Ambulatory Charge Entry WQ Specialist

• Oct 2018 - Present

Hybrid-Remote • Review, input and codes various electronic and paper data, such as patient demographics, insurance, provider information, CPT, HCPCS/Level II codes, and ICD-10 codes • Edit and correct encounters with specific data (e.g., modifiers, payer specific information, CPT, ICD-10 codes and date of injury) as appropriate for accurate electronic submission • Correct coding errors and evaluate educational needs in departments per analyzed work queue trends • Reduce and eliminate denials by correct use of modifiers, mapping and linking codes with services • Manage and correctly code encounters within work queues • Review and process charges within 48 hours of receiving data Show less

Clinical Data Specialist, Quality Assurance

• May 2018 - Sep 2018

• Performed validation procedures to assure most accurate data is collected and presented for evaluation to peers • Implemented Plan Do Check Act (PDCA) in accordance with employer's quality management plan and current standards for the Joint Commission, Centers for Medicare & Medicaid Services (CMS) and other governing agencies as deemed necessary by administrative staff • Coordinated and supported quality management departmental subcommittee by preparing and facilitating meetings • Performed validation procedures to assure most accurate data is collected and presented for evaluation to peers • Implemented Plan Do Check Act (PDCA) in accordance with employer's quality management plan and current standards for the Joint Commission, Centers for Medicare & Medicaid Services (CMS) and other governing agencies as deemed necessary by administrative staff • Coordinated and supported quality management departmental subcommittee by preparing and facilitating meetings

Medical Records Director/Quality Improvement Coordinator/Privacy Officer

• Jul 2016 - May 2018

• Managed, trained, mentored and led daily operations of various departments from health management to radiology staff • Provided employee performance feedback, evaluations, hire and disciplinary action (i.e., contractual, state and union) • Scheduled outside appointments (e.g., physician, procedure, hospital, dialysis) via phone, fax, email • Obtained prior authorizations, pharmacy and security detail for medical and other services as required • Maintained weekly corporate Excel spreadsheets and queried providers for clarity when necessary • Scheduled all internal physicians, nurse practitioners, dentists, optometrists, mental health professionals, nurse sick clinic, and simple procedures for the next day • Attended, audited and prepared medical records for weekly collegial meetings, including monthly and quarterly reviews • Coordinated, created and maintained records to execute data analysis for quality Improvement. • Processed and completed release of information requests • Maintained Illinois Department of Correction HIPAA access report as privacy officer • Maintained inventory reports (e.g., restraints, MSDS for gas and oxygen cylinders) per regulations Show less

Clinical / Insurance Verification and Prior Authorization Specialist

• Mar 2012 - Jul 2016

• Contacted insurance carriers to verify insurance eligibility, benefits, demographics and other needs • Obtained prior authorization from insurance carriers for medical services and procedures • Ensured proper clinical documentation present for preauthorization and queried providers as needed • Facilitated contact with financial counselors to arrange for reimbursement • Assisted with review and follow up of appeals and payment denials • Contacted insurance carriers to verify insurance eligibility, benefits, demographics and other needs • Obtained prior authorization from insurance carriers for medical services and procedures • Ensured proper clinical documentation present for preauthorization and queried providers as needed • Facilitated contact with financial counselors to arrange for reimbursement • Assisted with review and follow up of appeals and payment denials

Schedule Coordinator

• Jan 2014 - Mar 2014

• Scheduled shifts and hours by matching caregivers qualifications and availability to clients needs • Communicated new assignments and/or schedule changes to caregivers and clients • Processed manually or via computer, the data necessary to initiate accurate payroll and billing processes • Participated in on-call rotations as assigned • Participated in client case conferences as required by immediate supervisor • May assist with input, verification, and release of billing and payroll information as well as the assembly purposes • Computed wages and records data for use in payroll processing and competitive rate studies • Worked with Care Coordinator and Human Resources Specialist to assist resolution of caregiver issues Show less

Substitute Teacher

• 2013 - 2014

Performed related duties of a teacher to provide continuity in the day-to-day responsibilities during the absence of the regular employee; Note: Substitute employees are employed on an as needed, on-call, day-to-day basis and are not guaranteed work on a regular basis. There are no benefits associated with substitute employment. Performed related duties of a teacher to provide continuity in the day-to-day responsibilities during the absence of the regular employee; Note: Substitute employees are employed on an as needed, on-call, day-to-day basis and are not guaranteed work on a regular basis. There are no benefits associated with substitute employment.

Student (Full-time)

• 2011 - 2013

Substitute Teacher, Supervisor, Scheduler, Intermediate Aide

• 2002 - 2012

• Managed and supervised a classroom of 25-32 students during the absence of an assigned teacher including, but not limited to, field trips that included adults • Managed, supervised and scheduled mandatory testing 2-3 times per school year for over 500 students • Trained staff with computer hardware and software applications and updates • Managed and supervised a classroom of 25-32 students during the absence of an assigned teacher including, but not limited to, field trips that included adults • Managed, supervised and scheduled mandatory testing 2-3 times per school year for over 500 students • Trained staff with computer hardware and software applications and updates

Payroll Clerk

• 1994 - 1996

• Processed weekly payroll, union and other deductions and garnishments • Processed and reconciled A/P for union brokers, garnishments and other accounts • Maintained weekly/monthly financial accounts/reports • Provided timely, courteous and knowledgeable response to information requests • Processed weekly payroll, union and other deductions and garnishments • Processed and reconciled A/P for union brokers, garnishments and other accounts • Maintained weekly/monthly financial accounts/reports • Provided timely, courteous and knowledgeable response to information requests

A/R, A/P, Credit & Collections

• 1990 - 1994

• Posted daily lockboxes • Processed Accounts Payable • Reconciled Accounts Receivable including general ledger • Performed customer invoicing and administered collection process • Maintained weekly/monthly financial accounts/reports • Provided technical training and support to terminal satellites and new hire personnel regarding computerized accounting and billing process through corporate team based presentations, group classroom setting, one-on-one basis and telephone communication Show less

Secretary/Receptionist/Payroll

• 1990 - 1990

• Maintained multi-line switchboard • Managed all business correspondence including but not limited to, contracts, change orders, purchase orders, AIA forms and various other requests that administrative staff required • Processed Accounts Payable • Processed Payroll • Administered daily/weekly postal and bank affairs • Maintained multi-line switchboard • Managed all business correspondence including but not limited to, contracts, change orders, purchase orders, AIA forms and various other requests that administrative staff required • Processed Accounts Payable • Processed Payroll • Administered daily/weekly postal and bank affairs

Administrative Assistant

• 1986 - 1990

• Maintained multi-line switchboard • Performed Administrative duties which included typed, transcribed, processed and managed all business and social correspondence • Maintained sub-contractor insurance and various other files • Completed all AIA documents, specification books, waivers, contracts, change orders, purchase orders, time sheets • Maintained weekly reports and other useful forms and documents • Executed copies of blueprints on large-format blueprint machine Show less