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Skills

  • Claims Processing
  • Financial records review
  • Cost savings options
  • Forecasting
  • Data-driven decision making
  • Process improvement
  • Customer service
  • Root cause analysis
  • Problem resolution
  • Project organization

Work Experiences

  • Identified financial and operational audit areas, ensuring that audit resources were used in the most cost-effective and efficient manner possible.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Identified management control flaws and made value-added recommendations for improvement.
  • Completed recovery over 12 months.
  • Achieved 61% efficiency improvements.
  • Achieved 7 in revenue recovery.
  • Audited patient records and coding documentation, reducing claim rejection rates by $12 annually.
  • Collaborated with Salesforce vendors.
  • Advised on payer contract negotiations after identifying underpayments, securing an additional $7 in reimbursements over 11 quarters.
  • Collaborated with CPA team to design and implement audit programs, reducing coding errors by 62%.

Summaries

  • Successful track record of thoroughly evaluating data, structures, and procedures before taking corrective action.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Analytical Medical Auditor focusing on improving regulatory compliance and capturing revenue opportunities, driving billing accuracy improvements of up to 55%.
  • Achieved a 76% increase in audit compliance rates.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Working with private, public, and state government clients is a breeze.
  • Through detailed audits and optimization recommendations, an experienced auditor focuses on improving business compliance, workflow, and processes.
  • Excellent problem-solving and teamwork skills.
  • Collaborative professional with a focus on revenue cycle optimization, having led audit adjustments that recovered $17 while improving compliance adherence by 46%.
  • Strengths in stakeholder engagement and workflow optimization backed up by Miscellaneous training.

Accomplishments

  • Resolved product issue through consumer testing.
  • Transitioned customer success to ICD-10 billing protocol, reducing claims rejections by 27% in the first 8 months.
  • Enhanced reporting accuracy by migrating to an automated auditing system, reducing manual errors by 42%.
  • 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.
  • Supported department leadership with coding policy adjustments, ensuring auditors remained up to date with CMS regulation changes.
  • Managed annual audits for surgical procedures, identifying $129,000 in under-billed services and ensuring accurate reimbursements.
  • Worked with cross-functional teams to ensure that audit remediation tasks were completed within 15 days of report issuance.
  • Trained and mentored a team of 2 junior auditors, standardizing audit procedures and enhancing overall compliance accuracy by 59%.
  • Presented detailed audit reports to senior leadership, identifying and addressing compliance risks across 3 healthcare facilities.

Affiliations

  • Certified Risk Adjustment Coder (CRC), 2021 Certification Completion
  • Institute of Internal Auditors (IIA), Workshop Leader on Regulatory Compliance Auditing
  • Project Management Institute
  • American Health Information Management Association (AHIMA), ITIL Certification Holder
  • Association of Healthcare Internal Auditors (AHIA), State Chapter Representative
  • American Association of Medical Audit Specialists, Past President of 2016
  • Association of Information Technology Professionals
  • Healthcare Compliance Association (HCCA), Annual Conference Attendee
  • Freemason
  • Medical Group Management Association (MGMA), Regular Participant in Audit-Focused Webinars

Certifications

  • Certified Revenue Cycle Specialist (CRCS) - AAHAM
  • Registered Health Information Technician (RHIT) - AHIMA
  • Electronic Health Record Specialist Certification (CEHRS) - metric
  • Compliance and Ethics Professional (CCEP) - SCCE
  • Certificate in Risk Adjustment Coding (CRC) - AAPC
  • Certified Public Accountant (CPA)
  • Certified Healthcare Auditor (CHA) - AAHAM
  • Medical Auditing and Compliance Certification - AAPC
  • CompTIA A+ Technician
  • Cisco Certified Network Associate (CCNA)

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