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Skills

  • Time management
  • Discrepancy reporting
  • Knowledgeable in QuickBooks
  • External audit preparation
  • First Aid/CPR
  • Administrative support
  • Excel pivot tables for case tracking
  • Organization
  • Dashboard Development using SAP
  • Root cause analysis

Work Experiences

  • Addressed patient concerns.
  • Awarded in 2018.
  • Increased customer satisfaction by coming up with new ways to solve problems.
  • Addressed care and billing concerns.
  • Collaborated with marketing and quality control to ensure patient care plans aligned with hospital policies and state regulations.
  • Audited over 8 patient care files weekly.
  • Assisted the legal team in preparing documentation for court cases involving patient care malpractice, leading to favorable outcomes.
  • Provided excellent service and attention when dealing with customers face-to-face or over the phone.
  • Analyzed and interpreted aftercare documentation, ensuring smooth billing for procedures and reducing delay-related penalties by $15.
  • Addressed prolonged care costs.

Summaries

  • Strategic thinker with expertise in risk assessment.
  • Hospital Care Investigator is a hardworking and dependable Hospital Care Investigator who excels at project management and budget management.
  • Metric, initiative, and metric are all available.
  • Achieved a 47% increase in team performance.
  • Achieved 36% faster dispute resolution.
  • Knowledge of ServiceNow in depth, as well as project management and process improvement abilities.
  • Results-oriented Miscellaneous professional with client relations, team leadership, and budget management strengths.
  • Achieved 47% fewer formal patient grievances in 2017.
  • Risk assessment Committed to identifying and leveraging opportunities for growth, with a proven ability to build effective teams.
  • Collaborated with cross-functional teams.

Accomplishments

  • Proactively identified and corrected audit issues prior to federal review, avoiding potential penalties or loss of reimbursement totaling $224,000.
  • Interviewed key healthcare staff and patients to gather critical evidence used in the successful resolution of 16 hospital care disputes.
  • Proactively collaborated with human resources to draft new guidelines for handling patient billing disputes, which were later adopted system-wide.
  • Devised and implemented a new case tracking system that reduced lost case files by 20% and ensured faster resolution times.
  • Led a multi-disciplinary team in auditing healthcare provider compliance, achieving 76% adherence to federal and industry standards.
  • Led the training of a new team of investigators, achieving 6% investigation accuracy within the first 13 months of implementation.
  • Reduced the average billing dispute investigation time by 18 months through the introduction of automation, increasing case resolution output by 72%.
  • Managed external audits and liaised with regulatory bodies, ensuring full compliance with Medicare and Medicaid guidelines and avoiding any financial penalties.
  • Created advanced reporting dashboards using Asana, giving better insights into key financial discrepancies and reducing investigation time by 43%.
  • Completed initiative to enhance knowledge in fraud detection methodologies and assisted in the prevention of $88,000 in improper payouts.

Affiliations

  • Member of the Association for Clinical Risk Management (ACRM), focusing on patient safety and healthcare case resolution techniques.
  • Completion of advanced training from the American Institute of Healthcare Compliance (AIHC) in clinical audit and quality control.
  • Active contributor to Quality and Safety Programs under The Joint Commission in 2020, working to develop multi-departmental strategies for enhancing patient care records.
  • Certification from the Healthcare Financial Management Association (HFMA) in Patient Billing and Revenue Cycle Management, completed in 2016.
  • Participant, 2016 Medical Billing and Coding Summit, sharing industry insights on streamlining aftercare documentation.
  • Certified Professional Coder (CPC) through the AAPC, specializing in coding accuracy for healthcare claims and investigations.
  • Initiative Lead, process, organizing hospital-wide root cause analysis projects aimed at error reduction in patient documentation.
  • Registered volunteer reviewer with the Hospital Quality Institute, focusing on accurate care documentation and compliance with regulatory standards.
  • Member, Compliance Certification Board (CCB), contributing to ongoing education in hospital policy adherence and fraud prevention.
  • Attendee, 2015 Medicare and Medicaid Billing Workshop, discussing regulatory compliance in healthcare payment investigations.

Certifications

  • Certified Business Analysis Professional (CBAP)
  • Certified Fraud Examiner (CFE) – Healthcare
  • Registered Health Information Administrator (RHIA)
  • Cisco Certified Network Associate (CCNA)
  • Healthcare Risk Management (HCRM) Certification
  • Certified Professional in Patient Safety (CPPS)
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Health Data Analyst (CHDA)
  • SHRM Certified Professional (SHRM-CP)
  • Certified Professional Coder (CPC)

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