potential solutions, remedies, and controls.
- Critical thinking to a variety of practical and emergent situations and accurately follow-standardized procedures that may call for deviations.
- Identifies aberrant patterns of billing and detects potential abuse through paid claims data analysis.
- Performs ancillary audits on claims for correct payment.
- Clears the CCI edits for ancillary and radiology coding.
- Utilizing Encoder Pro.
- Anesthesia Coding.
- Inpatient coding.
- Contracting negotiating.
- Remote-based
- Developed and implemented engaging lesson plans to enhance student learning experiences.
- Collaborated with colleagues to design curriculum aligned with educational standards and best practices.
ED Coder/Compliance Auditor/HCC Auditor
Central Iowa Hospital
US
07.2015 - 08.2018
- Responsible for accurately abstracting and appending ICD-9, CPT, and HCPCS for ED charts.
- Cleared edits from EPIC for each ED chart coded.
- Responsible for meeting deadlines in a productivity-based environment.
- Coded E/M, I&I, I&D for Emergency Dept. (ED).
- Ancillary Coder.
- Radiology Coder.
- REMOTE-BASED, INPATIENT CODING
Education
AAS-RHIT -
Volunteer community college
CPC-AAPC - undefined
CRCR - undefined
HFMA
CSPR - undefined
HFMA
Skills
- Microsoft Office: Word
- Microsoft Office: Excel
- Microsoft Office: PowerPoint
- Microsoft Office: Publisher
- Microsoft Office: Outlook
- Microsoft Office: Visio
- Operating System Environments: Windows NT
- Operating System Environments: Windows XP
- Healthcare Related System/Skills: ICD-9/CPT Coding
- Healthcare Related System/Skills: E-Clinical
- Healthcare Related System/Skills: Medisoft
- Healthcare Related System/Skills: IDX
- Healthcare Related System/Skills: Epic
- Healthcare Related System/Skills: Cerner
- Healthcare Related System/Skills: 1CD-10 CERTIFIED
- Healthcare Related System/Skills: Power Chart
- Healthcare Related System/Skills: Mysis
- Healthcare Related System/Skills: Negotiated Contracting
- Analytical thinking
- Time management
Certification
- 245375
- 00050026
TECHNICAL KNOWLEDGE AND SKILLS
Word, Excel, PowerPoint, Publisher, Outlook, Visio, Windows NT, Windows XP, ICD-9/CPT Coding, E-Clinical, Medisoft, IDX, Epic, Cerner, Power Chart, Mysis, Negotiated Contracting
Timeline
Revenue Integrity Specialist/ED Educator
Trinity Medical Center
04.2023 - 02.2026
Sr. Charge Accuracy Analyst
Vanderbilt
02.2021 - Current
Claims Auditor Appeals- Compliance Auditor/ED
Well-path
08.2018 - 04.2023
ED Coder/Compliance Auditor/HCC Auditor
Central Iowa Hospital
07.2015 - 08.2018
CPC-AAPC - undefined
CRCR - undefined
HFMA
CSPR - undefined
HFMA
AAS-RHIT -
Volunteer community college