Donna Malone, CPC, CRC,CRC-I, AAPC Approved Instructor

Managing Consultant
717.556.1088
280 Granite Run Drive, Suite 310
Lancaster, PA 17601

A leading healthcare reimbursement consultant, Donna uses her expertise to help improve coding team performance and develop proactive approaches to policies, procedures, audits and coding review management. She has significant experience developing a range of risk adjustment provider education and support materials including simulating RADV audits to increase preparedness for CMS RADV, professional development and knowledge sharing, and best practices to maintain a strong understanding of ICD-9/ICD 10 coding rules, guidelines and ICD-10 preparedness. She assists clients with talent management efforts to hire, train and coach certified coders and provider educators.

Donna’s professional experience includes positions as Director, Ambulatory Clinical Documentation Quality Improvement (CDQI) at Mount Sinai Health Systems, as well as Director, Enterprise Risk Adjustment Coding and Provider Education at Tufts Health Plan, where she led Tufts’ Risk Adjustment, HCC Coding, Quality Assurance and Provider Education program, and served as Risk Adjustment Quality Assurance and Audit Supervisor. She also worked as Director of Ambulatory CDI – Risk Adjustment for Enjoin, a healthcare documentation and analytics company. Prior to that, she served as an HCC auditor for Blue Cross Blue Shield of Massachusetts, and the Director of Administration for AM B Care.

A dynamic and in-demand national speaker on reimbursement related matters, Donna regularly appears at national conferences for RISE, AAPC and AHIMA, and serves as Chair of RISE’s Risk Adjustment Academy HCC Coding Faculty Advisory Group. She also teaches medical coding and medical office administration courses and is a student advisor at Massachusetts Bay Community College.

  • Clark University
    • Master Certificate Medical Coding and Billing
  • Certified Professional Coder (CPC)
  • Certified Risk Adjustment Coder (CRC, CRC-l)
  • Advanced HCC Auditor (AHCCA)
  • Risk Adjustment Practitioner (RAP)