Brenda Watson, MLS, RHIA, CCS, CCS-P, CPC, CRC, CPMA, AHIMA-Approved ICD-10-CM/PCS Trainer, AAPC Approved Instructor, Senior Program Manager

Brenda Watson, MLS, RHIA, CCS, CCS-P, CPC, CRC, CPMA, AHIMA-Approved ICD-10-CM/PCS Trainer, AAPC Approved Instructor, Senior Program Manager

Sr. Program Manager
Advanta Government Services, LLC

Professional Summary

Ms. Watson has over 20 years of healthcare consulting experience. She currently serves as a Senior Program Manager at AGS, LLC, responsible for managing projects in support of state and federal programs; the development and implementation of compliance, coding, and billing audits for affiliate customers with multiple locations nationwide; and the development and implementation of training programs for affiliate internal staff and external students. She has over 20 years of experience in CPT and ICD-9-CM coding for diagnosis and procedures and over eight years of experience in ICD-10-CM/PCS coding. She has been an approved trainer since 2015.


Certifications

  • Registered Health Information Administrator (RHIA) – current through 12/31/2024
  • Certified Coding Specialist (CCS) and CCS-Physician (CCS-P) – current through 12/31/2024
  • Certified Risk Adjustment Coder (CRC) – current through 12/31/2024
  • Certified Professional Medical Auditor (CPMA) – current through 12/31/2024
  • Certified Professional Coder (CPC) – current through 12/31/2024
  • American Health Information Management Association (AHIMA) Approved ICD-10 Trainer – current through 12/31/2024.
  • American Academy of Professional Coders (AAPC) Approved Instructor – current through 12/31/2024.

Technical Proficiencies

  • Evaluation and Management Services Audits; validation audits in HCC risk coding, APR DRG, MSDRG, and Health Information legislative and regulatory policy review expert
  • Due diligence, investigation, and litigation reviews
  • Implementation of Compliance Audits and Program Development & Management
  • Training on Clinical Documentation, ICD-10-CM & PCS Coding, and Revenue Integrity
  • CPT/HCPCS/ICD-9-CM/ICD-10-CM/PCS/APR DRG/DRG/HCC/Case-mix auditing and education

Qualifications and Experience

Advanta Government Services, LLC (and formerly its parent company Advanta Medical Solutions, LLC), Annapolis Junction, MD, Senior Program Manager, 2017 – Present

Duties

    • Program Manager for the HSCRC Inpatient Outpatient Data Abstract Review contract
    • Subject matter expert for content review of ICD-10 CM and ICD-10 PCS modules
    • Engagement Manager for contracts involving disputes, investigations, and due diligence
    • Expert Trainer for internal CPC preparation study group and mentor for apprentices participating in AHIMA’s Apprenticeship Program
    • Advisor for the customization of software tools used in data validation and compliance review contracts

Accomplishments

    • Designed and developed multiple, comprehensive training modules for a unique online program

Berkeley Research Group, Senior Managing Consultant, 2012 – 2017

Duties

    • Analyzed client data to determine HCC risk coding validation and completed audits that focused on Maryland Hospital-acquired conditions to improve the accuracy of facilities for state quality ranking
    • Performed risk adjustment and HCC validation audits to improve quality documentation
    • Performed due diligence and litigation reviews, including professional fee and laboratory audits
    • Led internal coding quality and education programs

Accomplishments

    • Orchestrated ICD-10-CM/PCS provider training and provider audits focused on evaluation and management of cardiology, pathology, and laboratory

Navigant, Senior Managing Consultant, 2009 – 2012

Duties

    • Performed APR DRG audits and developed coding training materials
    • Completed documentation audits, coding analyses, and educational seminars for appropriate reimbursement

ACE Auditing and Coding Experts, Auditor, 2006 – 2008

Duties

    • Performed APR DRG audits and provider audits for multi-specialty faculty
    • Conducted provider training and education for coding quality
    • Completed documentation audits, coding analyses, and educational seminars for providers focused on documentation improvement for appropriate reimbursement.

Practice Dynamics, Director of Compliance and Reimbursement, 1998 – 2006

Duties

    • Developed an ICD-9-CM program to improve coding accuracy, compliance with Medicare Regulations, and reduce claim rejections.
    • Led a compliance team that conducted documentation audits, performed coding analyses
    • Designed and delivered ICD-9-CM coding training programs focusing on diagnosis and procedure services
    • Implemented a Provider Practice Plan Compliance Program

Education

  • Masters Legal Services in Healthcare Law, University of Oklahoma, Norman, OK, 2022
  • Bachelor of Science, Health Information Management, York College of Pennsylvania, York, PA, 1988

Professional Associations

  • AAPC, Member
  • AHIMA, Member, Membership advisory task force 2023, Council on Education Excellence, 2021, Program Committee Member, 2020 -2021, Clinical Coding Program Committee, 2018 – 2020
  • American Institute of Healthcare Compliance, Member
  • MdHIMA, Member, President, 2021 – 2022, President-Elect, 2020 – 2021, Delegate 2023-2025, Data Quality Chairperson, 2015 – Present, Distinguished Member of the Year, 2020 – 2021, Advocacy Co-Chairperson, 2021-Present
  • MdMGMA, Member
  • NAMAS, Member

Presentations/Speaking Engagements/Volunteer

  • Compliance Today May 2023 Co-author PERM Pearls article
  • HSCRC Quarterly Data Forum Contributor
  • MDHIMA Distinguished Member Award 2019-2020 & 2023-2024
  • AHIMA National Conference 2016 – Overview of HCCs
  • AHIMA Whitepaper SDoH Contributor
  • MdHIMA Speaking Engagements: ICD-11 NCHIMA & MdHIMA (2022-2023), MDHIMA & MDACDIS December 22 Query Updates (June2023), COVID-19 Co-Presenter, Clinical Terminology Expanding Career Pathways for Health Information Professionals (Oct 2020), Panel Member, Outpatient Coding Pitfalls, PCS Approaches (Dec 2017), ICD-10 CM Changes Update (Sept 2017), CPT Changes 2017 Overview (Dec 2016)
  • Ingenix Symposium, Claims Manager Product Implementation with A Focus on Customized Reporting
  • Decision Health Co-Speaker on Establishing Provider Budgets using Gross Collection Rates (GCR)