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Skills

  • Claims processing accuracy
  • Procedure equipment
  • Audit planning and execution
  • Operations monitoring
  • Business operations
  • CMS compliance auditing tools
  • Relationship development
  • Supervision
  • Data Reporting and Visualization
  • Materials inspections

Work Experiences

  • Achieved a 37% decrease in error rates.
  • Collaborated with IT to develop a CMS-compliant data entry system.
  • Collaborated with internal audit teams.
  • Authored annual Medicare compliance reports.
  • Boosted member scores by 82% %.
  • Achieved results within 10 weeks.
  • Analyzed Medicare claims data.
  • Collaborated with clinical teams to establish consistent quality metrics that ensured 11% compliance with the latest CMS regulations.
  • Completed analysis within one year.
  • Achieved 57% knowledge retention among staff.

Summaries

  • Achieved significant quality gains.
  • Bringing unrivaled technical troubleshooting and data interpretation expertise gained over 4 years of experience.
  • Collaborated across departments.
  • Experienced Quality Control Analyst with a track record of using hands-on inspections, testing methods, and data analysis to improve products and procedures.
  • Disciplined professional who approaches quality assurance in a systematic manner.
  • Quality Control Analyst with experience testing Adobe Creative Suite and Miscellaneous products.
  • Quality Control Analyst with 6 years of experience in the Miscellaneous industry.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Achieved a 17% increase in first-call resolution rates.
  • Achieved significant reductions in errors.

Accomplishments

  • Performed back-end audits on Medicare claims using Microsoft Excel, achieving an increase in error detection efficiency by 69%.
  • Designed and launched Medicare audit training for new hires, ensuring a consistent 100% compliance rate across operations audits.
  • Collaborated with a diverse team of auditors and healthcare professionals to reduce escalating Medicare claim escalations by 34% over 4 months.
  • Reduced the response time for Medicare appeals by 2 days through workflow streamlining and process improvements.
  • Led an audit to integrate CMS guidelines in claims processing, resulting in 57% reduction in compliance breaches over one year.
  • Achieved Employee of the Year for reducing audit discrepancies across Medicare Part A through data-driven quality control measures.
  • Analyzed CMS regulation updates and implemented policy changes across the Medicare Quality department, ensuring timely compliance and reducing regulatory risk by 69%.
  • Developed and implemented customized CMS audit plans for 3 Medicare programs, increasing overall adherence by 40%.
  • Spearheaded a compliance review initiative that led to a Employee of the Year for operating procedure improvements in Medicare services.
  • Wrote detailed reports based on audit findings, enabling Medicare service teams to improve claims verification accuracy by 52% within 10 months.

Affiliations

  • American Marketing Association
  • Institute for Healthcare Improvement (IHI)
  • National Committee for Quality Assurance (NCQA)
  • Project Management Institute
  • Association for Supply Chain Management (APICS)
  • Healthcare Financial Management Association (HFMA)
  • Council for Affordable Quality Healthcare (CAQH)
  • Certified Healthcare Data Analyst (CHDA)
  • Association of Information Technology Professionals
  • Accreditation Association for Ambulatory Health Care (AAAHC)

Certifications

  • Certified Professional in Utilization Review (CPUR)
  • Certified Medical Office Manager (CMOM)
  • CompTIA Security+
  • Lean Six Sigma Green Belt – Healthcare
  • ICD-10 Proficiency Certification
  • HEDIS Compliance Auditor Certification
  • Certified in Healthcare Compliance (CHC)
  • Certified Public Accountant
  • Certified Professional in Healthcare Quality (CPHQ)
  • Google Certified Professional Cloud Architect

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