Risk Adjustment Compliance Analyst

• May 2018 - Present

I work with team members to perform retrospective and prospective Chart Reviews or an NLP coding platform for MA and ACA members to identify missed HCC opportunities for accurate revenue capture. I assist with provider education and training on risk adjustment methodologies and opportunities to improve provider documentation and coding. I perform Government audit for the HHS RADV, CMS RADV and WI Badgercare. I work with team members to perform retrospective and prospective Chart Reviews or an NLP coding platform for MA and ACA members to identify missed HCC opportunities for accurate revenue capture. I assist with provider education and training on risk adjustment methodologies and opportunities to improve provider documentation and coding. I perform Government audit for the HHS RADV, CMS RADV and WI Badgercare.

Compliance Specialist

• May 2012 - May 2018

I audit medical documentation to ensure all the correct procedure codes (CPT) and diagnosis (ICD-9) are applied correctly. I make sure medical records are properly documented. Take care of any compliants that need to be investigated. Make sure departments are following the correct rules and regulations set by Medicare. I audit medical documentation to ensure all the correct procedure codes (CPT) and diagnosis (ICD-9) are applied correctly. I make sure medical records are properly documented. Take care of any compliants that need to be investigated. Make sure departments are following the correct rules and regulations set by Medicare.

Compliance Specialist

• May 2012 - May 2018

Revenue Integrity Review Specialist

• Jan 2012 - May 2012

· Payment Integrity Compass - identify underpayments from contracted insurance carriers and track and trend denials. · Internal staff audits. · Procedure and diagnosis code Cardio Testing reports, i.e.: echocardiograms, electrocardiograms, holter and event monitors · Training staff · Error correcting and refilling corrected claims to insurance companies with the correct billing information. · Payment Integrity Compass - identify underpayments from contracted insurance carriers and track and trend denials. · Internal staff audits. · Procedure and diagnosis code Cardio Testing reports, i.e.: echocardiograms, electrocardiograms, holter and event monitors · Training staff · Error correcting and refilling corrected claims to insurance companies with the correct billing information.

Billing Clerk

• Aug 1989 - Oct 2000

Maintain individual and group health insurance files Extensive experience working with health insurance companies Handling phone calls from agents and policyholders Maintain individual and group health insurance files Extensive experience working with health insurance companies Handling phone calls from agents and policyholders