Experience

Anthem

• United States
• Insurance
• 700 & Above Employee

• Manager

  • May 2014 - Present

• Clinical Reviewer

  • Aug 2008 - May 2014



TrustSolutions LLC

• United States
• Government Administration
• 1 - 100 Employee

• Clinical Quality Specialist

  • Mar 2007 - Aug 2008

  Originally trained to review DMEPOS claims then transitioned to the Quality Management team. This team's responsibility was expanded to include both Part B & DMEPOS claims. I participated in streamlining the process & redesigning audit tools. Clinical review managers were included in this design project to ensure they received valuable feedback for additional training needs.



National Government Services

• Insurance
• 700 & Above Employee

• Senior Clinical Specialist

  • Apr 1998 - Mar 2007

  Initially hired as an outside consultant for a special outpatient therapy claim review project. When this project ended, I was offered a permanent position as an onsite clinical auditor for inpatient SNF claims. Over the years additional responsibilities included preparations for CMS audits, developed a department orientation program for new associates, maintained department documentation & audited reviewer outcomes of inpatient SNF & Part B of A claims. Externally I worked with the CERT contractor & participated in national workgroups hosted by CMS Central Office.