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Skills

  • Project organization
  • Continuous Quality Improvement
  • Workflow Optimization
  • Claims Processing
  • Closing processes
  • Audit compliance training
  • Risk mitigation strategies
  • Effective communication
  • Organization
  • Financial records review

Work Experiences

  • Audited patient records.
  • Achieved 7 in revenue recovery.
  • Advised on payer contract negotiations.
  • Contributed to savings of $4.
  • Conducted in-depth medical audit reviews across 13 hospitals.
  • Achieved results over 8 quarters.
  • Achieved the highest possible compliance rating in 2022.
  • Achieved results within system.
  • Audited patient records and coding documentation, reducing claim rejection rates by $12 annually.
  • Conducted specialized audit projects focusing on Jira, discovering over $14 in lost revenue annually.

Summaries

  • Achieved coding accuracy improvements of 81% across departments.
  • Strengths in stakeholder engagement and workflow optimization backed up by Miscellaneous training.
  • Collaborated with CPA teams.
  • Addressed documentation and billing issues.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Achieved reductions in billing errors by 47%.
  • Medical Auditor is a multi-talented Medical Auditor who is consistently rewarded for planning and operational improvements.
  • Adept at identifying coding discrepancies.
  • Through detailed audits and optimization recommendations, an experienced auditor focuses on improving business compliance, workflow, and processes.
  • Advanced knowledge of Adobe Creative Suite.

Accomplishments

  • Co-led the transition to an advanced electronic medical record system, improving coding specificity and reducing denials by 70% %.
  • Trained and mentored a team of 2 junior auditors, standardizing audit procedures and enhancing overall compliance accuracy by 59%.
  • Monitored key performance indicators (KPIs) post-audit, driving a reduction in claim denials by 15% across the healthcare network.
  • Managed annual audits for surgical procedures, identifying $129,000 in under-billed services and ensuring accurate reimbursements.
  • Documented and resolved procedure which led to standard.
  • Collaborated with customer success and implemented a new audit process, increasing efficiency by 3 hours per audit cycle.
  • Optimized the audit workflow for outpatient clinics, improving claim submission timelines by 31% and reducing denial rates.
  • Developed and executed an audit strategy for marketing, which improved audit completion time by 16 days.
  • Worked with cross-functional teams to ensure that audit remediation tasks were completed within 15 days of report issuance.
  • Examined and corrected errors in high-risk areas, such as budget management, leading to $3 in recovered claims annually.

Affiliations

  • National Healthcare Anti-Fraud Association (NHCAA), Instructor on Medical Audit Best Practices
  • Freemason
  • Association of Information Technology Professionals
  • Institute of Internal Auditors (IIA), Workshop Leader on Regulatory Compliance Auditing
  • National Association of Social Workers
  • Jaycees
  • Association of Fraud Examiners (ACFE), Focused on Healthcare Fraud Detection
  • Toastmasters
  • American Institute of Certified Public Accountants (AICPA) - Healthcare Committee Member
  • Association for Healthcare Documentation Integrity (AHDI), Coordinator of Compliance Programs

Certifications

  • Certificate in Risk Adjustment Coding (CRC) - AAPC
  • Certified Professional Medical Auditor (CPMA) - AAPC
  • Certified Documentation Improvement Practitioner (CDIP) - process
  • CompTIA Security+
  • Electronic Health Record Specialist Certification (CEHRS) - metric
  • Salesforce
  • Auditing for Compliance and Risk Professionals (ACRP) Certification - HCCA
  • Certified Public Accountant
  • ServSafe
  • Certified Healthcare Auditor (CHA) - AAHAM

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