Emily S. Petersen is an associate director for the Healthcare Disputes, Compliance and Investigation practice. She has more than 20 years of experience in acute clinical care and professional management and is proficient in the use and promotion of quality-oriented documentation review practices, in accord with nationally recognized regulatory and governmental guidelines.
Emily has been instrumental in providing consultative clinical services attorney-mediated medical record reviews in fraud and abuse investigations as part of a multidisciplinary team. She has conducted long-term reviews for acute-care facilities under a Corporate Integrity Agreement from the OIG. She has participated in meetings with the Department of Justice on behalf of clients being investigated under the False Claims Act and assisted counsel in the preparation and delivery of voluntary disclosures and refunds to the government. Additionally, she has worked with facilities to improve controls and reporting to state Medicaid and Medicare agencies and instituting workflows ensuring future compliance.
Emily is highly skilled in assessment, measurement, and diagnosis of healthcare business needs and creating solutions to enhance productivity and market parity. She is experienced in reviewing and analyzing medical records, and identifying opportunities to improve the quality of physician documentation, optimize potential reimbursement, and maintain privacy and confidentiality. Ms. Petersen is certified in Healthcare Research Compliance (CHRC) by the HCCA and has assisted in the management of internal research misconduct investigations in partnership with internal and external counsel.
The types of matters Emily has been involved with include: long term acute care lengths of stay (LTAC), medical necessity reviews of internal cardioverter defibrillators (ICDs) and PTCA/stents, one-day stays, skilled nursing, adult and geriatric psychiatry, due diligence reviews, concurrent surgery reviews and the off-label promotion of drugs. She is adept in the use of Inter Qual and Milliman Care Guidelines.
Emily is also a certified risk adjustment coder (CRC) with expertise in reviewing medical records and assigning accurate medical codes for services provided by physicians and other healthcare providers in the office or facility setting. She has worked with large Medicare Advantage plans and provider groups in conducting internal audits as well as recently. Emily has a strong understanding of RADV, the audit process for risk adjustment models and determining correct HCC assignment. Additionally, she has successfully identified and communicated documentation deficiencies to providers in order to identify opportunities to improve documentation for accurate risk adjustment coding.
Emily's background in critical care nursing includes participation in staff development and training at hospitals affiliated with Yale University School of Medicine and Harvard Medical School. She engaged in primary nursing for major surgery, chronic medical, hospice and multiple trauma patients while assisting medical and surgical staff during invasive procedures.
Prior to Navigant, Emily was at a Fortune 200 HMO coordinating inpatient, outpatient, home health, ambulance transport and hospice benefits for both Medicare and Commercial members as a regional manager of Utilization Review. She was a certified Inter Qual™ Instructor, and had responsibility for all training of regional medical management clinicians in the principles of medical necessity and utilization review criteria.