Application Support Analyst

• Nov 2021 - Present

• Assist physicians, nurses, and other practice staff with inquiries, requests, and concerns related to the Office Practicum pediatric EHR software system and seek timely resolution of these issues • Investigate and troubleshoot client concerns related to the Office Practicum EHR, Intelichart, and OP Cloud technology in real time via phone, live chat, and email • Capture pertinent data and details related to cases to assist in swift diagnosis of problems and to ensure timely case closure, preventing unnecessary repeat contact with the practice • Collaborate across multiple departments to determine root causes of errors and best course of action for correction, as well as triage and escalate cases to the appropriate team as needed • Translate complex issues into simple terms when guiding physicians and practice staff through the OP system and Help Site articles • Stay current and knowledgeable on all software releases, enhancements, and reported issues through continuous training and case reviews Show less

Site Management Associate / In-House CRA

• Mar 2021 - Oct 2021

• Primary liaison for study and site management issues including addressing questions, inclusive of protocol questions, managing study supplies and conducting offsite central monitoring visits/contacts (pre-study, initiation, monitoring and close out visits). Escalates issues and risks as needed • Perform essential document collection and review throughout the study lifecycle inclusive of site activation. Responsible for the organization and maintenance of site clinical trial master file (TMF) documents • Ensure timely and complete data entry by site by performing data review inclusive of site level data review, and query resolution • Performs risk assessment and management responsibilities throughout the project including site process evaluation, addressing follow up items and issue escalation • Performs all tasks in accordance with applicable guidelines, (e.g., ICH-GCP), company and sponsor SOPs, project plan, study-specific processes, local regulatory requirements • Routinely work with 3rd party vendors to facilitate system access for site personnel and coordinates shipments such as regulatory binders to study site staff Show less

Healthcare Consultant

• Jun 2017 - Mar 2020

• Successfully recovered millions of dollars in overpayment recoveries across multiple clients including Carefirst and CIGNA Healthspring • Identified potential recovery opportunities through the use of Data Analytics, Data Mining techniques, and basic SQL • Developed and implemented a solution for recalculating claim payments which reduced write up time and increased overpayment recoveries per day. This also resulted in a substantial decrease in time needed for the Senior Consultant to QC written claims allowing for focus to be placed on potential new revenue generating concepts • Ensured quality control standards were met for the generated monthly reports prior to distribution across the audit team consisting of consultants and senior analysts • Implemented process improvements through direct collaboration with Data Analysts to support the audit process by refining reports leading to a reduction in false positives and ultimately increasing overpayment findings • Developed new audit recovery opportunities through research of current industry standards, medical policies, and provider contracts • Conducted educational training sessions for team members, administrative staff, and auditors on process and procedure guidelines for auditing and client system use • Developed reference and instructional resources for training purposes which decreased onboarding and cross-training time for analysts and consultants • Placed continuous focus on quality improvement initiatives through the review of audit efficiency reports and development of action plans to take meet and exceed accuracy standards • Consistently reached target deadlines for submission of claim validation files to client on a monthly basis Show less

Clinical Data Coding Specialist

• Aug 2014 - Jun 2017

• Conducted high quality reviews of protocols and investigator budgets in order to extract demographic, clinical data (ICD-9-CM / CPT codes), and associated charges for use in study development • Ensured accuracy of coded protocols and budget information through peer review resulting in high quality data collection • Achieved day to day productivity goals to support the Clinical Data Coding team’s efforts to reach and exceed targeted metrics • Collaborated and coordinated with leadership team regularly to assess projects to ensure desired outcomes were achieved • Served as a resource on coding issues, facilitating answers to questions and handling customer support issues as necessary through research, analysis, and documentation review • Assisted Clinical Data Coding Manager(s) with operational process evaluation and improvement efforts • Supported data analysts in quality improvement efforts by taking on special projects involving end-user software testing for quality assurance • Delivered training presentations to data operations team on coding policy and procedure updates Show less

Realtor

• Apr 2014 - May 2015

Healthcare Auditor - Team Lead

• Jan 2011 - Apr 2014

• Identified over 3 million dollars in overpayment recoveries through the review of paid medical claims across multiple accounts • Acquired and applied data mining and analytics knowledge to uncover potential recovery opportunities using data mining software and basic SQL • Assisted in the operations of an audit while gaining experience in various client electronic health record systems including Power MHS and Facets • Served as direct point person for both the client and internal team by leading meetings and conference calls to provide account updates and support for audit issues • Collaborated directly with IT Staff to develop and implement technological improvements that support the audit process, including the refining of reports to reduce false positives and ultimately increase overpayment findings per hour • Researched provider contracts, medical policies, and industry standards in order to develop and present new audit concepts and potential recovery opportunities to the client Governance Committee for approval • Provided orientation training for new hire team members, administrative staff and auditors, and provided continued mentorship until fully acclimated to the audit review process, audit guidelines, audit procedures, and client systems • Performed quality assurance checks on administrative staff and auditors to ensure accuracy of digital lockbox, refund request letters, and other client and provider correspondence • Verified the accuracy and completeness of claims identified by the audit team prior to client submission and provided constructive feedback to auditors regarding errors in order to avoid unnecessary redundancy in claim processing • Developed and organized training materials, manuals, and policies & procedures related to audit functions for use as reference and instructional resources • Prepared and analyzed reports of audit reviews and performance issues, with a focus on continuous quality improvement initiatives Show less

ABN (Advance Beneficiary Notice) Coordinator

• Aug 2010 - Dec 2010

• Conducted prospective reviews of patient records in order to determine ICD-9-CM codes that support medical necessity of scheduled labs and procedures according to appropriate Medicare local and national medical review policy • Performed light coding of outpatient cases by abstracting medical records and applying proper ICD-9-CM and CPT codes through the use of various software applications including Quadramed Quantim, Siemens Soarian, and Invision • Utilized Xactimed claim scrubber software to correct and process medical necessity edits in order to ensure proper reimbursement • Assisted Operations Manager through research involving Medicare medicalnecessity policies and information Show less

Management Internship

• Apr 2010 - May 2010

● Worked closely with the HIM Director and Director of Systems and Programming in order to gain valuable insight into the daily management activities within an HIM Department ● Performed quality assessments in filing area in order to determine error rates and determine possible causes and solutions ● Developed policies & procedures for the proper cataloging of fetal monitoring strips into the Fetal Monitoring System ● Developed an identification method for coded & closed ER charts which helped to improve efficiency and workflow while reducing workload for the HIM Department Show less