Healthcare Coding and Compliance Auditor

• Jul 2021 - Present

Healthcare Auditor and Consultant

• Jul 2017 - Present

Assists healthcare organizations in staying compliant with state and federal regulations related to Medicare and Medicaid services. Services include claim auditing, documentation audit/review, training, compliance and policy development/review. Assists healthcare organizations in staying compliant with state and federal regulations related to Medicare and Medicaid services. Services include claim auditing, documentation audit/review, training, compliance and policy development/review.

Revenue Cycle Supervisor

• Aug 2019 - Sep 2021

Oversee tasks assigned to the Revenue Cycle Department staff. Identify patient reimbursement issues, ensuring that claims, denials, and appeals are efficiently processed, and resolving billing-related issues. Code diagnoses and procedures correctly (as required). Manage performance of colleagues by providing regular feedback, performance reviews, and one-on-one meetings. Oversee the hiring and training of staff. Plan and structure the department workflow and staffing. Oversee tasks assigned to the Revenue Cycle Department staff. Identify patient reimbursement issues, ensuring that claims, denials, and appeals are efficiently processed, and resolving billing-related issues. Code diagnoses and procedures correctly (as required). Manage performance of colleagues by providing regular feedback, performance reviews, and one-on-one meetings. Oversee the hiring and training of staff. Plan and structure the department workflow and staffing.

Healthcare Audit Supervisor

• Jan 2019 - Aug 2019

Supervised department staff in conducting pre/post payment reviews, healthcare claims audits and claims data analysis to ensure compliance with Division contracts as well as State and Federal regulations. Provided technical assistance and training to subcontracted providers on claim submissions, audit requirements, and financial operations. Monitored, tracked and completed State deliverables as needed. Researched, tracked and wrote recommendations for provider claim disputes. Supervised department staff in conducting pre/post payment reviews, healthcare claims audits and claims data analysis to ensure compliance with Division contracts as well as State and Federal regulations. Provided technical assistance and training to subcontracted providers on claim submissions, audit requirements, and financial operations. Monitored, tracked and completed State deliverables as needed. Researched, tracked and wrote recommendations for provider claim disputes.

Senior Compliance Auditor

• Sep 2018 - Jan 2019

Claims Audit Supervisor

• Nov 2017 - Sep 2018

Supervised department staff in conducting pre/post payment reviews, healthcare claims audits and claims data analysis to ensure compliance with Division contracts as well as State and Federal regulations. Provided technical assistance and training to subcontracted providers on claim submissions, audit requirements, and financial operations. Monitored, tracked and completed State deliverables as needed. Researched, tracked and wrote recommendations provider for claim disputes. Supervised department staff in conducting pre/post payment reviews, healthcare claims audits and claims data analysis to ensure compliance with Division contracts as well as State and Federal regulations. Provided technical assistance and training to subcontracted providers on claim submissions, audit requirements, and financial operations. Monitored, tracked and completed State deliverables as needed. Researched, tracked and wrote recommendations provider for claim disputes.

Healthcare Claims Auditor

• Apr 2017 - Jun 2017

SIU Investigator

• Oct 2015 - Mar 2017

Create and manage internal and external trainings regarding data validation, program integrity, and clinical documentation standards according to the Center for Medicaid and Medicare Services (CMS) and the Arizona Health Care Cost Containment System (AHCCCS). Led in the development of the Corporate Compliance External Audit (CCEA) program at Mercy Maricopa Integrated Care (MMIC) and Mercy Care Plan (MCP). Create audit tools, conduct focused fraud, waste and abuse (FWA) external compliance audits from trending data and draft comprehensive finding reports to deliver to the State semi-annually. Oversee external contracting agencies performing claim audits of all providers within the MMIC and MCP provider network. Provide coding and billing guidance to internal staff and providers. Consult in the recoupment of Medicaid/Medicare dollars identified in FWA audits. Develop AHCCCS OIG referrals for fraud, waste, and abuse. Show less

Data Validation Supervisor

• Sep 2014 - Oct 2015

Ensured state/federal compliance of all agency documentation and examines it for accuracy, completeness, specificity and appropriateness of diagnosis codes according to services rendered. Supervised data validation team of 3 personnel. Created weekly and monthly analysis of data validation error rates and trends for the agency. Contributed to clinical quality meetings with executive management. Collaborated with Chief Compliance Officer and Clinical Directors to report data validation trends and training opportunities. Conducted new employee orientation and ongoing site training for data validation and state/federal documentation standards. Show less

Compliance Officer

• Jun 2013 - Aug 2014

Managed day-to-day operations of the compliance program to include collaboration with senior management to complete billing valid outpatient services, validating ICD/CPT-4 codes, review of daily service notes, auditing/internal reporting, and training. Provided clinical guidance and management to staff and senior management as needed. Managed day-to-day operations of the compliance program to include collaboration with senior management to complete billing valid outpatient services, validating ICD/CPT-4 codes, review of daily service notes, auditing/internal reporting, and training. Provided clinical guidance and management to staff and senior management as needed.

Behavioral Health Technician

• Jun 2011 - Apr 2013

Maintained and managed the safety of individuals in assessment or observation areas by assisting with voluntary/involuntary admittance, taking vitals, and documenting services provided utilizing an electronic health record system. Maintained and managed the safety of individuals in assessment or observation areas by assisting with voluntary/involuntary admittance, taking vitals, and documenting services provided utilizing an electronic health record system.

Direct Support Professional

• Sep 2009 - Jun 2011

As a Direct Support Specialist I, provided supervision of staff/direct care for clients within various programs, utilizing therapeutic approaches compatible with ICHD treatment philosophy while emphasizing empirical behavior techniques. Day to day responsibilities included creation and implementation of daily lesson/respite plans, transporting clients to/from academic or vocational programs, and completing daily documentation of services. As a Support Specialist III, provided supervision of staff in development of daily lesson/activity plans as well as assisting Day Program Coordinator with development of staff work schedule, providing oversight of program, and communicating concerns between staff and senior management. Show less

Signals Intelligence Analyst

• Oct 2003 - Feb 2008

Produced combat, strategic, and tactical intelligence reports while supervising analysis of various communications, performing human resource functions, and developing/implementing training for military and civilian personnel while maintaining unit training records. Produced combat, strategic, and tactical intelligence reports while supervising analysis of various communications, performing human resource functions, and developing/implementing training for military and civilian personnel while maintaining unit training records.