Meet the Sherlock Holmes of solving claim errors: Northwell Health’s Anthony McCallum
Give him a mystery.
Northwell Health’s own Anthony McCallum, CPC-I, CIRCC, CPC, CCS received the 2018 Omar Brito Life Achievement Award from the Roxbury Institute for Medical Management in recognition of his extraordinary personal and professional achievements. Here’s how he got here.
Anthony pursued coding over twenty years ago, starting with the CPC credential. He worked as a coder and coding consultant and then joined the Revenue Integrity Operations (RIO) team with Northwell Health in 2005 as an Outpatient Revenue Coding Specialist. “After a few years into my coding career and having worked for many years as a patient access representative, I was looking to return to a part-time position at Northwell,” Anthony said. “During the application process, the hiring manager picked up on my revenue cycle experience and felt I would be a good fit for RIO. From there I was interviewed, tested and ultimately offered the greatest opportunity of my life.”
While in RIO, he received three additional prestigious coding certifications, a B.S. degree in Health Care Management and an M.B.A. in Health Administration. “Northwell has provided a platform in which I have been able to advance. There is so much growth in this field and Northwell has provided an environment which encourages that growth. This has had a direct and positive impact on my career and job satisfaction.”
So what is the revenue cycle? According to Anthony, Revenue Cycle includes clinical and administrative functions which contribute to the capture, management, and collection of patient service revenue. RIO has the rare opportunity and skill of analyzing claims in their entirety and assuring that the medical record documentation supports every line item on that claim appropriately. The comprehensive analysis of claims and medical record documentation in conjunction with knowledge of charge capture processes allows RIO to identify the root causes of claim errors. Claim errors can be due to an array of issues; coding, charging, documentation, registration, and software application failures to name a few. RIO directs claims correction and works with the appropriate departments in an effort to mitigate future errors. Anthony feels like “in a sense, we are the Sherlock Holmes of solving claim error mysteries.”
Anthony is dedicated to providing continuous coding education with integrity and intelligence, and his contributions have also been recognized by the health information management community. “I was approached by Frank Chisena, the president of the Roxbury Institute for Medical Management; he explained that the award was given to prior students deemed to have excelled in the profession and he wanted to present me with the 2018 award due to my advancement in healthcare revenue cycle.”
Anthony’s greatest award is a rewarding career. “RIO is constantly seeking innovative ways to improve the organization’s bottom line is the most rewarding aspect of my job,” Anthony said. “It is particularly rewarding when RIO has identified additional revenue opportunities while mitigating claim errors and compliance concerns. It is gratifying to know that our work directly impacts the financial health of the organization, enabling Northwell to fulfill its mission.”
Find a career like Anthony’s at Northwell Health! Learn more about our open revenue cycle positions here.
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If you are an individual with a disability requesting an accommodation for the application process, please click the contact us link above to request assistance.
Learn more about our hiring experience.
Read answers to common questions about the application process.
© 2021 - Northwell Health
Click here to view the “EEO is the law” poster.
It is Northwell Health’s policy to provide equal employment opportunity and treat all applicants and employees equally regardless of their age, race, creed/religion, color, national origin, immigration status or citizenship status, sexual orientation, military or veteran status, sex/gender, gender identity, gender expression, disability, pregnancy, genetic information or genetic predisposition or carrier status, marital or familial status, partnership status, victim of domestic violence, sexual or other reproductive health decisions, or other characteristics protected by applicable law.
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Congratulations, Anthony! Great job. What do you suggest for someone who has an MBA in Finance and a BS in Accounting and would like to learn medical billing and coding. Do you have any suggestion?