Experience

Health Plan of San Mateo (HPSM)

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Business System Analyst

  • Aug 2022 - Present

• Project Manager

  • Nov 2021 - Jul 2022

• Claims Manager

  • Jul 2018 - Nov 2021

  South San Francisco, California



Stanford Health Care

• Hospitals and Health Care
• 700 & Above Employee

• Compliance Auditor

  • Dec 2013 - Jun 2018

  Lead auditor/ subject matter expert on Orthopaedics, Dermatology, Anesthesia and Pain Management specialty documentation guidelines and coding rules. Responsible for conducting audits to determine organizational integrity of billing for professional services, including detection and correction of documentation, coding, and billing errors. Audits consist of evaluation of the adequacy and accuracy of documentation in support of services billed, including ICD/CPT/HCPCS and other third-party payor… Show more Lead auditor/ subject matter expert on Orthopaedics, Dermatology, Anesthesia and Pain Management specialty documentation guidelines and coding rules. Responsible for conducting audits to determine organizational integrity of billing for professional services, including detection and correction of documentation, coding, and billing errors. Audits consist of evaluation of the adequacy and accuracy of documentation in support of services billed, including ICD/CPT/HCPCS and other third-party payor codes, Teaching Physician guidelines, medical necessity of services, reimbursement overpayments and underpayments, and compliance with other documentation, coding and billing standards. Evaluate the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional fee documentation, coding and billing, including federal and state regulations and guidelines, CMS and other third party payor billing rules, and OIG compliance standards. Apply standardized audit scoring methodology to evaluate consistency of documentation and coding, and standardized audit findings methodology to report audit results. Communicate audit results to physicians, physician leadership, senior hospital and School of Medicine management and staff, provide physician and coder education and make recommendations for management corrective action. Show less



Sutter Health - Palo Alto Medical Foundation

• United States
• Medical Practices
• 700 & Above Employee

• Clinical Billing Unit Supervisor

  • Oct 2012 - Dec 2013

  Responsible for the supervision of pre-A/R paper claims triage, review, collection and submissions for the MPD practice sites in centralized location. Oversee Billing Coordinator and staff processing of Non-office billing (NOB), ancillary service and all paper fee ticket submissions. Conduct Pre A/R review of paper fee tickets to maintain accurate code capture requirements. Act as liaison and contact for PAMF Revenue Cycle for Send Back report and stalled MPD charges. Assist non-clinical staff… Show more Responsible for the supervision of pre-A/R paper claims triage, review, collection and submissions for the MPD practice sites in centralized location. Oversee Billing Coordinator and staff processing of Non-office billing (NOB), ancillary service and all paper fee ticket submissions. Conduct Pre A/R review of paper fee tickets to maintain accurate code capture requirements. Act as liaison and contact for PAMF Revenue Cycle for Send Back report and stalled MPD charges. Assist non-clinical staff with support for authorizations/referrals specific for each payers. Analyze pending A/R reports working on resolution in collaboration with Clinical Site Managers and staff. Report identified coding error patterns to PAMF Audit dept for provider education assistance.

• Audit Unit Supervisor

  • Apr 2011 - Oct 2012

  Grandfathered into Palo Alto Medical Foundation/ Mills Peninsula Division in April 2011 when Peninsula Surgical Specialists merged and ceased as a company. I was promoted to Code and Audit Unit Supervisor from Surgery Unit Billing Coordinator in November 2011. Supervise the day to day audits and coding oversight activities assisting staff with decisions on appropriate actions required for timely, accurate and compliant code use. Oversee coding unit efforts to handle any patient or payer coding… Show more Grandfathered into Palo Alto Medical Foundation/ Mills Peninsula Division in April 2011 when Peninsula Surgical Specialists merged and ceased as a company. I was promoted to Code and Audit Unit Supervisor from Surgery Unit Billing Coordinator in November 2011. Supervise the day to day audits and coding oversight activities assisting staff with decisions on appropriate actions required for timely, accurate and compliant code use. Oversee coding unit efforts to handle any patient or payer coding dispute or inquiry in a timely manner. Provide coding support and education, E&M coding course, for PMC physician community working in coordination with other department Certified Coders. Oversee new on- boarding physicians coding patterns and work with them individually, educating them on correct, compliant coding rules and guidelines. Manage weekly and monthly spreadsheets that are provided back to physicians for additional coding education and review of missing information, data to support Medicare LCD’s, invalid or missing chart data and other requirements that are needed to satisfy correct claim submission. Attend meetings and provide positive feedback to department and staff. Assist coordinators and managers with developing lean, compliant work flows, to outline the company’s goal, to support staff and physician efforts. Perform chart reviews using my Certified Coding knowledge to audit and promote correct coding, working with physicians, educating them on proper code selection.



Peninsula Surgical Specialists

• Billing Office Supervisor

  • Jan 2006 - Apr 2011

  Burlingame, CA Supervise work of four employees, promoted from billing representative in 2007. Manage daily and monthly deposit log, balance accounts receivable at month end. Post daily insurance payment checks, while appealing underpaid contracted rates. Post all Medicare ERA’s. Send daily electronic claims, while working rejected claims reports. Update superbills yearly, with new, revised, or deleted CPT & ICD-9 codes as needed. Charge entry of general office visits, vascular office visits, wound care and… Show more Supervise work of four employees, promoted from billing representative in 2007. Manage daily and monthly deposit log, balance accounts receivable at month end. Post daily insurance payment checks, while appealing underpaid contracted rates. Post all Medicare ERA’s. Send daily electronic claims, while working rejected claims reports. Update superbills yearly, with new, revised, or deleted CPT & ICD-9 codes as needed. Charge entry of general office visits, vascular office visits, wound care and surgery facility charges. Manage monthly aging reports; appealing claims with additional information to guarantee payment. Work closely with Bariatric patients, to ensure their portion is collected and paid prior to their surgery. Manage patient collection accounts and payment history, while also reviewing any patient dispute letter for determination on balance. Show less